the colon or even artificial intelligence during screenings, but technol-
ogy will never replace technique. Physicians must be competent, con-
fident and consistent at detecting and removing polyps. What do all
gastroenterologists with above average ADR rates have in common?
"They come into every procedure with a very detailed understanding
of what precancerous lesions look like in the colon," says gastroen-
terologist Douglas K. Rex, MD, a professor at Indiana University-
Purdue University in Indianapolis. "They understand what serrated
and adenomatous polyps look like," adds Dr. Rex. And the physicians
who don't? They're likely missing critical methods for adenoma detec-
tion. These are the GI docs who don't expose all of the mucosa when
they're passing the scope through the haustral fold, who don't realize
the fold has hidden some mucosa from view and don't work at going
back in and poking the tip of the scope in between those folds and
exposing that mucosa, says Dr. Rex.
To prevent missed adenomas: Adhere to a minimum withdrawal
time of 6 minutes. That metric comes from the ASGE/ACG Taskforce.
"This is a process measure of the amount of time you spent looking for
polyps during a colonoscopy," says Rajesh N. Keswani, MD, medical
director of quality at Northwestern Medicine Digestive Health Center in
Chicago, Ill., a facility that does approximately 18,000 colonoscopies
each year. "It's a surrogate measure of how careful you are during
screenings looking for polyps, it highly correlates with the risk of devel-
oping cancer after colonoscopy and it's relatively easy to populate in
your unit," adds Dr. Keswani.
Another proven way to boost your ADR rates is to compare your
physicians' performances and focus on the outliers for improvement. At
Northwestern, this is accomplished through semi-annual ADR report
cards. "Every colonoscopist in our unit gets a report card with their 6-
month ADR rate that's benchmarked to their peers who have a similar
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