Quality Indicators for Colonoscopy
Priority QIs including ADR, SSLDR, BBPS, cecal intubation, withdrawal time, cold snare polypectomy, and PCCRC tracking — ACG/ASGE 2024 update.
ADR, BBPS, cecal intubation, withdrawal time
ACG/ASGE 2024 Priority Quality Indicators
The 2024 ACG/ASGE Quality Task Force defines priority indicators that every colonoscopist should routinely measure. These are chosen based on clinical relevance, performance variability, and feasibility of measurement.
| Indicator | Benchmark | Notes |
|---|---|---|
| Adenoma Detection Rate (ADR) | ≥25% overall (≥30% men, ≥20% women) | Most important QI. Every 1% ADR increase = 3% reduction in interval CRC. PRIMARY priority. |
| Cecal Intubation Rate (CIR) | ≥95% in screening exams | Incomplete exams miss right-sided lesions. Document with photo of IC valve/appendiceal orifice. |
| Adequate Bowel Prep Rate (BBPS ≥6) | ≥85% of exams | BBPS score ≥6 (≥2 per segment) = adequate. Poor prep = missed lesions. |
| Withdrawal Time (WT) | ≥6 minutes (average) | Average WT in negative exams. Shorter WT associated with lower ADR. |
| Serrated Sessile Lesion Detection Rate (SSLDR) | NEW indicator 2024 — benchmark TBD | Detects SSLs ≥5mm. SSLs drive serrated neoplasia pathway (20–30% of CRCs). Highly variable between endoscopists. |
| Post-Colonoscopy CRC Rate (PCCRC) | Track and benchmark | CRC diagnosed 6–36 months post-colonoscopy. Best measure of overall colonoscopy quality and missed lesions. |
Why Quality Indicators Matter
Colonoscopy quality is highly operator-dependent. A 1% increase in ADR is associated with a 3% reduction in interval colorectal cancer and 5% reduction in CRC death. Colonoscopists with ADR below 15% have a 10× higher interval CRC rate than those above 25%. Failure to measure performance is unacceptable per ACG/ASGE 2024.
Rex DK et al. ACG/ASGE Quality Indicators for Colonoscopy. Am J Gastroenterol. 2024;119:1754–1780.