Adenoma Detection Rate in a Small Ambulatory Surgery Center
Bibliographic record
Abstract
Introduction: Colonoscopy is the most common method to diagnose colon cancer. Colon cancer is the second leading cause of cancer death in our country. The adenoma detection rate has been recommended as one of the main quality indicator. The adenoma detection rate (ADR) is 25%. ADR is 30 % for men and 20% for women. ADR is the quality indicator with the strongest association to post-colonoscopy colorectal cancer or missed colorectal cancer. Improved adenoma detection rate will decrease the incidence of post-colonoscopy colorectal cancer. Newer studies have shown that for each 1% increase in ADR, risk of “missed” CRC decreases by 3%. There are very few studies regarding the adenoma detection rate in Colonoscopy performed in a small ambulatory surgery center. Methods: All patients who underwent screening colonoscopies in our ambulatory surgery center between 2013 to 2015 were included in the data analysis. The ADR is defined as the number of patients out of every 100 undergoing first time screening colonoscopy who have at least one adenoma removed. The withdrawl time was more than 6 minutes in all the screening colonoscopies. The cecal intubation rate was 96.8% in our center. Most of the patient's used split dose colonic prep. The patient's with incomplete colonoscopy secondary to poor prep was excluded from the analysis. Results: There were 4486 procedures performed by two physicians in our ambulatory surgery center. 54.3 % were colonoscopies, 28.8% were upper endoscopies, 0.2 were flexible sigmoidoscopies. 16.6 % were minor surgical procedures like skin abscess drainage, port placement. 616 patient's underwent screening colonoscopies. The mean age of screening colonoscopy group was 58.6 years. Our youngest patient was 50 years old and the oldest was 79 years old. 58.2 % were females and 41.8% were males. 291 patients were found to have adenoma giving adenoma detection rate of 47%. Conclusion: High adenoma detection rate can be achieved in small community ambulatory surgery center provided high quality measures like high cecal intubation rate, good quality prep, increased withdrawl time are achieved diligently. Newer technologies like Fusion scope by Endochoice will also increase the adenoma detection rate. ADR as a quality measure are now being tracked by Medicare and commercial insurance companies. Added pay for performance ADR benchmarks being considered and granted by some commercial payers.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".