Case-mix-adjusted mean number of polyps per 100 procedures : a new candidate gold standard colonoscopy key performance indicator

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Catlow, Jamie and Lu, Liya and Sharp, Linda and Rutter, Matt, NED APRIQOT Trialists Group (2025) Case-mix-adjusted mean number of polyps per 100 procedures : a new candidate gold standard colonoscopy key performance indicator. BMJ Open Gastroenterology, 12 (1). e001743. ISSN 2054-4774 (https://doi.org/10.1136/bmjgast-2025-001743)

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Abstract

Objective: Adenoma detection rate (ADR) has been criticised as a colonoscopy key performance indicator (KPI), for excluding serrated polyps, requiring histological data and fostering a ‘one-and-done’ attitude. We hypothesised that a case-mix-adjusted mean number of polyps (aMNP) would address these criticisms and provide a better measure of colonoscopy quality. We aimed to develop an aMNP using the National Endoscopy Database (NED) and assess its relationship with quality metrics. Methods: We extracted colonoscopy data from NED for 1 January 2019–4 April 2019. Multiple negative binomial regression was undertaken to estimate effects of patient variables on MNP and generate aMNP. Associations between aMNP and polyp detection rate (PDR), proximal polypectomy rate (PPR), postcolonoscopy colorectal cancer (PCCRC) rate and Joint Advisory Group for GI endoscopy (JAG) Global Rating Scale (GRS) were explored. Results: 92 892 colonoscopies were analysed. Patient age, sex and procedure indication were significantly associated with MNP and used to create aMNP. At endoscopist level, aMNP strongly correlated with PDR (Spearman rho=0.834, p

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