{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:14:06Z","timestamp":1792408446907,"version":"4.4.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012175","name":"Zhejiang Traditional Chinese Medicine Administration","doi-asserted-by":"publisher","award":["2020ZA050"],"award-info":[{"award-number":["2020ZA050"]}],"id":[{"id":"10.13039\/501100012175","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012175","name":"Zhejiang Traditional Chinese Medicine Administration","doi-asserted-by":"publisher","award":["2020ZA050"],"award-info":[{"award-number":["2020ZA050"]}],"id":[{"id":"10.13039\/501100012175","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Adenoma detection rate (ADR) is a validated primary quality indicator for colonoscopy procedures. However, there is growing concern over the variability associated with ADR indicators. Currently, the factors that influence ADRs are not well understood.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Aims<\/jats:title>\n                <jats:p>In this large-scale retrospective study, the impact of multilevel factors on the quality of ADR-based colonoscopy was assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 10,788 patients, who underwent colonoscopies performed by 21 endoscopists between January 2019 and December 2019, were retrospectively enrolled in this study. Multilevel factors, including patient-, procedure-, and endoscopist-level characteristics were analyzed to determine their relationship with ADR.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The overall ADR was 20.21% and ranged from 11.4 to 32.8%. Multivariate regression analysis revealed that higher ADRs were strongly correlated with the following multilevel factors: patient age per stage (OR 1.645; 95% CI 1.577\u20131.717), male gender (OR 1.959; 95% CI 1.772\u20132.166), sedation (OR 1.402; 95% CI 1.246\u20131.578), single examiner colonoscopy (OR 1.330; 95% CI 1.194\u20131.482) and senior level endoscopists (OR 1.609; 95% CI 1.449\u20131.787).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The ADR is positively correlated with senior level endoscopists and single examiner colonoscopies in patients under sedation. As such, these procedure- and endoscopist-level characteristics are important considerations to improve the colonoscopy quality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-021-01983-3","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T18:06:28Z","timestamp":1635185188000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The analysis of multilevel factors affecting adenoma detection rates for colonoscopies: a large-scale retrospective study"],"prefix":"10.1186","volume":"21","author":[{"given":"Liang","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"key":"1983_CR1","unstructured":"American Cancer Society. Cancer Facts & Figures 2020 [Internet]. American Cancer Society; 2020. [cited 2020]; Available from: http:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/annual-cancer-facts-and-figures\/2020\/cancer-facts-and-figures-2020.pdf"},{"key":"1983_CR2","doi-asserted-by":"publisher","first-page":"E359","DOI":"10.1002\/ijc.29210","volume":"136","author":"J Ferlay","year":"2015","unstructured":"Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359\u201386.","journal-title":"Int J Cancer"},{"issue":"4","key":"1983_CR3","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1136\/gutjnl-2015-310912","volume":"66","author":"M Arnold","year":"2017","unstructured":"Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683\u201391.","journal-title":"Gut"},{"key":"1983_CR4","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1002\/cncr.24760","volume":"116","author":"BK Edwards","year":"2010","unstructured":"Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975\u20132006, featuring colorectal cancer trends and impact of interventions (risk factors, screening and treatment) to reduce future rates. Cancer. 2010;116:544\u201373.","journal-title":"Cancer"},{"key":"1983_CR5","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.gie.2014.07.058","volume":"81","author":"DK Rex","year":"2015","unstructured":"Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31\u201353.","journal-title":"Gastrointest Endosc"},{"key":"1983_CR6","doi-asserted-by":"publisher","first-page":"2533","DOI":"10.1056\/NEJMoa055498","volume":"14","author":"RL Barclay","year":"2006","unstructured":"Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;14:2533\u201341.","journal-title":"N Engl J Med"},{"issue":"19","key":"1983_CR7","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1056\/NEJMoa0907667","volume":"362","author":"MF Kaminski","year":"2010","unstructured":"Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362(19):1795\u2013803.","journal-title":"N Engl J Med"},{"key":"1983_CR8","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1136\/gutjnl-2011-300651","volume":"61","author":"TJW Lee","year":"2012","unstructured":"Lee TJW, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel cancer screening programme. Gut. 2012;61:1050\u20137.","journal-title":"Gut"},{"issue":"1","key":"1983_CR9","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.gie.2015.02.019","volume":"82","author":"A Malhotra","year":"2015","unstructured":"Malhotra A, Shaukat A. What is the criterion for high-performing colonoscopists? Being meticulous! Gastrointest Endosc. 2015;82(1):130\u20132.","journal-title":"Gastrointest Endosc"},{"key":"1983_CR10","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1067\/mge.2000.108480","volume":"52","author":"CA Aronchick","year":"2000","unstructured":"Aronchick CA, Lipshutz WH, Wright SH, et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc. 2000;52:346\u201352.","journal-title":"Gastrointest Endosc"},{"issue":"11","key":"1983_CR11","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1038\/ajg.2014.232","volume":"109","author":"BT Clark","year":"2014","unstructured":"Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol. 2014;109(11):1714\u201323.","journal-title":"Am J Gastroenterol"},{"issue":"4 Suppl","key":"1983_CR12","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1016\/j.gie.2006.02.021","volume":"63","author":"DK Rex","year":"2006","unstructured":"Rex DK, Petrini JL, Baron TH, et al. Review quality indicators for colonoscopy. Gastrointest Endosc. 2006;63(4 Suppl):S16-28.","journal-title":"Gastrointest Endosc"},{"key":"1983_CR13","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.gie.2014.01.014","volume":"80","author":"D Lieberman","year":"2014","unstructured":"Lieberman D, Williams JL, Holub J, et al. Colonoscopy utilization and outcomes 2000\u20132011. Gastrointest Endosc. 2014;80:133\u201343.","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"1983_CR14","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.gie.2015.04.019","volume":"83","author":"MR Sanaka","year":"2016","unstructured":"Sanaka MR, Rai T, Navaneethan U, et al. Adenoma detection rate in high-risk patients differs from that in average-risk patients. Gastrointest Endosc. 2016;83(1):172\u20138.","journal-title":"Gastrointest Endosc"},{"issue":"11","key":"1983_CR15","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1056\/NEJMra1513581","volume":"374","author":"WB Strum","year":"2016","unstructured":"Strum WB. Colorectal Adenomas. N Engl J Med. 2016;374(11):1065\u201375.","journal-title":"N Engl J Med"},{"key":"1983_CR16","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/j.cgh.2009.01.008","volume":"7","author":"SP Nguyen","year":"2009","unstructured":"Nguyen SP, Bent S, Chen YH. Terdiman JP Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta- analysis. Clin Gastroenterol Hepatol. 2009;7:676\u201381.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"1983_CR17","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1093\/aje\/kwm400","volume":"167","author":"MJ Shrubsole","year":"2008","unstructured":"Shrubsole MJ, Wu H, Ness RM, et al. Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps. Am J Epidemiol. 2008;167:1050\u20138.","journal-title":"Am J Epidemiol"},{"key":"1983_CR18","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1111\/j.1572-0241.2005.41832.x","volume":"100","author":"JC Anderson","year":"2005","unstructured":"Anderson JC, Alpern Z, Sethi G, et al. Prevalence and risk of colorectal neoplasia in consumers of alcohol in a screening population. Am J Gastroenterol. 2005;100:2049\u201355.","journal-title":"Am J Gastroenterol"},{"issue":"6","key":"1983_CR19","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1097\/CEJ.0000000000000399","volume":"27","author":"J Plath","year":"2018","unstructured":"Plath J, Siebenhofer A, Haug U, et al. Utilization of colonoscopy and colonoscopic findings among individuals aged 40\u201354 years with a positive family history of colorectal cancer: a cross-sectional study in general practice. Eur J Cancer Prev. 2018;27(6):539\u201345.","journal-title":"Eur J Cancer Prev"},{"issue":"5","key":"1983_CR20","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1097\/CEJ.0000000000000097","volume":"24","author":"G Hemmasi","year":"2015","unstructured":"Hemmasi G, Sohrabi M, Zamani F, et al. Prevalence of colorectal adenoma in an average-risk population aged 40\u201350 versus 50\u201360 years. Eur J Cancer Prev. 2015;24(5):386\u201390.","journal-title":"Eur J Cancer Prev"},{"key":"1983_CR21","first-page":"76e80","volume":"27","author":"CM Hsu","year":"2012","unstructured":"Hsu CM, Lin WP, Su MY, et al. Factors that influence cecal intubation rate during colonoscopy in deeply sedated patients. J Gastroenterol Hepatol. 2012;27:76e80.","journal-title":"J Gastroenterol Hepatol"},{"key":"1983_CR22","doi-asserted-by":"publisher","first-page":"616e20","DOI":"10.1016\/j.dld.2014.03.007","volume":"46","author":"S Paggi","year":"2014","unstructured":"Paggi S, Rondonotti E, Amato A, et al. One or two operator technique and quality performance of colonoscopy: a randomised controlled trial. Dig Liver Dis. 2014;46:616e20.","journal-title":"Dig Liver Dis"},{"key":"1983_CR23","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/1471-230X-11-73","volume":"11","author":"G Hoff","year":"2011","unstructured":"Hoff G, Volker M, Bretthauer M, et al. Gastronet survey on the use of one- or two-person technique for colonoscopy insertion. BMC Gastroenterol. 2011;11:73.","journal-title":"BMC Gastroenterol"},{"key":"1983_CR24","first-page":"7631981","volume":"2016","author":"L Xu","year":"2016","unstructured":"Xu L, Zhang Y, Song H, et al. Nurse participation in colonoscopy observation versus the colonoscopist alone for polyp and adenoma detection: a meta-analysis of randomized, controlled trials. Gastroenterol Res Pract. 2016;2016:7631981.","journal-title":"Gastroenterol Res Pract"},{"key":"1983_CR25","doi-asserted-by":"crossref","unstructured":"Bannert C, Reinhart K, Dunkler D, et al. Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol 2012;107(12):1837\u20131848.","DOI":"10.1038\/ajg.2012.347"},{"issue":"1","key":"1983_CR26","first-page":"50","volume":"29","author":"R Nakshabendi","year":"2016","unstructured":"Nakshabendi R, Berry AC, Munoz JC, et al. Choice of sedation and its impact on adenoma detection rate in screening colonoscopies. Ann Gastroenterol. 2016;29(1):50\u20135.","journal-title":"Ann Gastroenterol"},{"issue":"6","key":"1983_CR27","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1111\/jgh.12537","volume":"29","author":"P Sol\u00eds-Mu\u00f1oz","year":"2014","unstructured":"Sol\u00eds-Mu\u00f1oz P, Sol\u00eds-Herruzo JA, Rodr\u00edguez-Mu\u00f1oz S. Experience of the endoscopist increases detection rates of smaller size and higher histological grade polyps. J Gastroenterol Hepatol. 2014;29(6):1237\u201341.","journal-title":"J Gastroenterol Hepatol"},{"issue":"3","key":"1983_CR28","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1055\/s-0042-100185","volume":"48","author":"R Jover","year":"2016","unstructured":"Jover R, Zapater P, Bujanda L, et al. Endoscopist characteristics that influence the quality of colonoscopy. Endoscopy. 2016;48(3):241\u20137.","journal-title":"Endoscopy"},{"issue":"3","key":"1983_CR29","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1016\/j.gie.2017.08.023","volume":"87","author":"A Mehrotra","year":"2018","unstructured":"Mehrotra A, Morris M, Gourevitch RA, et al. Physician characteristics associated with higher adenoma detection rate. Gastrointest Endosc. 2018;87(3):778-786.e5.","journal-title":"Gastrointest Endosc"},{"issue":"7","key":"1983_CR30","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1001\/jamasurg.2019.0564","volume":"154","author":"S Sarvepalli","year":"2019","unstructured":"Sarvepalli S, Garber A, Rothberg MB, et al. Association of adenoma and proximal sessile serrated polyp detection rates with endoscopist characteristics. JAMA Surg. 2019;154(7):627\u201335.","journal-title":"JAMA Surg"},{"issue":"3","key":"1983_CR31","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1038\/ajg.2013.442","volume":"109","author":"L Butterly","year":"2014","unstructured":"Butterly L, Robinson CM, Anderson JC, et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the new hampshire colonoscopy registry. Am J Gastroenterol. 2014;109(3):417\u201326.","journal-title":"Am J Gastroenterol"},{"issue":"12","key":"1983_CR32","doi-asserted-by":"publisher","first-page":"3579","DOI":"10.1007\/s10620-019-05808-y","volume":"64","author":"M Cavicchi","year":"2019","unstructured":"Cavicchi M, Tharsis G, Burtin P, et al. Difference in physician- and patient-dependent factors contributing to adenoma detection rate and serrated polyp detection rate. Dig Dis Sci. 2019;64(12):3579\u201388.","journal-title":"Dig Dis Sci"},{"issue":"12","key":"1983_CR33","doi-asserted-by":"publisher","first-page":"571","DOI":"10.4253\/wjge.v6.i12.571","volume":"6","author":"HJ Pullens","year":"2014","unstructured":"Pullens HJ, Siersema PD. Quality indicators for colonoscopy: current insights and caveats. World J Gastrointest Endosc. 2014;6(12):571\u201383.","journal-title":"World J Gastrointest Endosc"},{"issue":"11","key":"1983_CR34","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.11124\/JBISRIR-2017-003927","volume":"17","author":"M Lund","year":"2019","unstructured":"Lund M, Trads M, Njor SH, et al. Quality indicators for screening colonoscopy and colonoscopist performance and the subsequent risk of interval colorectal cancer: a systematic review. JBI Database Syst Rev Imp Rep. 2019;17(11):2265\u2013300.","journal-title":"JBI Database Syst Rev Imp Rep"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01983-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-021-01983-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01983-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T18:08:12Z","timestamp":1635185292000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-021-01983-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,25]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1983"],"URL":"https:\/\/doi.org\/10.1186\/s12876-021-01983-3","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,25]]},"assertion":[{"value":"22 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the ethics committee of the First Affiliated Hospital of Zhejiang Chinese Medical University.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"403"}}