of patient characteristics, colonoscopies performed, and anatomic ADRs (left,right, and right/left ratio) was determined by ANOVA, the Kruskall Wallis test,and Cuzick test for trend. Results: 55,489 colonoscopies were identifiedrepresenting 46,654 patients. Patients were 56% female, 63% white/non-Hispanic,with a mean age of 61.2 (SD 6.7). The median number of colonoscopiesperformed was 1713 (range 511-6479) among 27 physicians. 11,229 proceduresremoved or biopsied at least one tubular adenoma representing an overall ADRof 20.2%. When stratified by sex, there was substantial variation in the overalland anatomic ADRs (Figure 1). Individual physician ADRs ranged from 8.4% to46.4%. There was no significant difference in the number of colonoscopiesperformed or percent of female patients across physician ADR tertiles (Table 1).For individual physicians, left and right ADRs were similar (��0.88) but bothwere overall higher by ADR tertile. There was a trend toward lower left to rightADR ratios in the physicians in the lowest overall ADR tertile (P�0.03).Conclusions: Anatomic ADRs parallel total ADRs, suggesting that qualityimprovement efforts should focus on the entire extent of the colonoscopy.However, underperforming physcians perform worse relative to higherperforming peers in the detection of right-sided polyps; thus, the detection ofright sided polyps should be of particular focus in these efforts. Institutionsshould consider use of anatomic ADRs to provide a refined measure ofcolonoscopy quality and help guide efforts toward interventions and strategies toimprove endoscopic exams.

Table 1. Patient and colonoscopy characteristics by physician ADR tertile

Physician Adenoma Detection Rate Tertile

Overall (N�27physicians,

55489colonoscopies)

Low ADR Tertile(N�9)

Middle ADRTertile (N�9)

High ADRTertile (N�9) P value

Sex1

% femalepatients

57.6% (10.7%) 55.7% (12.2%) 61.4% (11.9%) 55.8% (7.6%) 0.44

Patient age2

Femalepatients

61.3 (1.8) 63.0 (1.6) 60.3 (1.2) 60.6 (1.2) �0.0014

Male patients 61.4 (1.7) 63.0 (1.7) 60.6 (1.1) 60.6 (1.2) �0.0014

Colonoscopiesperformed3

Total 1713 (511-6479) 1815 (511-6479) 1679 (652-3518) 1475 (622-4358) 0.85

Femalepatients

976 (264-3318) 1064 (264-3319) 976 (340-2326) 841 (326-2395) 0.95

Male patients 664 (73-3161) 844 (73-3161) 397 (137-1310) 648 (296-2258) 0.65

AdenomaDetectionRates (%)1

Total ADR 21.6% (9.3%) 12.7% (2.6%) 20.6% (2.9%) 31.5% (8.2%) N/A(definedtertiles)

Left ADR 10.9% (4.6%) 6.9% (1.9%) 10.3% (1.8%) 15.6% (4.1%) �0.00016

Right ADR 13.8% (7.4%) 7.1% (1.5%) 13.1% (3.4%) 15.6% (4.1%) �0.00016

Right ADR / LeftADR ratio

1.2 (0.3) 1.1 (0.2) 1.3 (0.5) 1.4 (0.2) 0.036

1Mean (SD) 2Mean of the means of patient ages for each physician 3Median (range) 4ANOVA5Kruskal Wallis test 6Cuzick test for trend across physician ADR tertiles.

Tu1333High Volume Days Appear to Reduce Adenoma Detection Rate.A Retrospective StudySreedevi Atluri*2, Manhal Olaywi1, Kinesh Changela1, Taruna Bhatia2,Vani Paleti2, Ghalib A. Jibara1, Sury Anand2

1Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY;2Division of Gastroenterology and Hepatology, The Brooklyn HospitalCenter, Brooklyn, NYIntroduction: A reduction in polyp detection rate (PDR) and adenoma detectionrate (ADR) has been linked to “endoscopist fatigue” and duration ofcolonoscopy. Although there have been studies showing the difference in PDRbetween morning and afternoon sessions, there has been no study correlatingPDR/ADR with the volume of endoscopic procedures on a given day. The goalof this study is to investigate the impact of the endoscopist fatigue factor ondaily PDR and ADR. Is there a cut off in the number of procedures in a daywhich could compromise PDR and ADR? To answer this question, we picked anarbitrary cut off number of 10 procedures in a day to determine if there is a dropoff in PDR and ADR. Methods: All endoscopic procedures including upperendoscopy, colonoscopies, ERCP and EUS that were performed at our institutionover two-month period were reviewed and included to calculate the cutoff of 10procedures. Only colonoscopies with good or excellent preparation wereincluded in calculating ADR and PDR. Data was reviewed for each endoscopistand PDR and ADR and number of procedures were tabulated. Acceptable ADRwas defined as 33% or more. High volume day (HVD) was defined as days inwhich the endoscopist performed more than 10 procedures. Results: More than1000 endoscopic procedures were reviewed. 277 colonoscopies were eligible tobe included in calculating PDR and ADR. Acceptable ADR of 33% was achievedin 53.3% of low volume days (LVD) and 13.3% of HVD (P 0.001). The mean PDRwas 54.2% (SD31.7%) for LVD and mean PDR for HVD was 40.4% (SD 21.8%) (P0.055). Conclusion: In this limited study we show that ADR showed a decreaseon high volume days. PDR trended lower on high volume days but was notstatistically significant. An arbitrary cutoff of 10 procedures was used todetermine HVD and an acceptable ADR was fixed at 33%. We intend to explorethis further to find the minimum cut off for HVD and refine the ADR/PDRnumber on these days.

Tu1334Segmental Adenoma Detection Rates (S-ADR): a Quality Initiativein Reporting Colonoscopy OutcomesShashideep Singhal*, Kinesh Changela, Manhal Olaywi,Deepanshu Jain, Devin Lane, Mojdeh Momeni, Sushil Duddempudi,Mahesh Krishnaiah, Sury AnandGastorenterology, The Brooklyn Hospital Center, Brooklyn, NYBackground: Efforts to improve quality of colorectal cancer (CRC) screeningprogram depend on adequately reporting screening colonoscopy findings.Understanding differences in segmental distribution of adenomas amongpopulation groups can help in an efficient and targeted approach. The study wasdesigned to evaluate the clinical utility of reporting S-ADR and determine racialdifferences. Methods: The study cohort included subjects reporting for screeningcolonoscopy. Demographics, colonoscopy and histopathology reports werereviewed. S-ADR and segmental advanced adenoma detection rates (S-AaDR)were calculated as percentage of adenomas and advanced adenomas seen ineach of 6 colonic segments. African Americans (AA) and Hispanics (H) werecompared to determine racial differences. Results: 2519 subjects with mean ageof 59.78 years; 58.7% AA, 31.2% H and 10.1% others constituted the study group.ADR was 25.6% in AA and 24% in H. The Advanced adenoma detection rate(AaDR) was 15% in AA and 14.4% in H. There was a significant linearincremental trend in S-ADR from lowest in rectum to highest in ascending colonin both AA and H (Fig 1). Similar linear incremental trend was seen in S-AaDR inboth ethnic groups (Fig 1). S-AaDR to S-ADR ratio was highest in the Hispanics(0.67) in ascending colon suggesting a higher proportion of adenomas wereadvanced adenomas in the segment. Conclusion: Linear increase in adenomasand advanced adenomas detection rates from left to right side of colon is seen inAA and H. S-ADR and S-AaDR can be valuable tools in improving quality ofcolonoscopy reports and comparing the differential distribution of adenomas incolonoscopy outcomes research.

Figure 1. Total and anatomic adenoma detection rates for 27 physiciansstratified by patient sex.

Abstracts

www.giejournal.org Volume 77, No. 5S : 2013 GASTROINTESTINAL ENDOSCOPY AB503