Conclusion
Although the ideal quality measure for colonoscopy is not unequivocally established, there are several proven quality indicators. The pros and cons of these metrics are summarized in Table 1. ADR remains the most reliable and best validated measure at this time, despite being somewhat burdensome to generate and not fully comprehensive. It is also clear that no single metric can fully encapsulate all the complexities that define the quality of a colonoscopy, and it is likely that a truly comprehensive assessment requires the use of several indicators simultaneously. The choice of indicators may depend in part on available resources for a given practice, but the ADR and cecal intubation rate appear to be the cornerstone elements. The use of colonoscopy video recordings and computerized quality assessment of video endoscopy will likely have a growing role in the future. With most of the problems of colonoscopy resulting from operator-dependent factors, it is no longer acceptable not to measure colonoscopy quality. The judicious use of quality metrics should allow identifying marginal performers and implementing educational initiatives to correct their performance to provide the best care possible to our patients.