Adenoma-Based Colonoscopy Quality Metrics for the 45-49 Years Old Military Screening Population

BACKGROUND AND AIMS: With the rising incidence of colorectal cancer in younger individuals, guidelines now recommend initiating average-risk screening at age 45 years. We sought to assess the impact of this younger screening population on established and emerging colonoscopy quality metrics. METHODS: We compared all well-described lesion detection rates by colonic segment removed during initial, average-risk screening colonoscopies in the San Antonio Market military healthcare network from July 2019 to September 2022. RESULTS: A total of 2165 colonoscopies met the inclusion criteria, with 755 (34.9%) colonoscopies performed on patients aged 45-49 years old. The detection rates for adenomas, proximal adenomas, advanced adenomas, and adenomas per colonoscopy were lower in the 45-49 years old group (33.4%, 18.7%, 3.8%, and 0.58, respectively) compared with the 50-75 years old group (42.7%, 24.2%, 7.7%, and 1.11, respectively; all P < 0.05). There was no difference in serrated polyp detection in the 45-49 years old group (11.5%) compared with the 50-75 years old group (12.5%; P = 0.287). There were no differences in withdrawal times, cecal intubation rates, or bowel preparation adequacy across age groups. CONCLUSION: In our screening population, we found that adenoma-based colonoscopy quality metrics were significantly lower in the 45-49 years old population compared to the traditional screening age cohort, while there was no difference in serrated polyp detection. Endoscopists should anticipate a small decline in colonoscopy quality benchmarks as the screening population becomes younger, although these results require validation through multicenter, prospective monitoring.