Carl R. Darnall Army Medical Center

This review summarizes current landscape of colonoscopy quality metrics, with an emphasis on priority intraprocedural indicators. We aim to clarify the rationale, evidence, and practical implementation of both traditional and recently introduced metrics-highlighting which measures are most relevant for improving patient outcomes in 2025. The 2024 ACG/ASGE guidelines reaffirmed the core quality indicators of adenoma detection rate (ADR), cecal intubation rate (CIR), bowel preparation adequacy, and guideline-based surveillance interval assignment. The guidelines also introduced new metrics such as sessile serrated lesion detection rate (SSLDR), adenomas per colonoscopy (APC), extended withdrawal time, and a distinct ADR benchmark for colonoscopies following positive fecal screening. Altogether, these updates reflect a shift toward more granular, detection-focused metrics. The traditional quality indicators remain the cornerstone of high colonoscopy quality due to their feasibility in most clinical settings and established correlation with reducing post-colonoscopy colorectal cancer rates (PCCRC). New detection-based metrics, particularly SSLDR and APC, have independent impacts on lowering PCCRC, but unique challenges in becoming widely adopted. We advocate for endoscopists to establish a strong foundation of traditional colonoscopy quality metrics while working towards establishing systems to monitor novel quality metrics like SSLDR and APC. Quality measurement, whether automated or manually tracked, remains the key to delivering high-quality, cancer-preventing colonoscopy.