title: Retrospective analysis of missed advanced adenomas on surveillance colonoscopy.
abstract: OBJECTIVE
  Miss rates of large polyp/cancer during colonoscopy are reported from tertiary centers where experts do the colonoscopies. This information is important for determining surveillance intervals for repeat colonoscopy, patient safety, and malpractice issues. We evaluated retrospectively the miss rates of advanced adenomas in the setting of a GI fellowship training where most colonoscopies are done by closely supervised fellows.
  
  
  METHODS
  We reviewed the 235 patients who had at least one repeat colonoscopy after initial polypectomy, between 1992 and 1999, at the Dayton Veterans Affairs Medical Center. Advanced adenomas were defined as polyps 10 mm or greater in size with or without a villous component or high-grade dysplasia. Data of missed advanced adenomas on 122 patients who had complete colonoscopy with satisfactory preparation and the excluded patients are reported.
  
  
  RESULTS
  Four advanced adenomas (one had intramucosal cancer) on second colonoscopy and two advanced adenomas on third colonoscopy were missed. The miss rate of advanced adenoma for 232 patients was 1.7%, and the miss rate for the 122 patients with complete colonoscopy and satisfactory colon preparation was 2.5% and 3.3% on second and third repeat colonoscopy, respectively. No cancer was missed.
  
  
  CONCLUSIONS
  The present study shows an advanced polyp miss rate that is comparable with other studies even in a fellowship training setting. Prospective studies with tandem surveillance colonoscopy are needed to confirm our findings.
authors.affiliation: Department of Veterans Affairs Medical Center, Dayton, Ohio 45428, USA.
authors.forename: Ihab
authors.initials: I
authors.lastname: Shehadeh
authors.forename: Srilakshmi
authors.initials: S
authors.lastname: Rebala
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Markert
authors.forename: Chris
authors.initials: C
authors.lastname: Barde
authors.forename: N
authors.initials: N
authors.lastname: Gopalswamy
mesh_terms: D000236:Adenoma / Q000473:pathology*; D003110:Colonic Neoplasms / Q000473:pathology*; D003113:Colonoscopy / Q000592:standards*; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies