title: Polyp miss rate determined by tandem colonoscopy: a systematic review.
abstract: OBJECTIVE
  Colonoscopy is the best available method to detect and remove colonic polyps and therefore serves as the gold standard for less invasive tests such as virtual colonoscopy. Although gastroenterologists agree that colonoscopy is not infallible, there is no clarity on the numbers and rates of missed polyps. The purpose of this systematic review was to obtain summary estimates of the polyp miss rate as determined by tandem colonoscopy.
  
  
  METHODS
  An extensive search was performed within PUBMED, EMBASE, and the Cochrane Library databases to identify studies in which patients had undergone two same-day colonoscopies with polypectomy. Random effects models based on the binomial distribution were used to calculate pooled estimates of miss rates.
  
  
  RESULTS
  Six studies with a total of 465 patients could be included. The pooled miss rate for polyps of any size was 22% (95% CI: 19-26%; 370/1,650 polyps). Adenoma miss rate by size was, respectively, 2.1% (95% CI: 0.3-7.3%; 2/96 adenomas > or =10 mm), 13% (95% CI: 8.0-18%; 16/124 adenomas 5-10 mm), and 26% (95% CI: 27-35%; 151/587 adenomas 1-5 mm). Three studies reported data on nonadenomatous polyps: zero of eight nonadenomatous polyps > or =10 mm were missed (0%; 95% CI: 0-36.9%) and 83 of 384 nonadenomatous polyps <10 mm were missed (22%; 95% CI: 18-26%).
  
  
  CONCLUSIONS
  Colonoscopy rarely misses polyps > or =10 mm, but the miss rate increases significantly in smaller sized polyps. The available evidence is based on a small number of studies with heterogeneous study designs and inclusion criteria.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, Academic Medical Center (University of Amsterdam), Amsterdam, The Netherlands.
authors.forename: Jeroen C
authors.initials: JC
authors.lastname: van Rijn
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Sander J
authors.initials: SJ
authors.lastname: van Deventer
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans