title: Proficiency in the diagnosis of nonpolypoid colorectal neoplasm yields high adenoma detection rates.
abstract: OBJECTIVE
  Current efforts to prevent colorectal cancer focus on the detection and removal of neoplasms. Nonpolypoid colorectal neoplasms (NP-CRN) have a subtle appearance that can be difficult to recognize during colonoscopy. Endoscopists must first be familiar with the patterns of NP-CRN in order to detect and diagnose them. We studied the adenoma detection rates of endoscopists who had trained to detect NP-CRN, versus endoscopists who had not.
  
  
  METHODS
  
  
  
  METHODS
  Retrospective Nested Case Control Study.
  
  
  METHODS
  Outpatient Screening Colonoscopy.
  
  
  METHODS
  Adult Veterans.
  
  
  METHODS
  Proficiency in the features and diagnosis of NP-CRN.
  
  
  METHODS
  Adenoma detection.
  
  
  RESULTS
  In total, 462 patients had screening colonoscopies-267 by colonoscopists who had trained in the features and diagnosis of NP-CRN. Patient characteristics were similar between groups-the majority were men with a mean age of 62 ± 6 years. Neoplasia was more prevalent (45.7 vs. 34.9%; p = 0.02) in patients evaluated by the trained compared to the conventionally trained group. Trained colonoscopists had a higher adenoma detection rate (0.76 vs. 0.54 adenomas per patient, p < 0.001); removed a higher proportion of neoplasia (77 vs. 35%, p < 0.001); and more frequently diagnosed NP-CRN lesions (OR 2.98, 95% CI: 1.46-6.08) compared to colonoscopists without supplemental training.
  
  
  CONCLUSIONS
  Endoscopists who are proficient in the detection of NP-CRN had significantly higher adenoma detection rates-of both polypoid and flat adenomas-compared to endoscopists without training, and were more specific in resection of adenomatous over hyperplastic lesions.
authors.affiliation: Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine, 3801 Miranda Ave, GI-111, Palo Alto, CA 94304, USA. endoresection@me.com
authors.forename: Tonya
authors.initials: T
authors.lastname: Kaltenbach
authors.forename: Sarah K
authors.initials: SK
authors.lastname: McGill
authors.forename: Venkat
authors.initials: V
authors.lastname: Kalidindi
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland
authors.forename: Roy
authors.initials: R
authors.lastname: Soetikno
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000473:pathology*; D018256:Adenomatous Polyps / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003113:Colonoscopy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005762:Gastroenterology / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies