title: The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies.
abstract: OBJECTIVE
  Colonoscopy is considered to be the gold standard for detecting adenomatous polyps. Polyps are missed during colonoscopic examination at a rate that varies from 6% to 27%. The adenoma miss rate affects colonoscopic surveillance intervals and procedural quality. We aimed to assess the adenoma miss rate and the variables affecting the rate using same-day, quality-adjusted, back-to-back colonoscopies.
  
  
  METHODS
  This prospective study was performed at a single institution and included 149 patients. Two consecutive same-day colonoscopies were performed by two experienced endoscopists. The adenoma miss rates and variables affecting the missed adenomas, including polyp characteristics and procedure times, were evaluated.
  
  
  RESULTS
  The miss rates of polyps, adenomas, and advanced adenomas were 16.8%, 17%, and 5.4%, respectively. The smaller polyps and increased number of polyps detected during the first colonoscopy were more likely to be missed. A longer insertion time during the colonoscopy was correlated with an increased adenoma detection rate.
  
  
  CONCLUSIONS
  There was a significant miss rate in the detection of colonic adenomas even in quality-adjusted, back-to-back colonoscopies. The adenoma miss rate can be reduced with a sufficient observation time during colonoscopic insertion. The development of specific technological methods to reduce the adenoma miss rate is necessary.
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea.
authors.forename: Sang Bong
authors.initials: SB
authors.lastname: Ahn
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.forename: Joong Ho
authors.initials: JH
authors.lastname: Bae
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Byun
authors.forename: Jong Pyo
authors.initials: JP
authors.lastname: Kim
authors.forename: Chang Soo
authors.initials: CS
authors.lastname: Eun