title: The Secondary Quality Indicator to Improve Prediction of Adenoma Miss Rate Apart from Adenoma Detection Rate.
abstract: Adenoma detection rate (ADR) cannot distinguish between endoscopists who detect one adenoma and those who detect ≥2 adenomas. Hypothetically, adenoma miss rate (AMR) may be significant for endoscopists with high ADRs who examine the rest of colon with less care after detecting first polyp. Our objective was to evaluate other quality indicators plus ADR vs. ADR alone in prediction of AMR.
  
  
  
  We conducted a cross-sectional study of asymptomatic participants aged 50-75 years who underwent back-to-back screening colonoscopies by four faculty endoscopists. Each round of colonoscopy was performed by two of the endoscopists in a randomized order. During each round of colonoscopy, all detected polyps were removed. The second endoscopist was blinded to the results of the first. The total number of adenomas per positive participant (APP), the total number of adenomas per colonoscopy (APC), the additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and ADR were calculated for prediction of AMR.
  
  
  
  In all, 200 participants underwent back-to-back colonoscopies. There were no significant differences in ADRs of four endoscopists (44, 50, 54, and 46%). APPs were 1.91, 2.12, 2.19, and 2.43. APCs were 0.84, 1.06, 1.18, and 1.12. ADR-Plus were 0.40, 0.56, 0.64, and 0.66, respectively. AMRs differed significantly between the endoscopists (36, 27, 21, and 13%; P=0.01). There was no correlation between ADR and AMR (r=-0.25; P=0.75). Whereas APP exhibited a strong inverse correlation with AMRs (r=-0.99; P<0.01). APC and ADR-Plus appeared to be inversely correlated with AMR, however this was not statistically significant (r=-0.82; P=0.18 and r=-0.93; P=0.07, respectively).
  
  
  
  Among high-ADR endoscopists, AMRs still varied. APP may be a promising secondary indicator for distinguishing between the one-and-done polyp endoscopist and the meticulous endoscopist. The evaluation of influence of new metrics on colorectal cancer (CRC) prevention requires a larger population-based study.
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Satimai
authors.initials: S
authors.lastname: Aniwan
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Piyachai
authors.initials: P
authors.lastname: Orkoonsawat
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Vichai
authors.initials: V
authors.lastname: Viriyautsahakul
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Phonthep
authors.initials: P
authors.lastname: Angsuwatcharakon
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Rapat
authors.initials: R
authors.lastname: Pittayanon
authors.affiliation: Faculty of Medicine, Department of Pathology, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Naruemon
authors.initials: N
authors.lastname: Wisedopas
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Sakolkun
authors.initials: S
authors.lastname: Sumdin
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Yuwadee
authors.initials: Y
authors.lastname: Ponuthai
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Sumitra
authors.initials: S
authors.lastname: Wiangngoen
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Pinit
authors.initials: P
authors.lastname: Kullavanijaya
authors.affiliation: Faculty of Medicine, Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D003113:Colonoscopy; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care
references.citation: Gut. 2012 Jul;61(7):1050-7
references.pmid: 21940723
references.citation: Gastrointest Endosc. 2012 Mar;75(3):561-7
references.pmid: 22341103
references.citation: Gut. 2014 Jan;63(1):125-30
references.pmid: 23503044
references.citation: Gastrointest Endosc. 2015 Jan;81(1):31-53
references.pmid: 25480100
references.citation: N Engl J Med. 2012 Feb 23;366(8):697-706
references.pmid: 22356323
references.citation: Gut. 2014 Jun;63(6):949-56
references.pmid: 23793224
references.citation: Am J Gastroenterol. 2014 Dec;109(12):1844-9
references.pmid: 24935271
references.citation: Endoscopy. 2015 Dec;47(12):1151-8
references.pmid: 26220283
references.citation: Gastrointest Endosc. 2013 Jan;77(1):71-8
references.pmid: 23261096
references.citation: Gastrointest Endosc. 2015 Sep;82(3):488-94
references.pmid: 25910661
references.citation: Gastrointest Endosc. 2015 Mar;81(3):525-30
references.pmid: 24998464
references.citation: PLoS One. 2014 Dec 03;9(12):e114267
references.pmid: 25470133
references.citation: Am J Gastroenterol. 2009 Mar;104(3):739-50
references.pmid: 19240699
references.citation: N Engl J Med. 2010 May 13;362(19):1795-803
references.pmid: 20463339
references.citation: Am J Gastroenterol. 2014 Jun;109(6):855-63
references.pmid: 24751581
references.citation: Gastrointest Endosc. 2015 Mar;81(3):719-27
references.pmid: 25708760
references.citation: Endoscopy. 2008 Apr;40(4):284-90
references.pmid: 18389446
references.citation: N Engl J Med. 2014 Jun 26;370(26):2541
references.pmid: 24963577
references.citation: Gastrointest Endosc Clin N Am. 2015 Apr;25(2):373-86
references.pmid: 25839691
references.citation: Br J Anaesth. 2014 Sep;113(3):424-32
references.pmid: 24727705
references.citation: Gut. 2015 Jan;64(1):121-32
references.pmid: 24647008
references.citation: Gastroenterology. 2007 Jul;133(1):42-7
references.pmid: 17631129
references.citation: Tech Coloproctol. 2013 Oct;17(5):487-96
references.pmid: 23652813
references.citation: Gastrointest Endosc. 2015 Apr;81(4):781-94
references.pmid: 25595062
references.citation: Am J Gastroenterol. 2012 Mar;107(3):363-70; quiz 371
references.pmid: 22186978
references.citation: Gut. 2012 Mar;61(3):402-8
references.pmid: 21997547
references.citation: Am J Gastroenterol. 2015 Mar;110(3):415-22
references.pmid: 25732415
references.citation: Gastrointest Endosc. 2015 Oct;82(4):676-82
references.pmid: 26385276
references.citation: Digestion. 2012;86(2):148-54
references.pmid: 22889865
references.citation: Ann Intern Med. 2004 Sep 7;141(5):352-9
references.pmid: 15353426
references.citation: Gastrointest Endosc. 2015 Sep;82(3):512-9
references.pmid: 25910665
references.citation: Gastroenterology. 2009 Aug;137(2):404-9
references.pmid: 19540838
references.citation: Endoscopy. 2014 Mar;46(3):196-202
references.pmid: 24573731
references.citation: Gastroenterology. 2015 Oct;149(4):952-7
references.pmid: 26164494
references.citation: Am J Gastroenterol. 2006 Feb;101(2):343-50
references.pmid: 16454841
references.citation: Am J Gastroenterol. 2014 Oct;109(10):1528-45
references.pmid: 25223578