title: Interendoscopist variability in proximal colon polyp detection is twice higher for serrated polyps than adenomas.
abstract: OBJECTIVE
  To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.
  
  
  METHODS
  This study was a retrospective analysis of prospectively collected data from a regional colorectal cancer (CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma (A), one proximal adenoma (PA), one distal adenoma (DA), and one proximal serrated polyp (PSP) was assessed by using multilevel logistic regression models.
  
  
  RESULTS
  The observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6% (mean = 35.7%) for A, from 19.1% to 39.0% (mean = 29.4%) for DA, from 6.0% to 22.9% (mean = 12.4%) for PA, and from 1.3% to 19.3% (mean = 6.9%) for PSP. After adjusting for patient-level variables (sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA (P= 0.03,P= 0.02,P= 0.02 andP= 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA (6.6%) compared with A (2.1%), and twofold higher for PSP (12.3%) compared with PA.
  
  
  CONCLUSIONS
  These results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated polyps, but not for distal adenoma detection. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.
authors: Jean-François Bretagne, Guillaume Bouguen, Service des maladies de l'appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France.
authors: Jean-François
authors: JF
authors: Bretagne
authors: Jean-François Bretagne, Guillaume Bouguen, Service des maladies de l'appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France.
authors: Stéphanie
authors: S
authors: Hamonic
authors: Jean-François Bretagne, Guillaume Bouguen, Service des maladies de l'appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France.
authors: Christine
authors: C
authors: Piette
authors: Jean-François Bretagne, Guillaume Bouguen, Service des maladies de l'appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France.
authors: Jean-François
authors: JF
authors: Viel
authors: Jean-François Bretagne, Guillaume Bouguen, Service des maladies de l'appareil digestif, hôpital Pontchaillou, Centre hospitalo-universitaire de Rennes, 35033 Rennes, France.
authors: Guillaume
authors: G
authors: Bouguen
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D055088:Early Detection of Cancer; D004724:Endoscopy; D005260:Female; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Adenoma; Colonoscopy; Colorectal cancer; Detection rate; Proximal polyp; Quality performance; Serrated polyp