The colonoscopy quality assurance movement has focused on a variety of process metrics, including the adenoma detection rate (ADR). However, the ADR only ascertains whether or not at least one adenoma is identified. Supplemental measures that quantify all neoplasia have been proposed. In this issue of theAmerican Journal of Gastroenterology, Aniwan and colleagues performed tandem screening colonoscopies to determine the adenoma miss rate among high-ADR endoscopists. This permitted validation of supplemental colonoscopy quality metrics. This study highlights potential limitations of ADR and the need for further refinement of colonoscopy quality metrics, although logistic challenges abound.
1VA Puget Sound Health Care System, University of Washington School of Medicine, Seattle, Washington, USA
2Department of Health Services Research, Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Health System, Los Angeles, California, USA
Correspondence: Jason A. Dominitz, MD, MHS, VA Puget Sound Health Care System, 1660 S. Columbian Way (111-Gastro), Seattle, Washington 98108, USA. E-mail: email@example.com
Received 01 February 2016; accepted 02 February 2016
Guarantor of the article: Jason A. Dominitz, MD, MHS.
Specific author contributions: Both the authors drafted the manuscript and approved the final draft submitted.
Financial support: This work was supported in part by resources from The Veterans Health Administration.
Potential competing interests: None.