Continuing Medical Education Questions: May 2023 : Official journal of the American College of Gastroenterology | ACG

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CME Questions

Continuing Medical Education Questions: May 2023

Holzwanger, Erik A. MD

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The American Journal of Gastroenterology 118(5):p 778, May 2023. | DOI: 10.14309/ajg.0000000000002271



After this activity, the participant will be able to distinguish quality metrics of colonoscopy and understand the importance of these quality metrics.


Based on this study, which of the following statements is true?

  1. Advanced adenoma miss rate is similar between 6-minute and 9-minute mean withdrawal times (m-WT)
  2. Adenoma detection rate is similar between 6 minute and 9-minute m-WT
  3. Adenoma miss rate is lower with 9-minute m-WT in comparison to 6-minute m-WT
  4. Surveillance interval recommendation did not change based on withdrawal time


A 55-year-old man is in the endoscopy lab for his first average-risk screening colonoscopy. He has a history of irritable bowel syndrome which is well-controlled with twice daily dicyclomine use. As he drank only 75% of bowel prep and his last bowel movement was light brown liquid, he is worried about the quality of his bowel prep. Additionally, he is concerned about undergoing sedation for his procedure.

Which of the following statements is correct based on this study?

  1. Lack of sedation is an independent risk factor for missed adenomas
  2. Propofol sedation is associated with a higher adenoma detection rate than opioid/benzodiazepine sedation
  3. Poor bowel prep quality is not associated with missed adenomas
  4. Dicyclomine is not associated with adenoma miss rate


Based on this study, which of the following statements is true regarding 9 minute m-WT?

  1. A 9-minute m-WT is associated with reduction of interval colorectal cancer
  2. Adenoma detection rate (ADR) did not improve in colonoscopists with ADR >25% when m-WT increased from 6 to 9 minutes
  3. Colorectal cancer miss rate is lower with 9-minute m-WT
  4. A 9-minure m-WT adenoma miss rate decreased even without ADR improvement in colonoscopists with high 6-minute m-WT ADR

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