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The identification, detection and removal of colonic adenomas reduce the risk of colorectal cancer (CRC).1 ,2 The impact of this strategy lies in the provision of high quality effective colonoscopy at index examination. A clear relationship exists between quality indicators and the subsequent risk of postcolonoscopy colorectal cancer (PCCRC). In a Polish study (Kaminski et al), individuals with an adenoma detection rate (ADR) <20% increased the risk of PCCRC in the following 5 years.3 In a study by Baxter et al, patients were less likely to develop interval cancers if a high ‘polyp’ detecting operator performed the initial colonoscopy; however, this impact was confined to the proximal colon, and the histological status of the polyps was not known.4 In a study by Corley et al, reviewing the association between ADR and subsequent CRC and death, for every 1% increase in ADR there was a 3% reduction in interval cancer (HR 0.97; 95% CI 0.96 to 0.98).5 …
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