Proficiency in the Diagnosis of Nonpolypoid Colorectal Neoplasm Yields High Adenoma Detection Rates

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Background and Aims

Current efforts to prevent colorectal cancer focus on the detection and removal of neoplasms. Nonpolypoid colorectal neoplasms (NP-CRN) have a subtle appearance that can be difficult to recognize during colonoscopy. Endoscopists must first be familiar with the patterns of NP-CRN in order to detect and diagnose them. We studied the adenoma detection rates of endoscopists who had trained to detect NP-CRN, versus endoscopists who had not.

Materials and Methods Design:

Retrospective Nested Case Control Study. Setting: Outpatient Screening Colonoscopy. Participants: Adult Veterans. Intervention: Proficiency in the features and diagnosis of NP-CRN. Main Outcomes Measurements: Adenoma detection.


In total, 462 patients had screening colonoscopies —267 by colonoscopists who had trained in the features and diagnosis of NP-CRN. Patient characteristics were similar between groups—the majority were men with a mean age of 62 ± 6 years. Neoplasia was more prevalent (45.7 vs. 34.9%; p = 0.02) in patients evaluated by the trained compared to the conventionally trained group. Trained colonoscopists had a higher adenoma detection rate (0.76 vs. 0.54 adenomas per patient, p < 0.001); removed a higher proportion of neoplasia (77 vs. 35%, p < 0.001); and more frequently diagnosed NP-CRN lesions (OR 2.98, 95% CI: 1.46-6.08) compared to colonoscopists without supplemental training.


Endoscopists who are proficient in the detection of NP-CRN had significantly higher adenoma detection rates—of both polypoid and flat adenomas— compared to endoscopists without training, and were more specific in resection of adenomatous over hyperplastic lesions.

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