Endoscopy 2008; 40(4): 284-290
DOI: 10.1055/s-2007-995618
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies

D.  Heresbach1 , T.  Barrioz2 , M.  G.  Lapalus3 , D.  Coumaros4 , P.  Bauret5 , P.  Potier6 , D.  Sautereau7 , C.  Boustière8 , J.  C.  Grimaud9 , C.  Barthélémy10 , J.  Sée11 , I.  Serraj3 , P.  N.  D’Halluin1 , B.  Branger12 , T.  Ponchon3 , and the Société Française d’Endoscopie Digestive (SFED)
  • 1Department of Gastroenterology, Hospital Pontchaillou, Rennes, France
  • 2Department of Gastroenterology, Hospital La Milétrie, Poitiers, France
  • 3Department of Gastroenterology, Hospital Edouard Herriot, Lyon, France
  • 4Department of Gastroenterology, Civil Hospital, Strasbourg, France
  • 5Department of Gastroenterology, Hospital Saint-Eloi, Montpellier, France
  • 6Department of Gastroenterology, Hospital La Source, Orléans, France
  • 7Department of Gastroenterology, Hospital Dupuytren, Limoges, France
  • 8Department of Gastroenterology, Hospital Saint-Joseph, Marseille, France
  • 9Department of Gastroenterology, Hospital Nord Saint-Antoine, Marseille, France
  • 10Department of Gastroenterology, Hospital Nord, Saint-Priest en Jarez, France
  • 11Department of Gastroenterology, Hospital Tenon, Paris, France
  • 12Biostatistics Unit of the Public Health Department, Hospital Pontchaillou, Rennes, France
Further Information

Publication History

submitted 30 April 2007

accepted after revision 14 January 2008

Publication Date:
04 April 2008 (online)

Background and study aim: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i. e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination.

Patients and methods: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas.

Results: The miss rates for polyps, adenomas, polyps ≥ 5 mm, adenomas ≥ 5 mm, and advanced adenomas were, respectively, 28 %, 20 %, 12 %, 9 % and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n = 1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36 % and 26 % but the corresponding rates were 23 % and 9.4 % when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (≥ 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate.

Conclusions: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.


D. Heresbach, , MD, PhD 

Service des Maladies de #l’Appareil Digestif
CHU Pontchaillou

35033 Rennes Cedex 09

Fax: +33-299-284189

Email: [email protected]