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Vol.17 No.3
May, 2023
Frequency : Bimonthly
pISSN 1976-2283
eISSN 2005-1212 
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
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Seung Wook Hong 
, Jeong-Sik Byeon
Correspondence to: Jeong-Sik Byeon
ORCID https://orcid.org/0000-0002-9793-6379
E-mail jsbyeon@amc.seoul.kr
See “Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study” by Jae Hee Han, et al. on page 716, Vol. 16, No. 5, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2022;16(5):661-662. https://doi.org/10.5009/gnl220365
Published online September 15, 2022, Published date September 15, 2022
Copyright © Gut and Liver.
It is well established that the incidence of colorectal cancer (CRC) and CRC-related mortality can be reduced by screening colonoscopy with polypectomy for an adenoma, which is a precancerous lesion of CRC.1,2 Based on these evidences, nationwide colonoscopy volume is steadily increasing.3 However, the quality of a colonoscopy can be different depending on various factors, including the endoscopist’s proficiency, adequate bowel preparation, and colonoscopy withdrawal time. Therefore, it is crucial to develop indicators to evaluate and monitor them. The adenoma detection rate (ADR) is the primary indicator of colonoscopy quality, which is defined as the proportion of screening cololonoscopies performed by an endoscopist that detected one or more adenomas. Corley
High ADR is considered to be significant in evaluating the colonoscopy quality, but there is a limitation that the ADR does not reflect the overall quality of the colonoscopy. The ADR is an indicator that cannot reflect missed adenomas in individuals with two or more adenomas. Considering that one of the major causes of interval CRC is a missed lesion, another colonoscopy quality indicator that can reflect a missed adenoma is warranted. In 2016, four endoscopists performed back-to-back colonoscopies for 200 participants, showing a significant difference in the adenoma miss rate (AMR) even among endoscopists with high ADR.6 Since back-to-back colonoscopy is inevitably required to determine the AMR, it is warranted to explore other colonoscopy indicators correlated with AMR.
Han
In previous studies, there have been attempts to explore a surrogate indicator for AMR. The study by Aniwan
ADR represents the ability to distinguish the presence from the absence of adenomas in all colonoscopies, whereas AMR represents the ability to distinguish the magnitude of adenomas which may compensate for ADR's weakness. Thus, not only ADR but also AMR should be considered for qualified colonoscopy. An optimal surrogate indicator of AMR without back-to-back colonoscopy should fulfill the following conditions: (1) have a high correlation with AMR; (2) be simple to calculate on a single colonoscopy; (3) derive reliable results from a qualified colonoscopy; and (4) propose a validated cutoff value.
Despite efforts of many researchers, a good surrogate quality indicator that can reflect AMR adequately has not been established to date. It is necessary for large-scale subsequent studies with well-controlled confounders related to adenoma detection to elucidate which surrogate indicators of AMR are optimal. Given the clinical significance of missed adenoma, we should continuously explore a reliable surrogate indicator reflecting it and seek ways to reduce it.9,10 We look forward to the subsequent studies regarding missed adenoma or AMR in colonoscopy.
No potential conflict of interest relevant to this article was reported.
Gut and Liver 2022; 16(5): 661-662
Published online September 15, 2022 https://doi.org/10.5009/gnl220365
Copyright © Gut and Liver.
Seung Wook Hong , Jeong-Sik Byeon
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence to:Jeong-Sik Byeon
ORCID https://orcid.org/0000-0002-9793-6379
E-mail jsbyeon@amc.seoul.kr
See “Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study” by Jae Hee Han, et al. on page 716, Vol. 16, No. 5, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
It is well established that the incidence of colorectal cancer (CRC) and CRC-related mortality can be reduced by screening colonoscopy with polypectomy for an adenoma, which is a precancerous lesion of CRC.1,2 Based on these evidences, nationwide colonoscopy volume is steadily increasing.3 However, the quality of a colonoscopy can be different depending on various factors, including the endoscopist’s proficiency, adequate bowel preparation, and colonoscopy withdrawal time. Therefore, it is crucial to develop indicators to evaluate and monitor them. The adenoma detection rate (ADR) is the primary indicator of colonoscopy quality, which is defined as the proportion of screening cololonoscopies performed by an endoscopist that detected one or more adenomas. Corley
High ADR is considered to be significant in evaluating the colonoscopy quality, but there is a limitation that the ADR does not reflect the overall quality of the colonoscopy. The ADR is an indicator that cannot reflect missed adenomas in individuals with two or more adenomas. Considering that one of the major causes of interval CRC is a missed lesion, another colonoscopy quality indicator that can reflect a missed adenoma is warranted. In 2016, four endoscopists performed back-to-back colonoscopies for 200 participants, showing a significant difference in the adenoma miss rate (AMR) even among endoscopists with high ADR.6 Since back-to-back colonoscopy is inevitably required to determine the AMR, it is warranted to explore other colonoscopy indicators correlated with AMR.
Han
In previous studies, there have been attempts to explore a surrogate indicator for AMR. The study by Aniwan
ADR represents the ability to distinguish the presence from the absence of adenomas in all colonoscopies, whereas AMR represents the ability to distinguish the magnitude of adenomas which may compensate for ADR's weakness. Thus, not only ADR but also AMR should be considered for qualified colonoscopy. An optimal surrogate indicator of AMR without back-to-back colonoscopy should fulfill the following conditions: (1) have a high correlation with AMR; (2) be simple to calculate on a single colonoscopy; (3) derive reliable results from a qualified colonoscopy; and (4) propose a validated cutoff value.
Despite efforts of many researchers, a good surrogate quality indicator that can reflect AMR adequately has not been established to date. It is necessary for large-scale subsequent studies with well-controlled confounders related to adenoma detection to elucidate which surrogate indicators of AMR are optimal. Given the clinical significance of missed adenoma, we should continuously explore a reliable surrogate indicator reflecting it and seek ways to reduce it.9,10 We look forward to the subsequent studies regarding missed adenoma or AMR in colonoscopy.
No potential conflict of interest relevant to this article was reported.
pISSN 1976-2283
eISSN 2005-1212
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
