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Adenoma detection rates (ADRs) measure endoscopist performance. Improving other components of examinations could increase adenoma detection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Aims<\/jats:title>\n                <jats:p>To investigate how endoscopist performance at flexible sigmoidoscopy (FS) affects adenoma detection and CRC incidence.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Among 34,139 participants receiving FS screening by the main endoscopist at one of 13 centres in the UK FS Screening Trial, median follow-up was 17\u00a0years. Factors examined included family history of CRC, bowel preparation quality, insertion and withdrawal time, bowel segment reached, patient pain and ADR. Odds ratios (OR) for distal adenoma detection were estimated by logistic regression. Hazard ratios (HR) for distal CRC incidence were estimated by Cox regression.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At screening, 4,104 participants had distal adenomas detected and 168 participants developed distal CRC during follow-up. In multivariable models, a family history of CRC (yes vs. no: OR 1.40, 95%CI 1.21\u20131.62), good or adequate bowel preparation quality (vs. excellent: OR 0.84, 95%CI 0.74\u20130.95; OR 0.56, 95%CI 0.49\u20130.65, respectively) and longer insertion and withdrawal times (\u2265\u20094.00 vs.\u2009&lt;\u20092.00\u00a0min: OR 1.96, 95%CI 1.68\u20132.29; OR 32.79, 95%CI 28.22\u201338.11, respectively) were associated with adenoma detection. Being screened by endoscopists with low or intermediate ADRs, compared to high ADRs, was positively associated with CRC incidence (multivariable: HR 4.71, 95%CI 2.65\u20138.38; HR 2.16, 95%CI 1.22\u20133.81, respectively).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Bowel preparation quality and longer insertion and withdrawal time are key for improving distal adenoma detection. Higher ADRs were associated with a lower risk of distal CRC.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-024-03125-x","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T09:02:07Z","timestamp":1706000527000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The impact of endoscopist performance and patient factors on distal adenoma detection and colorectal cancer incidence"],"prefix":"10.1186","volume":"24","author":[{"given":"Sharon","family":"Power","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Wooldrage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Saunders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda J.","family":"Cross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,23]]},"reference":[{"key":"3125_CR1","unstructured":"Cancer Research UK. 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Trial registration: ISRCTN28352761. All individuals who underwent FS provided written informed consent prior to examination. The Patient Information Advisory Group (now Confidentiality Advisory Group) granted permission to obtain and process patient data (PIAG 4\u201307(j)\/2002). All the methods were carried out according to the relevant guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"BPS has\u00a0done\u00a0consultancy work, been a speaker for, had loan equipment and a research grant from Olympus in the last 3\u00a0years; all other authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"44"}}