Adenoma detection rate vs. adenoma per colonoscopy as quality indicators for colon cancer screening.

is known as the ‘One and done’ approach. In operators who are focused on using ADR as a quality indicator, it is very well possible that they may perform a quality examination until they find one adenoma and then unintentionally decrease the quality of the rest of the examination of the colonoscopy, which will indirectly affect the quality of the procedure without affecting ADR (7). Additionally, operator-based variability is also exhibited by differences in proximal and distal adenoma detection rate, and ADR metric by its calculable metric standard cannot account for these differences (8)