To the Editor In their carefully conducted and well-reported study, Sarvepalli et al1 conclude that prior reports of lower polyp detection rates among nongastroenterologists were flawed by residual confounding. However, their study may be flawed by the opposite error: overadjusting for factors that operate as part of the causal pathway linking endoscopist characteristics with polyp detection. Specifically, eAppendix 1 in the Supplement lists preparation adequacy (which could be a function of quality of patient education delivered by different clinician types), cecal intubation, and withdrawal time as control variables. Prior studies have noted associations between each of these factors and polyp detection,2-4 and it is not unreasonable to assume that any or all would be associated with endoscopist specialty. It would be interesting to examine the results with these 3 variables omitted.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Kravitz RL. Patient Characteristics and Adenoma Detection Rates. JAMA Surg. 2019;154(12):1170. doi:10.1001/jamasurg.2019.3372
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: