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.
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Kravitz RL. Patient Characteristics and Adenoma Detection Rates. JAMA Surg. Published online September 04, 2019. doi:10.1001/jamasurg.2019.3372
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