Editorial: On the Quality of Quality Metrics: Rethinking What Defines a Good Colonoscopy.

The colonoscopy quality assurance movement has focused on a variety of process metrics, including the adenoma detection rate (ADR). However, the ADR only ascertains whether or not at least one adenoma is identified. Supplemental measures that quantify all neoplasia have been proposed. In this issue of the American Journal of Gastroenterology, Aniwan and colleagues performed tandem screening colonoscopies to determine the adenoma miss rate among high-ADR endoscopists. This permitted validation of supplemental colonoscopy quality metrics. This study highlights potential limitations of ADR and the need for further refinement of colonoscopy quality metrics, although logistic challenges abound.