Correspondence

endoscopists who miss adenomas would benefit from a technique that increased the adenoma detection rate. The patients in our study1 included those referred for colorectal cancer screening, surveillance, and diagnostic evaluation of abdominal complaints. Therefore adenoma miss rates of up to 48% as expected by Dawwas would not have been likely. Both patient groups (those receiving full spectrum endoscopy and those receiving standard forward-view colonoscopies) had identical rates of adenoma presence (34%), indicating that the process of randomisation had performed as expected. Our data are not unique in showing that standard forward-view colonoscopy misses clinically significant lesions, and high quantities of lesions.5 Previous studies6,7 have reported that standard forward-view colonoscopes give a more restricted view behind the folds and flexures of the colon, and could thereby lead to missed adenomas. Finally, with respect to patient comfort and insertion tube design, data from a randomised study by Neumann and colleagues8 show that patients undergoing full-spectrum colonoscopy required less propofol than patients undergoing standard forward-view colonoscopy (170 mg vs 230 mg). Moreover, significantly more patients in the standard forward-view colonoscopy group needed analgesia (meperidine; p=0·01). Their data also showed that the endoscopists were able to reach the caecum significantly faster using full-spectrum than standard forward-view colonoscopy (4·1 min vs 5·5 min, p