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23, 47 These rates should be calculated after subtracting those Oxacillin exams, which were incomplete owing to a poor bowel preparation, severe colitis, or an obstructing lesion such as a tumor. For many gastroenterologists in the United States, cecal intubation rates are in the 97�C99% range for both men and women.18, 19, 48, 49 What is the impact of cecal intubation rates on interval cancer rates? An analysis of a British screening program observed an adjusted cecal intubation rate that ranged from 76.2 to 100%,50 and noted a correlation between the cecal intubation rate and an endoscopist's ADR. A study from Japan observed that 4 out of 15 interval cancers were diagnosed after an incomplete colonoscopy.51 One study of 14,064 patients from Ontario, Canada examined the impact of an endoscopist's completion rate on the occurrence of interval cancers.52 When compared with patients whose exams were performed by endoscopists this website with a IPI-145 in vivo A recent review of 12 Dutch endoscopy departments found that the compliance rate for photo-documentation of having reached the cecum ranged from 44.8 to 97.1%.53 Photo-documentation of the cecum is vital for subsequent physicians who may alter treatment or diagnosis if there is any doubt that a complete exam was performed. It has been suggested that the optimal photograph should be taken distal enough from the cecum so that it contains an image of the appendiceal orifice with the ileocecal valve.47, 54 An image of the ileum with villi may be helpful in confirming cecal intubation.17 The recent recommended benchmarks from the ACG/ASGE task force for successful cecal intubation rates with photo-documentation of appropriate landmarks are 90% for all exams and 95% for screening exams.23 WITHDRAWAL TIME To maximize adenoma detection, adequate mucosal inspection is required to ensure complete examination. Studies of tandem colonoscopies have revealed that endoscopists may miss adenomas larger than 1 cm.55, 56 To ensure adequate adenoma detection, studies have suggested that an endoscopist's withdrawal time, not including polyp resection, should be on average at least 6�C9?min.