In Reply We thank you all for taking the time to critically evaluate our work.¹ With regards to Kawada’s statement, we agree that generally speaking, one would expect that the odds ratio (OR) of the number of annual colonoscopies for proximal sessile serrated polyp detection rate (pSSPDR) to be statistically significant and decreasing with increasing volume. This seems discordant with our study’s findings and may be driven by the fact that pSSPDR was only recently accorded importance as a quality indicator. Therefore, those who have trained more recently have been trained more rigorously to identify pSSPDR. However, this does not take away from the realization that with increased procedure volume, one becomes better at identifying them. Thank you for the clarification regarding the Crockett et al study² evaluating sessile serrated polyp detection not being derived solely from proximal sessile serrated polyps. While most sessile serrated polyps are proximal, we do agree that further studies are needed with focus on pSSPDR to be an adequate comparator with our study.

在答复中，我们感谢大家花时间认真评估我们的工作。^1个关于Kawada的陈述，我们同意，一般而言，人们可以预期，无柄锯齿状息肉检出率（pSSPDR）的年度结肠镜检查数量的比值比（OR）具有统计学意义，并且随着交易量的增加而降低。这似乎与我们的研究结果不一致，并且可能是因为pSSPDR仅在最近才被视为重要的质量指标这一事实。因此，最近接受过培训的人员都经过了更加严格的培训，以识别pSSPDR。但是，这并不能使人们意识到，随着程序量的增加，人们会更好地识别它们。感谢您对Crockett等人研究²的澄清评估无柄锯齿状息肉的检测并非仅来自近端无柄锯齿状息肉。尽管大多数无柄锯齿状息肉是近端的，但我们确实同意需要进行进一步的研究，重点是pSSPDR才能成为我们研究的适当比较者。