Bevan R, et al. - Via analyzing data from six pilot flexible sigmoidoscopy screening centres, researchers studied factors affecting the adenoma detection rate (ADR). They conducted a retrospective analysis of the flexible sigmoidoscopy screening procedures carried out at six pilot sites in England in the National Health Service Bowel Scope Screening program in people aged 55 years. On multivariate analysis, factors correlated with adenoma detection were male sex and a withdrawal time from the splenic flexure of at least 3·25 min in negative procedures. Investigators found that women, individuals with adequate or poor bowel preparation, and those with mild or moderate or severe discomfort were less likely to have a procedure reaching the splenic flexure. Key performance indicators for flexible sigmoidoscopy screening, including standards for insertion and withdrawal times, optimal depth, and bowel preparation, should be defined. By recommending a withdrawal time from the splenic flexure of at least 3·25 min (ideally 3·5–4·0 min), ADR could be improved.