Short-term post-colonoscopy colorectal cancer (PCCRC) risk is more strongly associated with the quality of the endoscopist than with the presence of high-risk polyps.

Each 1-point increase in adenoma detection rate (ADR) reduced PCCRC risk by 6%, and each 1-point increase in proximal serrated polyp detection rate (PSPDR) reduced it by 8%.

 Even endoscopists who exceeded the Dutch minimum ADR threshold of 40% showed higher missed cancer rates than top performers, suggesting current standards may be too lenient.

Incorporating ADR and PSPDR into risk stratification and surveillance interval decisions could enhance early cancer prevention.

The strongest impact of endoscopist quality was observed within three years post-colonoscopy, underscoring the importance of meticulous examination technique during initial procedures.