We would like to thank Dr Gleason for his observation that lead absorption in the gut decreases in distal intestinal segments. We agree with the implications of the few extant animal models; however, we disagree with the suggestion that colonoscopy or other interventions have no role in the treatment of lead poisoning in humans.1
As our article suggested, endoscopy for reachable objects or surgical intervention for retained objects that result in persistently high lead levels should be considered.2 We believe that intervention in the current case was warranted for several reasons. The risks and benefits offered by Gleason were not clear to us. Serial radiography showed no definitive placement of the sinkers in the gastrointestinal tract, but the radiology reports were suggestive of anatomical location. As the legend for Figure 1 stated, the lead sinkers were "probably in the ileum or distal small bowel."2(p486) Even on hospital day 5, we believed that several of the sinkers were still located in the cecum. Follow-up serial films, obtained almost 30 days after ingestion, revealed that the sinkers that had been retained in the distal small intestine were absent.
Mowad E, Haddad I, Gemmel DJ. Advisability of Colonoscopy in the Management of Ingested Lead Poisoning—Reply. Arch Pediatr Adolesc Med. 1998;152(12):1247. doi: