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October 22/29, 2003

Optimal Intervals and Techniques for Screening SigmoidoscopyOptimal Intervals and Techniques for Screening Sigmoidoscopy

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(16):2122-2123. doi:10.1001/jama.290.16.2122-a

To the Editor: Dr Schoen and colleagues1 acknowledged that some of the "new" lesions discovered at 3 years were found because of increased depth of insertion or better bowel preparation at the second examination. Data from the Veterans Affairs (VA) Cooperative Study2 suggest that if a greater amount of the colon is examined at sigmoidoscopy, the yield can be improved. In the VA study,2 we performed screening colonoscopy in 3121 asymptomatic persons, aged 50 to 75 years. We reported differences in sigmoidoscopy yield based on extent reached, and found that 188 of 3121 patients (6.0%) had advanced neoplasia or cancer in the rectum and sigmoid colon. When the examination reached the splenic flexure, 228 patients (7.3%) were found to have distal advanced neoplasia. Overall, 329 patients (10.5%) had at least 1 advanced lesion in the colon. These data suggest that if more colon is examined at sigmoidoscopy, more advanced pathology is found. These conclusions are reinforced by the Norwegian Colorectal Cancer Prevention study (NORCCAP).3 All these data demonstrate that sigmoidoscopy is an effective, but imperfect, screening tool. Most, but not all, serious pathology can be detected using sigmoidoscopy.2,4 This may be the best that we can expect from sigmoidoscopy in practice.