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September 16, 1974


JAMA. 1974;229(12):1577-1578. doi:10.1001/jama.1974.03230500013005

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To the Editor.—  Marks's (228:1411, 1974) very sensible article has stressed that the main indication for coloscopy is the failure of conventional sigmoidoscopy and roentgenography of the colon to establish a diagnosis. Coloscopy is unnecessary, "too costly," and a procedure not to be taken lightly. This point needs to be stressed because as a result of recent publicity, many clinicians have come to believe that coloscopy has supplanted roentgenography.The biopsy forceps used with coloscopy is too small in size and therefore incapable of removing tissue representative of the entire lesion. No pathologist can resolve the big issue (infiltration) on the basis of little superficial tissue; only total biopsy is the answer to this problem. Biopsy studies may show benignity near to an infiltrating cancer. Little, if any, mention has ever been made that coloscopists have missed known or existing cancers.Thus far, I have seen only one paper on