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September 18, 1981

Who Should Do Gastrointestinal Endoscopy?

JAMA. 1981;246(12):1301. doi:10.1001/jama.1981.03320120013010

To the Editor.—  We take issue with the COMMENTARY "Who Should Be Doing Gastrointestinal Endoscopy?" by Melvin Schapiro, MD (1981; 245:577). Dr Schapiro's criteria will clearly limit all endoscopy to gastroenterologists and general surgeons.Colon cancer is increasing in the elderly, and sigmoidoscopy is essential in the presence of even minor symptoms. The flexible fiberoptic sigmoidoscopy has increased the diagnostic value of this procedure, making it possible to examine areas inaccessible to the rigid instrument.1 Failure to perform sigmoidoscopy in the presence of minor symptoms has been called the greatest repetitive error in day-to-day practice.2 The rigid sigmoidoscopy generally allows visualization of only the most distal 15 to 18 cm of the colon.3 Recent studies by Snyder et al4 have clearly documented a change in the distribution of colon carcinoma, with a shift from the rectum to the colon, confirming the earlier work in this area