To the Editor I read with concern Dr Fleshman’s commentary in a recent issue of JAMA Surgery.1 There is little reason for colorectal surgeons to fear high-resolution anoscopy (HRA). On the contrary, there are good reasons to embrace this helpful tool.
As a nurse practitioner at Kaiser Permanente in Oakland, California, I work closely with our 3 colorectal surgeons and see 90% or more of the new referral patients for screening with HRA and for anal warts. We have found that HRA obviates the need for most examinations under anesthesia in the operating room for patients with condyloma. Outcomes with HRA-guided fulguration of condyloma compare favorably, and the patient is spared the risks of general anesthesia. We also use HRA to follow-up with patients with a history of anal cancer who were treated either with excision or chemoradiation. Our surgeons are discussing the potential for HRA to be used in the operating room to better guide the excisional biopsy of microinvasive anal cancer.
Barnell G. High-Resolution Anoscopy: A Valuable Skill for Colorectal Surgeons and Nurse Practitioners. JAMA Surg. 2015;150(12):1202–1203. doi:10.1001/jamasurg.2015.2782
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