Z Gastroenterol 2008; 46: 43-44
DOI: 10.1055/s-2007-963484

© Georg Thieme Verlag KG Stuttgart · New York

Quality Assurance for Screening Colonoscopies

B. Birkner1
  • 1Gastroenterologie am Max-Weber-Platz, München
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26. März 2008 (online)


Three methods of preventing colorectal cancer are widely accepted: the fecal occult blood test (FOBT), the flexible sigmoidoscopy and the screening colonoscopy. Three large randomized trials with an annual application of the FOBT have revealed a significant decrease of colorectal cancer mortality and incidence in the screened population. Good evidence indicates that flexible sigmoidoscopy is an effective screening method, too. As far as the effectiveness of colonoscopy as a screening tool is concerned, however, only indirect evidence has so far been derived from the US national polyp study [1].

Nevertheless, the screening colonoscopy is recommended as the gold standard for colorectal cancer prevention. Its effectiveness, however, has been disputed since an article by Robert Barclay and colleagues in the New England Journal of Medicine in December 2006 found a great variation in the detection rate of adenomas which correlates with the withdrawal time of the colonoscope [2]. This questions the effectiveness of the screening colonoscopy for colorectal cancer prevention in general. Another study on missed carcinomas recently published in Gastroenterology showed a 2 - 6 % miss rate after colonoscopy in usual practice [3].


Berndt Birkner

Gastroenterologe, FEBG, FASGE, AGAF, Gastroenterologie am Max-Weber-Platz

Einsteinstr. 1

81675 München

Telefon: ++ 49/89/47 90 30

eMail: birkner@die-gastroenterologie.de