During 1999 - 2000, a number of important issues related to endoscopy and colorectal
polyps and cancer were investigated. Several papers consider whether flat adenomas
with high malignant potential are as common in the West as in Japan. Clinical series
indicate that signs of rectal bleeding are more predictive of colorectal cancer than
gastrointestinal symptoms. Colonoscopy is more accurate than double-contrast barium
enema for detecting polyps, and virtual colonoscopy is a promising new diagnostic
and screening technique.
Primary prevention dietary studies using adenoma recurrence as an end point yield
negative results. Surveillance colonoscopy protects individuals in families with hereditary
nonpolyposis colorectal cancer, but gastroenterologists continue to perform cancer
surveillance in patients with ulcerative colitis in an inconsistent manner. Screening
for colorectal neoplasia with fecal occult blood tests and flexible sigmoidoscopy
is being better defined and promoted, although many now advocate direct colonoscopy
screening based on increasing indirect evidence of efficacy.
Better methods of treating large sessile neoplasms are being developed and evaluated,
and follow-up surveillance for adenoma patients increasingly is being tailored to
individual patient risk.
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J. H. Bond,M.D.
Gastroenterology Section (111D)
VA Medical Center
One Veterans' Drive
Minneapolis, MN 55 417
USA
Fax: Fax:1-612-725-2248
eMail: E-mail:John.Bond@med.va.gov
