Colonoscopy: What Does It Take to Get It “Right”?
Authors: David S. Weinberg
Journal: Annals of Internal Medicine (2011)

Editorials4 January 2011Colonoscopy: What Does It Take to Get It "Right"?David S. Weinberg, MD, MScDavid S. Weinberg, MD, MScFrom Fox Chase Cancer Center, Philadelphia, PA 19111.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-1-201101040-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In theory, colonoscopy should prevent most cases of colorectal cancer (CRC), nearly all of which arise from existing polyps. The progression from polyp to cancer requires an estimated 5 to 10 years in average-risk populations (1, 2). Finding and removing polyps during this window interrupts malignant transformation and reduces the incidence of and mortality from CRC. In 1993, the National Polyp Study supported this contention, demonstrating that patients who had polypectomies developed colorectal cancer up to 90% less than untreated historical controls (3). Subsequently, colonoscopy has become a standard, and for some the preferred, method of CRC screening (4). Other ...References1. Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36:2251-70. [PMID: 1203876] CrossrefMedlineGoogle Scholar2. Stryker SJ, Wolff BG, Culp CE, Libbe SD, Ilstrup DM, MacCarty RL. Natural history of untreated colonic polyps. Gastroenterology. 1987;93:1009-13. [PMID: 3653628] CrossrefMedlineGoogle Scholar3. Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977-81. [PMID: 8247072] CrossrefMedlineGoogle Scholar4. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-50. [PMID: 19240699] CrossrefMedlineGoogle Scholar5. Seeff LC, Richards TB, Shapiro JA, Nadel MR, Manninen DL, Given LS, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology. 2004;127:1670-7. [PMID: 15578503] CrossrefMedlineGoogle Scholar6. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1-8. [PMID: 19075198] LinkGoogle Scholar7. Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst. 2010;102:89-95. [PMID: 20042716] CrossrefMedlineGoogle Scholar8. Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139:1128-37. 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[PMID: 20877348] MedlineGoogle Scholar13. Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology. 2007;132:96-102. [PMID: 17241863] CrossrefMedlineGoogle Scholar14. Soetikno RM, Kaltenbach T, Rouse RV, Park W, Maheshwari A, Sato T, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008;299:1027-35. [PMID: 18319413] CrossrefMedlineGoogle Scholar15. Azzoni C, Bottarelli L, Campanini N, DiCola G, Bader G, Mazzeo A, et al. Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: arguments for different mechanisms in the tumorigenesis. Int J Colorectal Dis. 2007;22:115-26. [PMID: 17021745] CrossrefMedlineGoogle Scholar16. Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795-803. [PMID: 20463339] CrossrefMedlineGoogle Scholar17. Lieberman D, Nadel M, Smith RA, Atkin W, Duggirala SB, Fletcher R, et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Gastrointest Endosc. 2007;65:757-66. [PMID: 17466195] CrossrefMedlineGoogle Scholar18. Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology. 2010;:. [PMID: 20854818] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: David S. Weinberg, MD, MScAffiliations: From Fox Chase Cancer Center, Philadelphia, PA 19111.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2688.Corresponding Author: David S. Weinberg, MD, MSc, Department of Medicine, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoProtection From Colorectal Cancer After Colonoscopy Hermann Brenner , Jenny Chang-Claude , Christoph M. Seiler , Alexander Rickert , and Michael Hoffmeister Metrics Cited byEfficacy of repeat forward‐view examination of the right‐sided colon during colonoscopy: A prospective randomized controlled trialAcarbose improved survival for Apc +/Min miceColonoscopy Quality AssessmentImpact of Retroflexion Vs. Second Forward View Examination of the Right Colon on Adenoma Detection: A Comparison StudyPseudobezoars: Technology Progress and New Prospects as a Medical PlatformPhysical Activity and Risks of Proximal and Distal Colon Cancers: A Systematic Review and Meta-analysisOpportunities for Cost Reduction of Medical Care: Part 3A morphologic analysis of sessile serrated polyps observed during routine colonoscopy (with video)Self-Stabilizing Colonic Capsule Endoscopy: Pilot Study of Acute Canine ModelsMissed polyps, missed opportunities 4 January 2011Volume 154, Issue 1 Page: 68-69 Keywords Adenomas Colon Colonoscopy Colorectal cancer Endoscopy Lesions Population statistics ePublished: 4 January 2011 Issue Published: 4 January 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...