Screening Colonoscopy vs Flexible Sigmoidoscopy

To the Editor: The Commentary by Drs Neugut and Lebwohl¹ illustrated an increasing ambivalence toward screening colonoscopy (vs flexible sigmoidoscopy or fecal occult blood testing [FOBT]) due to reported modest protection rates in recent population-based studies of colonoscopy. These community-based studies examined protection rates following colonoscopies performed by practicing gastroenterologists (including, in some studies, a small minority performed by primary care physicians). A little-emphasized feature of these studies was the lack of performance standardization on any dimension, including procedure protocols (bowel prep, polyp search and removal, sedation, infrastructure) and completeness criteria (cecal intubation, procedure duration) that are contributors to adenoma miss rates,² or lesion yield rates. The scientific rigor in these studies was limited to the follow-up protocol, not in ensuring standardized colonoscopy performance.