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Volume 342:1766-1772 June 15, 2000 Number 24 Next

	Full Text PDF Editorial by Fletcher, R. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background After patients have undergone colonoscopic polypectomy, it is uncertain whether colonoscopic examination or a barium enema is the better method of surveillance.

Methods As part of the National Polyp Study, we offered colonoscopic examination and double-contrast barium enema for surveillance to patients with newly diagnosed adenomatous polyps. Although barium enema was performed first, the endoscopist did not know the results.

Results A total of 973 patients underwent one or more colonoscopic examinations for surveillance. In the case of 580 of these patients, we performed 862 paired colonoscopic examinations and barium-enema examinations that met the requirements of the protocol. The findings on barium enema were positive in 222 (26 percent) of the paired examinations, including 94 of the 242 colonoscopic examinations in which one or more adenomas were detected (rate of detection of adenomas, 39 percent; 95 percent confidence interval, 33 to 45 percent). The proportion of examinations in which adenomatous polyps were detected by barium enema was significantly related to the size of the adenomas (P=0.009); the rate was 32 percent for colonoscopic examinations in which the largest adenomas detected were 0.5 cm or less, 53 percent for those in which the largest adenomas detected were 0.6 to 1.0 cm, and 48 percent for those in which the largest adenomas detected exceeded 1.0 cm. Among the 139 paired examinations with positive results on barium enema and negative results on colonoscopic examination in the same location, 19 additional polyps, 12 of which were adenomas, were detected on colonoscopic reexamination.

Conclusions In patients who have undergone colonoscopic polypectomy, colonoscopic examination is a more effective method of surveillance than double-contrast barium enema.

Source Information

From the Departments of Medicine (S.J.W.), Epidemiology and Biostatistics (A.G.Z.), and Pathology (S.S.S.), Memorial Sloan-Kettering Cancer Center, New York; the Department of Radiology, Medical College of Wisconsin, and Froedtert Memorial Lutheran Hospital, Milwaukee (E.T.S.); the Departments of Medicine (J.H.B.) and Radiology (H.A.), Minneapolis Veterans Affairs Medical Center, Minneapolis; the Department of Medicine, Mount Sinai Hospital, New York (J.D.W.); the Department of Radiology, Massachusetts General Hospital, Boston (D.H.); the Department of Radiology, Cedars–Sinai Medical Center, Los Angeles (J.A.H.); the Department of Medicine, Valley Presbyterian Hospital, Van Nuys, Calif. (M.S.); and the Mallory Institute of Pathology, Boston Medical Center, Boston (M.J.O., L.S.G.). Other authors were Walter J. Hogan, M.D. (Department of Medicine, Medical College of Wisconsin, and Froedtert Memorial Lutheran Hospital, Milwaukee); Mansho Khilnani, M.D. (Department of Radiology, Mount Sinai Hospital, New York; deceased); Frederick W. Ackroyd, M.D. (Department of Surgery, Massachusetts General Hospital, Boston); Joel F. Panish, M.D. (Department of Medicine, Cedars–Sinai Medical Center, Los Angeles); Larry Kussin, M.D. (Department of Radiology, Valley Presbyterian Hospital, Van Nuys, Calif.); and Martin Edelman, M.D. (Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York).

Address reprint requests to Dr. Winawer at the Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, or at winawers{at}mskcc.org.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 2000; 343:1728-1730, Dec 7, 2000. Correspondence

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