Jerry Drexler, MD
To the Editor: Achkar and Carey (1) showed that a small polyp in the rectosigmoid, whether hyperplastic or neoplastic, is 1.6 to 2.4 times more likely to indicate the proximal presence of an adenomatous rather than a hyperplastic polyp. They therefore suggest that a full colonoscopy be done in cases where a polyp of any size or histologic type is found at proctosigmoidoscopy.
Unfortunately, such a recommendation would be disasterously expensive and poorly productive if followed to the letter. Rigid proctosigmoidoscopy in asymptomatic patients over age 45 yields diminutive polyps (defined as a mucosal excrescence) 5mm or less in size
Drexler J. Colonic Polyps in Asymptomatic Patients. Ann Intern Med. ;110:747–748. doi: 10.7326/0003-4819-110-9-747
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Published: Ann Intern Med. 1989;110(9):747-748.
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