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Colonoscopy: What Does It Take to Get It “Right”?

David S. Weinberg, MD, MSc
[+] Article, Author, and Disclosure Information

From Fox Chase Cancer Center, Philadelphia, PA 19111.

Potential Conflicts of Interest: 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.

Ann Intern Med. 2011;154(1):68-69. doi:10.7326/0003-4819-154-1-201101040-00013
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Brenner and colleagues' study in this issue offers reassurance that colonoscopy can provide substantial protection against right- and left-sided CRC. The editorialist discusses why these findings differ from recent studies showing lower-than-expected rates of protection against CRC and comments on the role of quality of endoscopy in detection and prevention of cancer.



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Getting colonoscopies "Right"
Posted on January 11, 2011
Stephen M. Picca
Conflict of Interest: None Declared


Weinberg's recent editorial (1) discussing problems with detecting right sided colorectal cancer by screening colonoscopy fails to mention a very important variable, namely the health care provider who is sedating the patient for the procedure. Colonoscopy is an inherently unpleasant experience and can only be tolerated if the patient receives significant sedation. Just as a poor bowel prep will lead to an incomplete exam, a poorly sedated patient will be unable to tolerate a complete examination. In particular, a poorly sedated patient may tolerate a partial colonoscopy involving the left colon but not be able to tolerate a full examination of the distal colon which could easily explain why, in some studies, screening colonoscopies are not as effective in screening for tumors of the distal colon. In the past the doctor performing the colonoscopy would also be responsible for sedating the patient. Now, many colonoscopies in the United States are done with a dedicated anesthesiologist providing sedation but this is far from a universal standard. Proper interpretation of studies concerning the effectiveness of colonoscopies for right sided lesions must account for this variable.

Stephen M. Picca MD 57 Kenwood Drive Massapequa NY 11758 SMPicca@aol.com 516-732-6514


1)Weinberg D, Colonoscopy: What does it take to get it "right"? Ann Intern Med. 2011; 154:68-69.

Conflict of Interest:

None declared

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