1/2. Colorectal screening after polypectomy: a national survey study of primary care physicians.BACKGROUND: Recommendations by primary care physicians for colorectal screening after polypectomy will influence rates of colonoscopy in open-access systems that do not require consultation by a gastroenterologist before colonoscopy. OBJECTIVE: To determine the surveillance recommendations of primary care physicians after polypectomy and compare them with recommendations from the U.S. Multisociety Task Force on Colorectal Cancer. DESIGN: Cross-sectional study of physicians. SETTING: united states. PARTICIPANTS: A random sample of 500 physicians from the American College of physicians and 500 physicians from the American Academy of family physicians, obtained by using a mail survey. MEASUREMENTS: physicians were asked when they would recommend repeated colonoscopy for a hypothetical 55-year-old man with no family history of colorectal cancer after the following 6 results on colonoscopy: hyperplastic polyp, one 6-mm tubular adenoma, two 6-mm tubular adenomas, one 12-mm tubulovillous adenoma, one 12-mm tubular adenoma with focal high-grade dysplasia, and no polyp but a previous tubular adenoma. RESULTS: The overall response rate was 57% (568 physicians). Of the respondents, 48% were internists and 52% were family practitioners. Sixty-one percent of respondents would survey a hyperplastic polyp in 5 years or less, 71% would survey a single tubular adenoma in 3 years or less, and 80% would survey 2 tubular adenomas in 3 years or less. LIMITATIONS: The results are based on physicians' self-reported practices from clinical vignettes and may not match actual practice. CONCLUSION: Primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. Retroflexion of the sigmoidoscope for the detection of rectal cancer.Flexible sigmoidoscopy is a procedure that is commonly used by primary care physicians for the evaluation of rectal disorders and for colorectal screening. Retroflexion of the endoscope improves views of the anorectum and rectal vault, which increases the diagnostic yield of sigmoidoscopy. We report three cases of rectal lesions that were not detected when flexible sigmoidoscopy was performed without retroflexion. The lesions were all malignant or premalignant. The illustrative cases demonstrate the value of retroflexion in flexible sigmoidoscopy for the detection of rectal lesions.- - - - - - - - - - ranking = 0.083333333333333keywords = physician (Clic here for more details about this article) |