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To the Editor: Dr Schoen and colleagues¹ acknowledged that some of the "new" lesions discovered at 3 years were found because of increased depth of insertion or better bowel preparation at the second examination. Data from the Veterans Affairs (VA) Cooperative Study² suggest that if a greater amount of the colon is examined at sigmoidoscopy, the yield can be improved. In the VA study,² we performed screening colonoscopy in 3121 asymptomatic persons, aged 50 to 75 years. We reported differences in sigmoidoscopy yield based on extent reached, and found that 188 of 3121 patients (6.0%) had advanced neoplasia or cancer in the rectum and sigmoid colon. When the examination reached the splenic flexure, 228 patients (7.3%) were found to have distal advanced neoplasia. Overall, 329 patients (10.5%) had at least 1 advanced lesion in the colon. These data suggest that if more colon is examined at sigmoidoscopy, more advanced pathology . . . [Full Text of this Article]

Amnon Sonnenberg, MD, Msc
Portland Veterans Affairs Medical Center
Portland, Ore

David Lieberman, MD
Division of Gastroenterology
Oregon Health & Science University
Portland

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