Send letter to journal:
Re: Colorectal Investigations

Dear Editor

There are certain inconsistencies in the results. Twenty four procedures were abandoned due to poor bowel preparation but all 316 procedures have been presented in the results. Table 1 seems to be completely erratic as it lists Transverse Colon, Ascending Colon and Caecum as sites of advancement of the Sigmoidoscope. Moreover the number of procedures upto the Splenic flexure in the table do not add upto the number quoted in the results. It would be interesting to know the age distribution of the audit population and compare the incidence of pathology discovered among different age groups. Resource implications are the primary constraint to implementation of widespread Colonoscopy services. This makes Flexible Sigmoidoscopy even more relevant as a primary screening tool in a specialist setting and a yield of nearly 57% achieved in this audit illustrates this point. With the current pressure on Colonoscopy services, a judicious use of Flexible Sigmoidoscopy and Barium enema if appropriate, in a Specialist setting will certainly help in identifying patients that need urgent Colonoscopic evaluation. Faecal Calprotectin is as yet poorly specific for Colorectal cancer and needs further investigation as a biomarker.[1-3] It seems rather optimistic to surmise that it might limit unnecessary Colonoscopies.

Competing interests
None declared

References

1.Screening of first degree relatives of patients operated for colorectal cancer: evaluation of fecal calprotectin vs. hemoccult II. AU - Kristinsson J; Nygaard K; Aadland E; Barstad S; Sauar J; Hofstad B; Stray N; Stallemo A; Haug B; Ugstad M; Ton H; Fuglerud P SO - Digestion 2001;64(2):104-10.

2.Fecal excretion of calprotectin in colorectal cancer: relationship to tumor characteristics. AU - Kristinsson J; Armbruster CH; Ugstad M; Kriwanek S; Nygaard K; Ton H; Fuglerud P SO - Scand J Gastroenterol 2001 Feb;36(2):202-7.

3.Prospective evaluation of fecal calprotectin as a screening biomarker for colorectal neoplasia. AU - Limburg PJ; Devens ME; Harrington JJ; Diehl NN; Mahoney DW; Ahlquist DA SO - Am J Gastroenterol 2003 Oct;98(10):2299-305