Affiliations of authors: R. E. Schoen, University of Pittsburgh, Pittsburgh, PA; T. R. Levin, Kaiser Permanente Division of Research, Oakland, CA.
Correspondence to: Robert E. Schoen, M.D., M.P.H., Division of Gastroenterology and Hepatology, Mezzanine Level, C Wing, PUH, 200 Lothrop St., Pittsburgh, PA 152132582 (e-mail: rschoen{at}pitt.edu).
Gatto et al. (1) report on perforation rates after sigmoidoscopy and colonoscopy to better inform clinicians making screening decisions. However, the perforation rates for sigmoidoscopy far exceed those reported in the screening setting, including 1/50 000 in the Kaiser Permanente Colorectal Cancer Prevention (CoCaP) sigmoidoscopy screening program (2); 1/40 332 in the U.K. screening trial (3); and 1/25 000 in a series from the Mayo Clinic, Scottsdale, AZ (4). The elevated sigmoidoscopy perforation rate reported by Gatto et al. is due to inclusion of failed colonoscopy and special, high-risk sigmoidoscopy. Their broad inclusion criteria are demonstrated by the codes used for sigmoidoscopy, which include sigmoidoscopy with polypectomy, control of bleeding, decompression of volvulus, and removal of a foreign body. The inclusion of high-risk procedures and failed colonoscopy explains their observed 30- to 50-fold increase in sigmoidoscopy perforations compared with the perforation rate in screening populations. As such, their results do not inform clinicians about sigmoidoscopy screening decisions. Their anomalous results demonstrate the pitfall of using procedure codes in an administrative database without verifying their applicability to the underlying premise with chart reviews.
REFERENCES
1 Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI. Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 2003;95:2306.
2 Levin TR, Conell C, Shapiro JA, Chazan SG, Nadel MR, Selby JV. Complications of screening flexible sigmoidoscopy. Gastroenterology 2002;123:178692.[CrossRef][ISI][Medline]
3 Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 2002;359:1291300.[CrossRef][ISI][Medline]
4 Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 2000;95:341822.[CrossRef][ISI][Medline]
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