Detecting colorectal neoplasms. Assessment based on hypothetical cases

Because of the controversy surrounding the detection of colorectal neoplasia, I used 10 hypothetical, typical patients to assess the testing attitudes of 33 experienced colonoscopists. There was great disagreement on the type and frequency of the advised diagnostic investigation in some cases. The magnitude of interphysician variation in testing attitudes has major implications concerning cost and risk. This is particularly applicable to the interval between follow-up colonoscopies after polypectomy and cancer surgery, and the evaluation of patients with a positive fecal occult blood test. I reviewed the recent literature most pertinent to the patients. Although I could not derive firm guidelines for most of the cases from my review, consideration of the case management decisions, in light of available information, suggests that some gastroenterologists are testing many patients more than necessary, especially with colonoscopy.