Guidelines for clinical practice

Abstract

A major task of the physician, and, arguably, the gastroenterologist's most important public obligation, is the diagnosis of colorectal neoplasia. Colorectal cancer is responsible for approximately 10% of cancer deaths in the United States, and cancer, itself, is the second most common cause of death in this nation, after heart diseases (1). Most colorectal cancers arise from benign, neoplastic polyps: precursor lesions found in the colons of 30% of people over age 60 (2, 3). It is the gastroenterologist who often diagnoses colorectal polyps and formulates a plan for treatment and follow-up of patients with these lesions in the hope of preventing the future development of colorectal cancer. An immense amount of clinical research has been done during the past 50 years to answer questions about the appropriate management of colorectal polyps and to provide guidance to the physicians responsible for their identification and removal. Issues addressed have included the efficient, early diagnosis of polyps, the characterization of polyps that ought to be removed to minimize morbidity and mortality from colorectal cancer, the techniques for removal of polyps at different stages in their development, and the surveillance of patients to identify recurrent or new lesions. In conjunction with the study of these issues, expensive medical technology has been devised to facilitate discovery and removal of colorectal polyps. The decision to apply this technology (and often its actual use), guided by an understanding of the best way to manage the problem of colorectal polyps, is left, in many instances, to the gastroenterologist. Thus, as frequently occurs in medicine, physi-