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High magnification chromoscopic colonoscopy as a screening tool in acromegaly
  1. D P Hurlstone,
  2. S S Cross,
  3. A J Lobo,
  4. D S Sanders
  1. Halamshire Hospital, Sheffield, UK
  1. Correspondence to:
    Dr D P Hurlstone
    17 Alexandra Gardens, Lyndhurst Rd, Nether Edge, Sheffield S11 9DQ, UK; p.hurlstone{at}shef.ac.uk

https://doi.org/10.1136/gut.52.12.1797

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    We read with great interest the paper by Jenkins et al (Gut 2002;51:v13–14) regarding screening guidelines for colorectal cancer (CRC) and polyps in patients with acromegaly and the subsequent discussion by Renehan addressing screening inconsistencies compared with other high risk groups.1,2

    The optimal colorectal screening modality and frequency in this group however requires clarification. Colonoscopy in this patient group is technically demanding and often complicated by inadequate bowel preparation.3 However, despite current controversies regarding true CRC risk categorisation in acromegaly, previous data from the largest published series showed a trend for adenoma and carcinoma formation in the right hemi colon.4 This is an important observation for many reasons.

    Flat adenomas and carcinomas can be difficult to detect by conventional colonoscopy alone, often presenting as subtle mucosal erythema, mucosal pallor, fold convergence, interruption of innominate grooves, air induced deformation, or loss of vascular net pattern.5 The neoplastic risk for this morphologically distinct group has additionally been shown by many authors to …

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