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Editor,—We read with interest a recent paper by Jenkins et al(Gut1999;44:585–587). However, we are concerned with their assertion that acromegaly is a high risk condition for colorectal neoplasia, and their recommended advice on colonoscopic screening and surveillance. Jenkins and colleagues had found that 33 (26%) of 129 patients (updated to 155), treated for acromegaly at St Bartholomew's Hospital, had at least one adenoma and six (5%) had adenocarcinomas.1
We feel that the choice of controls in this study was inappropriate because although there is no ideal control population, the authors used comparative data on the incidence of adenomatous polyps from only two cohorts: a published study of left sided adenomas,1a and colonoscopic records of all patients without acromegaly that had been examined by one of the authors. Matched for age (and side), the relative risk of adenomas was higher in patients with acromegaly when compared with data from the first study, but not when compared with data from the second.
In an attempt to estimate more appropriately the prevalence of adenomas in the normal population, we have carried out a comprehensive review of the literature on adenoma prevalence per decade …