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Guidelines for completion colonoscopy after polyps are found at flexible sigmoidoscopy for investigation of haemorrhoidal-type rectal bleeding
  1. Philip Bagshaw1,2,
  2. Brian Cox3,
  3. Francis Antony Frizelle4,
  4. James M Church5
  1. 1 Canterbury Charity Hospital Trust, Christchurch, New Zealand
  2. 2 Surgery, University of Otago Christchurch, Christchurch, New Zealand
  3. 3 Department of Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
  4. 4 Surgery, University of Otago, Christchurch, Canterbury, New Zealand
  5. 5 Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Philip Bagshaw, Canterbury Charity Hospital Trust, Christchurch 8543, New Zealand; p.s.bagshaw{at}

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We read with interest the paper by Rutter et al on surveillance guidelines after colonoscopic polypectomy and postcolorectal cancer resection.1 However, like all similar recognised guidelines, they do not address the issue of following up polyps found on a flexible sigmoidoscopy (FS) done to investigate rectal bleeding. With colonoscopy services in short supply in many countries, FS is often used at rectal bleeding clinics in cases where other known personal risk factors for colorectal neoplasia are absent.

At FS, the finding of a normal rectum and sigmoid combined with a likely anal cause of the bleeding excludes significant left-sided neoplasia. However, the appropriate follow-up of an adenoma found in the rectum or sigmoid colon has been a topic of much study and debate, centred on the likelihood of detecting significant proximal colonic neoplasia.

One of the most …

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  • Contributors PB made the original observation that no published guideline addresses this issue. He contributed to the review of the literature and the writing of the letter. The other three authors contributed to the research of the literature and the writing of the letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PB is the unpaid Chair, Canterbury Charity Hospital Trust.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.