When colonoscopy became first available, technique was the main issue and everyone was preoccupied with reaching the cecum. With technical advances, more and more polyps became accessible and they were all removed. It was obvious that some lesions were worth removing and some were not and that, in general, the smaller the lesion the less advanced it was. I do not recall any heated discussions about polyps found on a barium enema; the issue of polyp size came up in the context of lesions removed at sigmoidoscopy and debates were staged regarding size or histology as determinants to obtaining a colonoscopy. In time, as the use of screening sigmoidoscopy plummeted, preoccupation with size shifted to the proper interval for follow-up colonoscopy after removal of diminutive adenomas from the colon. Consequently, most present recommendations include longer intervals between colonoscopies than we were used to in the past.
In the January 2004 issue of the journal, we published a debate on the GI match (1,2). Our intent was to call attention to the inequities and inconsistencies of the present selection system for training positions in gastroenterology and to create an opportunity for an open dialogue on the issue.
