Guidelines for completion colonoscopy after polyps are found at flexible sigmoidoscopy for investigation of haemorrhoidal-type rectal bleeding.

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 …