[Endoscopy and polypectomy for the early detection of carcinoma of the rectum and the colon (methods, significance, and limitations) (author's transl)].

The possibilities for the early detection and prophylaxis of colorectal carcinoma have been considerably increased by the endoscopic examination of the rectum and the colon via rectoscopy, sigmoidoscopy, and coloscopy combined with a coloscopic polypectomy. The routine use of these examinations was, however, impossible for reasons of personnel, patient psychology and cost. The risk groups need to be selected. To do this, the occult blood test (included since January 1, 1977 in the routine cancer detection examination) is used to demonstrate the presence of occult blood in fecal matter. The endoscopic examination of the colon could be included in the checkups for members of those groups selected. The 60% to 70% accuracy in detecting colorectal carcinoma with rectoscopy is only theoretical. The rate of early detection can be increased only if the rectoscopic technique is expanded by incorporating flexible instruments which are now being developed. High coloscopy should be attempted only after a double-contrast enema has been administered. A biopsy should be made of endoscopically diagnosed polypoid lesion; polyps should be excised in toto. Only then is it possible to make any statements regarding the histomorphology of the total structure. For a focal carcinoma, endoscopic polypectomy is not only a diagnostic procedure but also a curative-therapeutic procedure and, at the same time, an effective prophylaxis against carcinoma.