I read with great optimism the case-control study by Müller and Sonnenberg.1 They impressively reported a 5-year protective effect of diagnostic largebowel endoscopy on colorectal cancer mortality of approximately 60%. To ascribe protection to endoscopy alone, cases were noted if there was a possibility of nonsteroidal anti-inflammatory drug (NSAID) use, since NSAID consumption appears to reduce the risk of fatal colorectal cancer. For the purpose of the study, this was a necessary precaution. It is possible, however, that the combination of large-bowel endoscopy and NSAIDs could synergistically reduce the risk of fatal colorectal cancer.
Many patients receiving large-bowel endoscopy will have increased risks of colorectal cancer. The study by Müller and Sonnenberg suggests that the combination of endoscopy and polypectomy can arrest the polypcancer sequence. There is good evidence that treatment with NSAIDs can also arrest this sequence.2,3 Perhaps the combination of endoscopy and NSAIDs could form the