Sir.—I read with interest the article by Berezin et al1 that appeared in the March 1989 issue of AJDC. It was commendable that the authors obtained informed consent from the legal guardian(s) of the infants before undertaking colonoscopy. It was also commendable that the protocol for the study was approved by the institutional review board for the protection of human subjects at the center involved. Another strong point of the study was the precise definition of a case of diarrhea.
The authors conclude that the presence of hematochezia is an indication for colonoscopy with videotape in infants and that the procedure is the most effective means of definitive diagnosis.
The accepted method of withdrawal and challenge is definitely more cost-effective and potentially less risky than colonoscopy with videotape in infants. The issues of cost-effectiveness and morbidity were not considered by the authors before recommending the adoption of colonoscopy