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PubMed1991

Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy.

Asymptomatic individuals undergoing screening flexible sigmoidoscopy were prospectively studied. Polyps were found in 185 subjects. The endoscopist recorded an opinion on the polyps' histology based on endoscopic appearance. No polyps were removed at sigmoidoscopy. All subjects with rectosigmoid polyps then underwent colonoscopy and polypectomy. Of them, 99 subjects (54%) had at least one rectosigmoid adenoma, 69 (37%) had only hyperplastic polyps, and 17 (9%) had other findings. The endoscopists' opinion of the histopathology of polyps at sigmoidoscopy was correct for 61% of the lesions. Of subjects with adenomatous rectosigmoid polyps, 29% had additional adenomas at more proximal sites. Proximal adenomas were found in 28% of patients with hyperplastic rectosigmoid polyps. Patients with rectosigmoid hyperplastic polyps had the same risk for additional proximal adenomas as patients with rectosigmoid adenomatous polyps.

Adult↗
PubMed2004

Colorectal cancer screening with flexible sigmoidoscopy-participants' experiences and technical feasibility.

AIM: To evaluate tolerability and technical feasibility of colorectal cancer screening with flexible sigmoidoscopy. METHODS: One thousand men and women aged 59-61 years, randomly selected from the population register of Uppsala, Sweden, were invited by mail. After random allocation, half of them were called up by a nurse (group 1), while the other half were asked to call themselves (group 2) to book a sigmoidoscopy. After the examination, the participants anonymously answered a questionnaire about their subjective experiences. Endoscopists and their assisting nurse filled out structured forms documenting various technical aspects including an estimation of the subjects' discomfort. RESULTS: Four hundred and sixty-nine subjects participated. Mean intubation depth was 59 cm (range 28-60) and mean duration 5.8 min (range 2-23). On average, participants reported low degrees of discomfort and feeling of exposure, but 19 and 27% rated pain and distension, respectively, on the upper half of a visual analogue scale (VAS). Most subjects found the duration acceptable. Patient discomfort, as appraised by the endoscopists, was lower in men than in women, positively linked to duration of the procedure, but inversely associated with intubation distance. However, the overall differences between strata of participants were small. Among self-reported variables, group 1 and 2 differed significantly only with regard to 'other discomfort'. All but six subjects would accept a repeat examination. Failures, resulting in incomplete examinations, occurred in 14 subjects. CONCLUSIONS: Flexible sigmoidoscopy is generally well tolerated and technically feasible in screening for colorectal cancer. A more personalised invitation did not have any important effects on the subjective experience.

Colorectal Neoplasms↗
PubMedDate not supplied

Intraoperative sigmoidoscopy in gynecologic surgery.

Intraoperative sigmoidoscopy is underused by the majority of practicing gynecologists and is not widely taught in obstetrics and gynecology training programs. In this report, a step-by-step approach is provided in order to perform sigmoidoscopy. Indications for use, along with various intraoperative applications, are discussed. Results from our center's experience with its use during laparoscopic treatment of adhesions, endometriosis, and associated disease of the bowel also are provided. Intraoperative sigmoidoscopy is a safe and efficacious procedure that can aid in the evaluation and treatment of pelvic pathology and facilitate identification and management of bowel injuries. It should be considered a valuable adjunct when such cases are encountered by gynecologic and pelvic surgeons.

Endometriosis↗
PubMedDate not supplied

Same-day versus separate-day sigmoidoscopy and double contrast barium enema: a randomized controlled study.

A randomized controlled study was carried out in 400 patients to investigate whether same-day sigmoidoscopy impairs the quality of a double contrast barium enema. There was no difference with regard to spasm, fluid, and air retention as well as barium coat in patients undergoing both procedures during the same day or on different days. The overall quality of the radiographic films received similar ratings in a blind appraisal by an outside radiologist. In contrast, the performance of sigmoidoscopy was facilitated by the more thorough bowel cleansing for same-day procedures. It is concluded that same-day sigmoidoscopy and double contrast barium enema diminishes the cost and patient discomfort for colonic investigation without impairing its quality, provided that CO2 instead of air is used during the endoscopic study.

Barium Sulfate↗
PubMedDate not supplied

Performing screening flexible sigmoidoscopy using colonoscopes: experience in 500 subjects.

There is still controversy regarding the optimal length of flexible sigmoidoscopes. We performed screening distal colon examinations using 168-cm colonoscopes in 500 asymptomatic subjects who were unsedated and had sigmoidoscopy cleansing preparation. The mean depth of penetration was 66 cm and was similar in persons in whom the examination was discontinued because of poor preparation versus those with discomfort. Polyps were detected in 87 patients, but only 5 subjects had polyps detected above 60 cm. We conclude that in a group of unsedated subjects scheduled for flexible sigmoidoscopy after a sigmoidoscopy prep, the use of instruments longer than 60 cm gives very little additional yield.

Colonic Neoplasms↗
PubMedDate not supplied

Sigmoidoscopy training for nurses and resident physicians.

Five gastrointestinal nurses (three licensed practical nurses and two registered nurses) and five resident physicians were enrolled in a sigmoidoscopy training protocol. Patients referred for a screening sigmoidoscopy were randomized to have the procedure performed by a nurse or a resident. Objective criteria for proficiency were depth of endoscope insertion, procedure time, and identification of anatomic landmarks and pathologic lesions; subjective criteria included thoroughness and the need for assistance. Four nurses and all of the residents were deemed proficient at a mean of 20 procedures in both groups. One registered nurse did not achieve proficiency after 35 procedures; this determination was based on subjective criteria. Insertion depth and identification of normal anatomy improved with experience. Trainees missed 1.4% of pathologic lesions, and no complications were observed. Nurses can be trained to perform a screening sigmoidoscopy in a safe and effective manner, with results similar to those for doctors.

Education, Nursing, Continuing↗
PubMed1995

Intravenous antispasmodic and patient-controlled analgesia are of benefit for screening flexible sigmoidoscopy.

The possible benefits of premedication with the antispasmodic hyoscine n-butyl bromide (hyoscine) and analgesia with inhaled nitrous oxide/oxygen mixture (nitrous oxide) were assessed in a double-blinded, placebo-controlled trial. Consecutive patients at normal risk for cancer undergoing screening flexible sigmoidoscopy were randomly allocated to receive either (1) intravenous hyoscine 20 mg plus inhaled oxygen on demand (n = 40), (2) sterile water injection plus inhaled nitrous oxide on demand (n = 48), or (3) sterile water injection plus inhaled oxygen on demand (n = 43). One recently trained primary care physician performed all procedures. Duration of the procedure, endoscopic findings, and depth of insertion were recorded. After the examination, screenees rated their degree of pain during the procedure using a visual analogue scale. Depth of insertion did not differ between the three study groups, but the duration of the procedure was significantly less in the hyoscine group (median, 12.5 minutes) as compared with placebo (median, 18 minutes; p = .0008). Fifty-four percent of screenees chose to use the on-demand gas. Pain scores were significantly lower in those individuals who inhaled nitrous oxide as compared with placebo (p = .045). Premedication with antispasmodic shortens total procedure time for flexible sigmoidoscopy by a moderately experienced endoscopist as compared with placebo. In this study, a significant number of screenees experienced discomfort during flexible sigmoidoscopy, which appeared to be reduced by offering nitrous oxide inhalation.

Administration, Inhalation↗
PubMed1997

Nitrous oxide inhalation as sedation for flexible sigmoidoscopy.

BACKGROUND: Flexible sigmoidoscopy is usually performed without sedation in screening programs for colorectal cancer. Most patients report some degree of discomfort or pain during the procedure. The aim of this study was to evaluate self-administered nitrous oxide as a method to reduce patient discomfort, thereby improving the procedure and conceivably increasing patient compliance and motivation. METHODS: In a double-blind, randomized, placebo-controlled study, 38 patients undergoing sigmoidoscopy self-administered 60% nitrous oxide (n = 18) or oxygen (n = 20) by mask. The endoscopist recorded the depth of insertion of the sigmoidoscope, duration of the procedure, and time to patient recovery. Patients scored the degree of pain and discomfort felt during the examination. RESULTS: There were no significant differences between the groups with regard to patients' age, gender, pain or discomfort, duration of procedure, or depth of insertion. Recovery time was significantly longer in the nitrous oxide group (3.3 +/- 0.6 minutes vs 0.5 +/- 0.5 minutes; p = 0.02), but this finding was of no practical or clinical consequence. CONCLUSIONS: The addition of "on demand" nitrous oxide did not improve sigmoidoscopy performance or diminish pain and discomfort. However, further studies using improved administration techniques and larger study groups are justified in the search for ways to increase compliance with and motivation for colorectal cancer screening.

Administration, Inhalation↗
PubMed2005

A prospective national study on colonoscopy and sigmoidoscopy in 2000 in France.

AIM: The aim of this study was to evaluate the practice of colonoscopy and sigmoidoscopy in France in 2000. METHODS: A prospective study was conducted in November 2000 using questionnaires sent to all gastroenterologists practicing in France (N=2858) who were asked to reply to items concerning colonoscopies and sigmoidoscopies performed on two workdays chosen in advance. The response rate was 32.8%. Data were extrapolated to establish estimates for the entire year. RESULTS: An estimated 894000 colonoscopies and 115320 sigmoidoscopies were performed in 2000. Single-use material was used in 22.1% of the procedures. Indications for endoscopy were mainly hematochezia (21.6%), gastrointestinal symptoms (35%) and surveillance of patients with a history of previous polypectomy (15%). Colorectal cancer screening was the indication for 20% of colonoscopies. Abnormal findings were reported for 54.8% of the endoscopies (polyps for 287218 procedures and cancer for 32799). Failure was noted in 4.9% of colonoscopies. The complication rate was 0.48%. Most polyps were adenomas (64.4%) or hyperplasic polyps (28.1%). The overall estimated number of colonoscopies with polypectomy was 224133. CONCLUSION: In 2000 there was an increased rate of colonoscopy for colorectal cancer screening (20%) but an overall decrease (2.5%) in the total number of colonoscopies compared to 1999. Abnormal findings were disclosed by 54.8% of the procedures. Extrapolation from these data indicates that colonoscopic screening enabled the diagnosis of 32799 colorectal cancers.

Aged↗
PubMed1998

Glutaraldehyde as a possible cause of diarrhoea after sigmoidoscopy.

BACKGROUND: An outbreak of proctitis at the start of a colorectal cancer screening programme utilizing flexible sigmoidoscopy prompted scrutiny of the incidence of this complication and the role of glutaraldehyde in its aetiology. METHODS: Questionnaires completed 1 day and 3 months after sigmoidoscopy were reviewed for 388 patients, and glutaraldehyde levels in the recycled rinse water of the endoscope washing machine were measured. The incidence of symptoms in the subsequent 612 patients after installation of a washer that does not recycle rinse water was examined. RESULTS: Five patients (1.3 per cent) presented to hospital with bloody diarrhoea occurring immediately after a normal flexible sigmoidoscopy. Repeat examination confirmed the presence of proctitis. Symptoms subsided rapidly with either no treatment or steroid enemas. Eight additional patients (2.1 per cent) recorded similar problems but received no treatment and the symptoms settled spontaneously. Glutaraldehyde levels rose progressively in the rinse water after each wash cycle with 2 per cent glutaraldehyde solution. Only one possible case of proctitis (0.2 per cent) was identified from the questionnaires completed by 612 patients after changing to a washer that did not recycle the rinse water. CONCLUSION: These observations should prompt the careful assessment of cleaning techniques. The use of washing machines that do not recycle rinse water may avoid this complication.

Colorectal Neoplasms↗
PubMed2002

Compliance and findings in a Swedish population screened for colorectal cancer with sigmoidoscopy.

AIM: The aim of this study was to evaluate the patterns of compliance and the frequency of adenomas and neoplasms in a Swedish population. METHODS: In 1996, 2000 men and women born in 1935 or 1936 were selected at random from the population registers of Uppsala and Malmö/Lund. All subjects were invited by mail to participate. In a randomised study design, subjects were either called up by a nurse to schedule the appointment for sigmoidoscopy or instructed to call themselves. At sigmoidoscopy subjects with a cancer, an adenoma (neoplastic polyp) or more than three hyperplastic polyps were scheduled for a complete colonoscopy. RESULTS: Thirty-nine percent (770/1988) of all the invited subjects had a sigmoidoscopy. The participation differed between the two centres, 47% at the Uppsala centre and 30% at the Malmö/Lund centre (P<0.01). There was no statistically significant difference between the two different invitation groups. In all, 98 subjects (13%) were planned for colonoscopy. Thirty-one (35%) of the subjects having a colonoscopy were women and 57 (65%) were men. Fifty-five true adenomas were found in 46 subjects. All together, six subjects had proximal adenomas. Five adenocarcinomas were diagnosed, all within the reach of the sigmoidoscope. CONCLUSIONS: The compliance was lower and the adenomas were fewer than expected. To increase compliance it is necessary with rigorously controlled invitation routines.

Adenoma↗
PubMed2000

The use of inhaled nitrous oxide for flexible sigmoidoscopy: a placebo-controlled trial.

BACKGROUND AND STUDY AIMS: Flexible sigmoidoscopy is a widely used diagnostic technique which is increasingly being adopted as part of bowel cancer screening programmes. It is conventionally performed without sedation or analgesia, but significant numbers of patients experience mild to moderate discomfort during the procedure. The aim of this study was to assess the usefulness of self-administered nitrous oxide to reduce discomfort during flexible sigmoidoscopy, which may have an effect of improving compliance. PATIENTS AND METHODS: In a double-blind, randomized, placebo-controlled study, 87 patients were enrolled. Of these, 45 received nitrous oxide/oxygen (50% mix) to inhale during the procedure and 42 received oxygen alone. The patients recorded their opinions on the efficacy of the agent in a questionnaire after the examination. The endoscopist recorded the success of the procedure. RESULTS: The groups were well matched for age and sex. Significant reductions in levels of discomfort and increased levels of agreement to undergo the procedure again were noted for the actively treated group (P < 0.05). No significant differences in side effects or success of the procedure were observed. CONCLUSIONS: The addition of self-administered nitrous oxide offered significant benefits in the area of patient discomfort during flexible sigmoidoscopy. The availability of this agent is useful in clinical practice and may enhance compliance with a screening programme.

Anesthetics, Combined↗
PubMed2002

Use of a disposable sheath system for flexible sigmoidoscopy in decentralized colorectal cancer screening.

BACKGROUND AND STUDY AIMS: To prevent transmission of infectious agents and to reduce instrument reprocessing time, the use of disposable sheath systems instead of conventionally reprocessed endoscopes has been promoted for flexible sigmoidoscopy. This trial primarily investigated the feasibility of a disposable sheath system for flexible sigmoidoscopy in decentralized colorectal cancer screening. PATIENTS AND METHODS: In an ongoing colorectal cancer screening trial, 226 consecutive participants were randomly allocated to have their flexible sigmoidoscopy performed with either a fiberoptic sigmoidoscope covered with a disposable sheath ("EndoSheath group") or a conventional video colonoscope ("standard colonoscope group"). All examinations were performed at a temporary screening center. The patients' experience was documented using a questionnaire. The feasibility of running temporary screening units was evaluated. RESULTS: Examinations beyond the 60-cm level were excluded. Thus, 113 patients (examined with the disposable instrument) and 87 (standard instrument) were eligible for analysis. When the sheathed system was used, all the devices needed could be satisfactorily transported. A screening center could be set up within a few hours. No differences were observed in patient discomfort. Fewer patients with polyps were observed in the EndoSheath group (48 [42%]), compared with 55 (63%) in the standard colonoscope group; P = 0.005). No significant differences were observed for polyps larger than 5 mm (14 [12%] in the EndoSheath group, 13 [15%] in the standard colonoscope group; P = 0.6). CONCLUSIONS: Using the disposable system, decentralized colorectal cancer screening was easily established. However, fewer polyps were found, possibly due to the fiberoptic nature of the instrument. Sheathed video instruments are desirable and may increase the diagnostic yield.

Colorectal Neoplasms↗
PubMed2000

Inhaled patient-administered nitrous oxide/oxygen mixture does not impair driving ability when used as analgesia during screening flexible sigmoidoscopy.

BACKGROUND: Entonox (nitrous oxide/oxygen mixture) has an analgesic effect, but its use is currently contraindicated in patients who plan to drive after its administration. We assessed the effect on driving ability of Entonox used as analgesia in patients undergoing screening flexible sigmoidoscopy. METHODS: Forty men and 40 women scheduled for screening flexible sigmoidoscopy who had not driven to the examination site were recruited together with a matched control subject from the same list. Before the examination complex motor skills were assessed in both groups using an adaptive tracking task, previously demonstrated to be the most sensitive test for detecting impairment of driving ability due to drugs. During the examination Entonox analgesia was available to the study group only, and after the screening examination complex motor function was retested on the same computer. RESULTS: Both groups improved their computer score on repeat testing, by 0.53 (range -1.9 to 4.6) in the study group and by 0.44 (range -0.6 to 2.5) in the control group. CONCLUSIONS: These data strongly support the view that Entonox analgesia does not impair driving ability. In the context of screening flexible sigmoidoscopy its use may lead to an increase in compliance.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Flexible sigmoidoscopy training for nurses.

Colorectal cancer will account for approximately 55,300 deaths in 1995. In addition, 138,200 new cases of colorectal cancer will occur. The American Cancer Society encourages accessible, affordable sigmoidoscopy by primary care physicians or highly trained paramedical personnel for all persons, aged 50 years and older, every 3 to 5 years or as advised by their physician. As a result of these recommendations, there has been an increase in demand for the screening sigmoidoscopy. The increase in requests for this examination has overwhelmed existing resources, including physician time, space, and staff in the ambulatory care setting. The Kaiser Foundation Health Plan of Georgia, Inc., has developed an innovative approach to performing screening sigmoidoscopies by training two registered nurse endoscopists to conduct these examinations. The goal of the nurse endoscopy program is to provide quality colorectal cancer screening within an established appointment standard while promoting comfort and safety.

Clinical Competence↗
PubMed1999

The small polyp at flexible sigmoidoscopy: an historical perspective on why practices still vary.

Current practices vary regarding the approach to small polyps discovered during screening flexible sigmoidoscopy. The most common practice is to perform colonoscopy whenever any adenoma is detected, a strategy that generally uses biopsy of polyps < or = 5 mm in size. However, data suggest that tubular adenomas < 1 cm in size in the distal colon have less predictive value than other distal adenomas for advanced adenomas in the proximal colon. Thus, some centers reserve colonoscopy for distal adenomas with tubulovillous or villous histology, > 1 cm in size, or with high-grade dysplasia. At the other end of the spectrum, another school of thought advocates screening colonoscopy, recognizing that most patients with advanced proximal adenomas do not have polyps in their distal colon. Advocates of this approach use any excuse to perform colonoscopy, whether it be a positive fecal occult blood test, minor symptoms, or small polyp at flexible sigmoidoscopy, even if hyperplastic. This review describes the history of the controversy regarding management of findings at flexible sigmoidoscopy, the data pertinent to the controversy, and the basis for the three approaches described above, all of which are currently within the standard of medical care.

Colonic Polyps↗
PubMed2001

Do undesirable effects of screening affect all-cause mortality in flexible sigmoidoscopy programmes? Experience from the Telemark Polyp Study 1983-1996.

There is substantial evidence for the beneficial effect of screening programmes aimed at reducing mortality from colorectal cancer (CRC). The effect on all-cause mortality, however, may not necessarily be beneficial. In the present study we used the follow-up results 13 years after a flexible sigmoidoscopy screening to evaluate the long-term effects of informing participants about findings at flexible sigmoidoscopy (FS) screening. There were no severe complications and there was no long-term difference in deaths related to whether there had been any mucosal rupture (biopsy or snare resection) or not. As a group, those who attended in 1983 and were informed that they had polyps tended to improve their smoking habits more than those informed that they had no polyps. Similarly, and in spite of more people giving up smoking, the group with polyps had a trend towards a smaller increase in BMI (+0.7 (95% CI 0.2-1.1)) than the polyp-free group (+1.2 (95% CI 0.9-1.6)) (P = 0.07). The observations suggest that flexible sigmoidoscopy screening may face an educational challenge to avoid unfavourable changes in the lifestyle of screenees, an effect that may more than outweigh the beneficial effect of screening.

Colonic Polyps↗
PubMed2001

Towards better informed consent in endoscopy: a study of information and consent processes in gastroscopy and flexible sigmoidoscopy.

OBJECTIVE: To determine the level of knowledge achieved by patients who have read a simple information sheet on gastroscopy and flexible sigmoidoscopy, and to determine the levels of information required by patients and solicitors specializing in clinical negligence. DESIGN: Self-administered questionnaires were sent to 516 patients in Leicester and 79 solicitors specializing in clinical negligence in England and Wales. The main objective outcome measures were the correct scores measured in a simple test of the content of information sheets about gastroscopy and flexible sigmoidoscopy. Other scores were based on the opinions of patients and solicitors on the type of information patients should receive and the levels of risk about which they should be informed. RESULTS: Of the clinical negligence specialists, 75%, compared with 44% of patients, felt that consent to procedures should be obtained 2 weeks before the test. In addition, 86% of solicitors felt that patients needed to be told about tests on at least two occasions and favoured booklets and videos. Both 48% of solicitors and 38% of patients felt that patients should be told of very uncommon risks, with 16% of clinical negligence specialists expecting patients to be told of risks of 1 in 1,000,000. The majority of patients (98%) and solicitors (95%) felt that patients should be formally tested as to whether they understand what they are told in the consent process. In an initial study of an information leaflet, South Asian patients had significantly poorer scores than English patients on formal testing of their knowledge of the leaflet's content. The poorest response (61% correct) was to a question including the word 'indigestion', which had been omitted from the information leaflet. Its inclusion led to a significant increase in the number answering the question correctly (96%). The positioning of a word in the list of reasons for doing the test was also important. In the flexible sigmoidoscopy leaflet, the word 'anaemia' was placed in the middle of a list of reasons for doing the test; only 85% answered the question correctly. In the sample of patients who received the modified gastroscopy leaflet, recall at 6 months was significantly impaired with most loss of memory being related to the purpose of the test. CONCLUSIONS: Consent needs to be supported by easy-to-read information and the patients' understanding needs to be formally tested. Important concepts must be included in this information as well as any uncommon risks of the procedure. In order to ensure that the information can be understood, the text should be reviewed by an experienced educationalist. If the text is to be used in a multicultural setting, it is important to ensure that patients for whom English is not their first language can easily understand it. The movement away from 'informed consent' towards an 'informed decision' process should facilitate these improvements.

Cultural Characteristics↗