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PubMedDate not supplied

Flexible sigmoidoscopy as a screening test for colorectal cancer.

Flexible sigmoidoscopy (FS) is one of the screening modalities for colorectal cancer. The rationale for screening with flexible sigmoidoscopy is that it provides direct visualisation of the colon, and suspicious lesions can be biopsied. The most obvious disadvantage is that it examines only the lower third of the colon. The technical aspects of FS are sufficiently clear to enable us to define what FS can and cannot do. From the point of view of screening, FS clearly cannot completely exclude the presence of colon cancer in all asymptomatic people. A distinction must be made between screening the general population and testing the individual seeking screening. For the former, obtaining the greatest mortality benefit safely and at an acceptable cost to the nation is the crux of the matter. Recently published data indicate that FS is a cost-effective screening strategy, although colonoscopy and annual fecal occult blood test avert a greater number of cancer deaths. The results of randomised controlled trials of screening FS and colonoscopy, currently being conducted, will allow us to make a more accurate comparison with the established data regarding fecal occult blood test. In conclusion, flexible sigmoidoscopy every 5 years with or without FOBT is one of the screening methods recommended by major professional organizations. It identifies 50 to 70% of the advanced neoplasms, if any discovery of a distal neoplasia is followed up with a total examination of the colon by colonoscopy.

Age Factors↗
PubMed1988

The role of sigmoidoscopy and rectal biopsy in diagnosis and management of inflammatory bowel disease: personal experience.

Conventional sigmoidoscopy and rectal biopsy are very useful in the diagnosis, differential diagnosis, and management of inflammatory bowel disease. The rectal biopsy is particularly important in establishing the diagnosis of Crohn's disease when the rectal mucosa is grossly normal. The sigmoidoscopy and biopsy serve to assess the response to medical therapy in inflammatory bowel disease and are important adjuncts to colonoscopy in surveillance for dysplasia and carcinoma in patients with ulcerative colitis. Sigmoidoscopy is quick, requires no preparation, is cost effective, and the biopsies are extremely safe with the use of the cupped bronchoscopic forceps.

Biopsy↗
PubMed1985

Symposium on outpatient anorectal procedures. Flexible fiberoptic sigmoidoscopy: an office procedure.

Patients who had benign polyps and cancers were studied retrospectively to define whether use of the 60-cm flexible sigmoidoscope would markedly improve the diagnostic yield over the 25-cm rigid sigmoidoscope. Of the polyps found, 48% could have been seen by the rigid sigmoidoscope and 85% by the flexible sigmoidoscope. Cancers were within reach of digital examination in 21%, of the rigid sigmoidoscope in 38% and of the flexible sigmoidoscope in 60%. This verifies the greater diagnostic yield by the flexible sigmoidoscope. In 211 asymptomatic patients who underwent flexible fiberoptic sigmoidoscopy, the scope reached to 25 cm in all and to 50 cm in 75%. The average time required for the examination was 4.9 minutes. Of these patients, who had also undergone rigid sigmoidoscopy previously, 76% preferred the flexible scope, 18% preferred the rigid scope and 6% could tell no difference. The yield of neoplasms was 4% in the distal 25 cm of the colon and rectum, but an additional 8% were found in the sigmoid colon. This review supports the need for flexible sigmoidoscopy in the office as a screening tool for detection of polyps and early diagnosis of cancer in the asymptomatic patient over 40 years of age. Technique, costs and complications are discussed.

Ambulatory Care↗
PubMed1984

Training in sigmoidoscopy. An assessment in three teaching hospitals.

To assess the standard of training in postgraduate sigmoidoscopy in Melbourne, a questionnaire was prepared and distributed to resident medical officers (RMOs) in three teaching hospitals. The survey showed that practical instruction in technique is inadequate, and that most individuals perform too few sigmoidoscopies to become competent at either examining or recognizing lesions. A substantial number of RMOs had never seen common and important lesions such as polyps or colorectal cancer. Most RMOs considered their training to be poor and stated that they lacked confidence in their ability to perform sigmoidoscopy. The current training programme needs detailed reassessment and improvement.

Australia↗
PubMed1984

Enterococcal endocarditis following sigmoidoscopy and mitral valve prolapse.

There is considerable controversy regarding antimicrobial prophylaxis against infective endocarditis for routine sigmoidoscopy without biopsy in patients with underlying valvular heart disease. Sigmoidoscopy is known to produce brief, low-grade bacteremia in some patients. Persons with mitral valve prolapse (MVP) may be at risk of infective endocarditis developing during transient bacteremia. We describe a 67-year-old man with known MVP in whom enterococcal endocarditis developed following routine sigmoidoscopy. We believe this to be the first such reported case.

Aged↗
PubMed1982

Flexible sigmoidoscopy.

Flexible sigmoidoscopy became available in 1976. To date, studies comparing it with rigid sigmoidoscopy support an increase of 2.5 to six times in the flexible sigmoidoscope's ability to detect polyps, and a two- to threefold increase in detection of colonic neoplasms in the same patients. This paper summarizes the current reported results of flexible sigmoidoscopy to date and describes the instrument and procedure as done at the UCLA Family Practice Residency Program. The flexible sigmoidoscope deserves evaluation for widespread primary care application.

Colonic Neoplasms↗
PubMed1982

Sigmoidoscopy.

Rigid sigmoidoscopy is an obligatory part of the routine anorectal examination and enables inspection of the rectum in nearly every case. The extent of bowel examined by flexible sigmoidoscopy is greater and more abnormalities are therefore discovered. With suitable organization, flexible sigmoidoscopy is practicable in the outpatient department. Neither technique examines the large bowel completely so air-contrast barium enema examination with colonoscopy is necessary and should be requested if more proximal disease is thought possible.

Anus Diseases↗
PubMed1982

Impact of flexible sigmoidoscopy on physician compliance with colorectal cancer screening protocol.

The flexible sigmoidoscope may represent a partial solution to the longstanding problem of physician and patient noncompliance with sigmoidoscopy for the detection of colorectal cancer. A three-year longitudinal audit of medical records revealed at least a sevenfold increase in the number of sigmoidoscopies performed after the introduction of flexible sigmoidoscopy to a salaried medical group. This procedure has made a significant contribution to patient care and resident education in the UCLA family practice residency program.

Adult↗
PubMed1975

Results of routine preoperative sigmoidoscopy and barium enema on patients with inguinal hernia.

The diagnostic findings of history, physical examination, rectal examination, barium enema, and sigmoidoscopy in 684 patients with the initial complaint of inguinal hernia were examined. History and physical examination led to the diagnosis of four cancers of the colon and one villous adenoma. No significant new findings were made by sigmoidoscopy when symptoms elicited by history did not indicate some abnormality. A cost analysis of finding significant disease in these patients with inguinal hernias indicates that in-hospital evaluation by barium enema and sigmoidoscopy is probably not warranted.

Adolescent↗
PubMed1993

Comparison of three bowel preparations for sigmoidoscopy.

The efficacy of three lower bowel preparations in 96 patients undergoing rigid sigmoidoscopy was studied. The maximal length of insertion and clarity of view were assessed in each group and compared to patients without bowel preparation. Blood per rectum and diarrhoea were the main indications for sigmoidoscopy. The maximal insertion of the instrument was similar for all groups and the rectosigmoid junction was examined in the majority. The clarity of view was good in 71% of patients receiving Fleet enema, 68% of those receiving Dulcolax micro-enema, 36% in the Dulcolax suppository group and 16% in the group without bowel preparation. There were no adverse effects or complications arising from bowel preparation or sigmoidoscopy. Bowel preparation significantly improves the number of satisfactory sigmoidoscopic examinations, and the use of simple disposable enemas is safe and effective.

Adult↗
PubMed1996

Feasibility of high-volume screening sigmoidoscopy using a flexible fiberoptic endoscope and a disposable sheath system.

OBJECTIVES: Sigmoidoscopy is an effective screening test for colorectal cancer but has yet to have a major impact on mortality because, in part, of inadequate utilization by physicians. To address concerns of inefficient use of time and resources, we examined the feasibility of high volume, single-day flexible sigmoidoscopy (FS) screening sessions using an innovative fiberoptic sigmoidoscope with a disposable sheath system. METHODS: All City of Boston employees over the age of 50 yr (n = 6137) were invited by mail to undergo a screening FS at Boston City Hospital (BCH). Respondents (n = 564) were contacted by phone by the program coordinator on receipt of a prepaid postcard and were scheduled (n = 227) consecutively into 15-min slots on 1 of 6 1/2-day (3-h) weekend sessions. Preregistration was completed at BCH during the week before each session and included enrollment, completion of a brief risk questionnaire, documentation of informed consent, and bowel prep instructions. Procedures were performed by three physician endoscopists rotating among four endoscopy rooms per session. Each room was staffed with a nurse to aid in patient care and a technician to set up equipment. RESULTS: A total of 198 of the 227 (87%) scheduled patients underwent screening FS during the three sessions. Physicians performed a mean of 3.5 procedures per room per hour, or 4.7 procedures per hour overall, with a mean depth of scope insertion of 51 +/- 10 cm and a mean procedure time of 4.7 +/- 3.3 min. Equipment set-up time and patient turnaround time averaged 4.6 +/- 1.7 min and 11.0 +/- 6.0 min, respectively. Polyps were detected in 29 (14.6%) patients, and a Dukes' A cancer was detected in one (0.5%). The only complication was a cardiac arrhythmia. A crude estimate of direct costs approximated $ 75 per examination. CONCLUSION: High volume, single-day FS using the fiberoptic sigmoidoscope with a disposable sheath system offers an effective strategy for enhancing physicians compliance, and possibly patient compliance, with screening sigmoidoscopy through more efficient use of time and resources.

Aged↗
PubMed1997

Evidence of gender bias in patients undergoing flexible sigmoidoscopy.

Some studies have revealed gender bias against women in various aspects of medical care. There is no substantial evidence of gender bias in patients undergoing cancer evaluations, specifically colorectal cancer screening and diagnosis of colorectal complaints. This study was designed to examine the role of gender bias related to patients undergoing flexible sigmoidoscopy. At the University of South Florida, we conducted a retrospective study of 1910 patients at three distinct flexible sigmoidoscopy clinics over several years, through 1992. The proportions of male and female patients who underwent the procedure for indications of either screening for colorectal cancer or the diagnosis of colorectal complaints were determined. These proportions were compared with the respective male and female patient proportion from the total number of currently active patients at each site who were eligible to have the procedure for an appropriate indication. At all three sites, a significantly smaller proportion of women (p < 0.01) underwent the procedure than expected. This was true for both screening and diagnostic indications. Conversely, at all sites significantly more men (p < 0.01) underwent the procedure for both indications. The results of this study suggest gender bias against women for patients undergoing flexible sigmoidoscopy for both screening and diagnosis. This bias may adversely affect the lethality of colorectal cancer in women. It is important to determine if such biases are influenced by the physician's recommendation or mainly due to patient attitudes.

Adult↗
PubMed1999

Flexible sigmoidoscopy: screening for colorectal cancer.

Flexible sigmoidoscopy is an important screening procedure because of its ability to detect early changes in the distal colon. The 60-cm flexible sigmoidoscope provides excellent visualization with minimal discomfort to patients. Successful sigmoidoscopy requires adequate patient preparation, proper equipment and an experienced examiner who can recognize both normal and abnormal findings. Complications arising from sigmoidoscopy are rare, but patients may experience some cramping, gas or watery stools. Screening and primary preventive measures, including regular exercise and increased dietary fiber intake, can lower the morbidity and mortality associated with colorectal cancer.

Colorectal Neoplasms↗
PubMed1991

Flexible sigmoidoscopy as a screening procedure in rural patients.

In this study of flexible sigmoidoscopy as a screening procedure for rural, impoverished patients, 16% of asymptomatic patients who were screened by sigmoidoscopy and 23% of patients with a positive test for fecal occult blood were found to have a polyp or carcinoma. Flexible sigmoidoscopy appears to be an important part of the physical examination of patients older than 50. It is a test that can readily be done by primary care physicians in a rural setting.

Adenocarcinoma↗
PubMed2003

Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy.

BACKGROUND: The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies. METHODS: Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. RESULTS: Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%). CONCLUSIONS: Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.

Adenomatous Polyps↗
PubMed2003

Results of repeat sigmoidoscopy 3 years after a negative examination.

CONTEXT: The necessary frequency of endoscopic colorectal cancer screening after a negative examination is uncertain. OBJECTIVE: To examine the yield of adenomas and cancer in the distal colon found by repeat flexible sigmoidoscopy (FSG) 3 years after a negative examination. DESIGN, SETTING, AND PARTICIPANTS: Participants were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a randomized, controlled community-based study of cancer screening. The mean (SD) age was 65.7 (4.0) years at study entry (1993-1995) and 61.6% were men. Individuals underwent screening FSG at baseline and at 3 years as part of the protocol and were referred to their personal physicians for further evaluation of screen-detected abnormalities. Results from subsequent diagnostic evaluations were tracked in a standardized fashion. Of 11 583 eligible for repeat screening FSG 3 years after an initial negative examination, 9317 (80.4%) returned. MAIN OUTCOME MEASURES: Polyp or mass detection in distal colon at year 3 repeat FSG; incidence of adenoma or cancer in distal colon at year 3 examination; determination of reason for detection (increased depth of insertion or improved preparation at the year 3 examination or detection in a previously examined area). RESULTS: A total of 1292 returning participants (13.9%) had a polyp or mass detected by FSG 3 years after the initial examination. In the distal colon, 3.1% (292/9317) were found to have an adenoma or cancer. The incidence of advanced adenoma (n = 72) or cancer (n = 6) in the distal colon was 78 (0.8%) of 9317. Of individuals with advanced distal adenomas detected at the year 3 examination, 80.6% (58/72) had lesions found in a portion of the colon that had been adequately examined at the initial sigmoidoscopy. CONCLUSIONS: Repeat FSG 3 years after a negative examination will detect advanced adenomas and distal colon cancer. Although the overall percentage with detected abnormalities is modest, these data raise concern about the impact of a prolonged screening interval after a negative examination.

Adenoma↗
PubMed1992

Flexible sigmoidoscopy and the despecialization of gastrointestinal endoscopy. An environmental impact report.

BACKGROUND: Gastrointestinal endoscopy is a diagnostic and therapeutic tool for the prevention of premature death from cancer. Flexible equipment innovations during the 1970s increased the power of this technique dramatically. For family physicians and general internists, dissemination of these techniques started around 1979 and continued during the 1980s. METHODS: In this report, data describing the gradual reformation of primary-care cancer screening are discussed. RESULTS: For example, one longitudinal study revealed a sustained improvement in physician compliance with American Cancer Society guidelines associated with the advent of flexible sigmoidoscopy and short colonoscopy skills. For symptomatic patients, compliance increased from 2% to 79% over 5 years. CONCLUSIONS: Flexible sigmoidoscopy is now well accepted. Endoscopic biopsy, full colonoscopy, and polypectomy skills are now available to many primary-care physicians. This represents a technical advance, and it is a small part of a larger medical-care revolution in which technology is decentralized. This holds great promise for the eradication of premature death from colorectal cancer.

Colonoscopy↗
PubMed1982

Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas.

One hundred consecutive new patients attending a general surgical and gastrointestinal outpatient clinic had a flexible fibreoptic sigmoidoscopic examination before a double contrast barium enema. Colonic lesions were found in 45 patients and flexible sigmoidoscopy was superior to barium enemas in diagnosing lesions in the sigmoid colon. Two cancers, 1 histologically a Dukes' A lesion and 6 adenomatous polyps greater than 0.5 cm in diameter, in the sigmoid colon, were not detected by barium enemas. In 6 of these patients extensive diverticular disease was present. In patients with rectal bleeding found to have diverticular disease demonstrated radiographically, an endoscopic examination must be performed to exclude polyps or cancer. Flexible fibreoptic sigmoidoscopy may reduce the numbers needing barium enemas.

Adult↗