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PubMed1985

The benefits of systematic fiberoptic flexible sigmoidoscopy.

We used the flexible fiberoptic sigmoidoscope (FFS) on 656 subjects who were receiving their yearly physical examinations. Neoplastic disease was disclosed by the FFS in 138 subjects (21%), including 26 adenocarcinomas, 19 of which were out of reach of a rigid sigmoidoscope. Nineteen of the subjects whose adenocarcinomas were found by the FFS had barium enemas, which detected the carcinomas in only 11. Routine FFS in asymptomatic persons is helpful in detecting both premalignant and malignant lesions, it should be seriously considered as a part of regular preventive physical examinations.

Adenocarcinoma↗

PubMed1985

Bowel preparation for flexible sigmoidoscopy.

One hundred ten consecutive patients undergoing 35-cm flexible sigmoidoscopy were enrolled in a study to compare the efficacy of one vs two enemas (Fleet's) in achieving adequate bowel preparation. Fifty-five patients received two enemas administered one and three hours before sigmoidoscopy. The other 55 subjects received one enema given one hour before the procedure. Bowel preparation was considered inadequate if sigmoidoscopy was terminated prematurely because fecal material obscured visualization through the sigmoidoscope. Inadequate bowel preparation occurred in 12.9 percent of subjects who received one enema and in 20.0 percent of those who received two enemas (chi 2 = 0.97, P = .36). There was no difference between the groups in depth of penetration of the sigmoidoscope or duration (in minutes) of the examination. It is concluded that either one or two enemas are equally effective in preparing patients for sigmoidoscopy. Patient acceptance of sigmoidoscopy could be enhanced by using one enema instead of two with no decrease in adequacy of bowel preparation.

Enema↗

PubMed1983

[Clinical spectrum of amebic colitis].

We present six cases to illustrate the protean clinical and sigmoidoscopic features of the amebic colitis. Three cases presented with a clinical picture resembling ulcerative colitis. In one fatal case, diverticular disease, ischemic colitis and toxic megacolon of uncertain origin were considered before arriving at the proper diagnosis. Two cases were believed to have pseudomembranous colitis on sigmoidoscopic examination. Given the multiple expressions of this entity, amebic colitis should be considered a diagnostic possibility in any protracted inflammatory condition of the colon. From the cases summarized here, it is evident that the clinical and endoscopic features of amebic colitis are variable and may often mimic other illnesses.

Adult↗

PubMed1980

Flexible fibreoptic sigmoidoscopy--an alternative to colonoscopy?

The results of 166 colonoscopic examinations are reported with particular reference to site and nature of the lesion identified. One hundred and fifty-five polyps and 13 colorectal cancers were found, 62 polyps and five cancers being beyond 50 cm from the anal verge. It is suggested that the number of lesions beyond the reach of a flexible fibreoptic sigmoidoscope would be unacceptably high and that there can be no justification for the purchase of such an instrument as an alternative to a full length colonoscope. Whilst the fibreoptic instrument does have advantages as a sigmoidoscope its cost will preclude its widespread use in New Zealand at the present time.

Carcinoma↗

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

Rectal sparing in antibiotic-associated pseudomembranous colitis: a prospective study.

A prospective study of 22 patients with antibiotic-associated pseudomembranous colitis demonstrated that the most distal location of the pseudomembranes was noted from 0 to 25 cm from the anus in 17 patients, from 25 to 60 cm from the anus in 3 patients, and greater than 60 cm from the anus in only 2 patients. These data suggest that the pseudomembranes will be noted by the rigid sigmoidoscope in 77% of the patients and by the flexible sigmoidoscope in 91% of the patients. Colonoscopic examination beyond 60 cm from the anus was necessary for the diagnosis of pseudomembranous colitis in 2 (9%) patients.

Adolescent↗

PubMedDate not supplied

[Usefulness of fiber-sigmoidoscopy in diagnosis of bleeding from the lower part of the digestive tract].

Out of 1000 consecutive fiber-sigmoidoscopic examinations performed using the CF-P 10 S flexible recto-sigmoidoscope, 350 examinations carried out in patients with overt rectal bleeding were subjected to analysis. Among other, 132 cases of haemorrhoids, 47 cases of proctitis, 64 cases of ulcerative colitis, 39 cases of cancer and 37 cases of adenomatous polyps were diagnosed. Only in nearly 3% of cases the examination failed to provide diagnostic conclusions. In 13.4% of cases fiber-sigmoidoscopy failed to show any lesion which led to further diagnostic management (coloscopy and/or large intestine X-ray examination). The usefulness is stressed of fiber-sigmoidoscopy in the diagnosis of bleeding from the lower part of the digestive tract as well as the need for its possibly early performance as the first examination in each case of rectal bleeding.

Adult↗

PubMedDate not supplied

Endoscopic screening for colorectal cancer: recent studies from Indiana University.

Fecal occult blood testing is inadequate as a sole screening measure for colorectal cancer. Endoscopic screening and adenoma removal is now proven to reduce colorectal cancer mortality. At the Indiana University Colorectal Cancer Screening Center, studies have clarified several issues regarding endoscopic screening for colorectal cancer. Screening colonoscopy in 621 asymptomatic adults aged 50 to 75 years demonstrated that 27% had colonic adenomas. Increasing age and male gender were both powerful predictors of an increased prevalence of colonic adenomas. A family history of a single first-degree relative who developed colorectal cancer at age 60 or older did not predict a higher prevalence of colonic adenomas. All cancers and all adenomas greater than or equal to 1 cm in size found in average-risk persons were found in persons aged 60 or older. Half of the people with adenomas had no neoplasia within reach of the flexible sigmoidoscope. Based on these findings, we have suggested that a single screening colonoscopy performed in average-risk person in their early sixties may be an effective method to reduce colorectal cancer mortality. In the screening colonoscopy study, distal colonic hyperplastic polyps were shown to not predict proximal colon adenomas. Therefore, colonoscopy is not warranted when only hyperplastic polyps are detected by flexible sigmoidoscopy in asymptomatic, average-risk people. Screening sigmoidoscopic exams using colonoscopes showed that 60 cm scopes have the optimal length for flexible sigmoidoscopy in unsedated patients. Finally, a screening colonoscopy study demonstrated that women with a personal history of breast cancer do not have an increased prevalence of colonic adenomas.

Aged↗

PubMed1996

Volvulus of the sigmoid colon at Baragwanath Hospital.

Fifty-six patients treated for sigmoid volvulus over a period of 5 years are reviewed. The purpose of this study is to evaluate our management policy and to compare it with other studies, particularly from other parts of Africa. The patients were evaluated by retrospective allocation into one of three treatment modalities. Patients with clinical evidence of ischaemia underwent a Hartmann's procedure. There was a 33% mortality rate in this group. In those patients who had sigmoidoscopic reduction, a second-stage sigmoidectomy and primary anastomosis were performed. The results in this group were excellent. In the group of patients with failed sigmoidoscopic resection the majority underwent a Hartmann's procedure with a mortality rate of 15%.

Adult↗

PubMed1996

Sigmoidoscopy.

The use of a rigid sigmoidoscope, a skill any GP can easily acquire, may save a patient the inconvenience and expense of the more complex procedures of flexible colonoscopy or barium enema. Most colonic pathology occurs within reach of a 25 cm sigmoidoscope. Rigid sigmoidoscopy can be quickly and safely performed in most cases without bowel preparation and in the GP's office.

Colonic Diseases↗

PubMed1996

Colonoscopic screening for families of patients with colorectal cancer.

We conducted a prospective study using primary colonoscopy in the families of patients with surgically treated colorectal cancer (CRC) to evaluate its feasibility as a screening method for CRC. The presumed detection sensitivity of sigmoidoscopy in this group was also evaluated. Over a 3-year period, 142 first-degree relatives (73 men and 69 women) of 117 patients with CRC participated in this colonoscopic screening study. The average age at presentation for examination was 49.1 years (range, 31-79 yr). Forty-nine patients had adenomatous polyps (AP) and four patients had cancer, yielding a frequency of 37% (53/142). Thirty-six family members were under 40 years of age, eight of whom had AP. In total, there were 111 AP and four invasive cancers; 42% (48/111) of AP and 75% (3/4) of cancers were beyond the reach of conventional flexible sigmoidoscope. Of 53 patients with AP or cancer in the large bowel, 36 had AP or cancer in the distal colon (rectosigmoid region and descending colon), 15 (42%) of whom were found to have at least one AP or cancer in the proximal colon (proximal to the descending colon). The remaining 17 patients' lesions were confined to the proximal colon, and would not have been detected with a flexible sigmoidoscope. Sigmoidoscopy in high-risk patients with neoplasm in the large bowel has a sensitivity of 68%. We conclude that a vigorous surveillance program using primary colonoscopy should be set up for those who are first-degree relatives of patients with CRC. Routine examination should start at the age of 40, and the entire colon should be evaluated.

Adult↗

PubMed1997

Five-year follow-up of asymptomatic patients with negative fecal occult blood test results in whom clinically significant colorectal pathology was detected.

OBJECTIVES: To determine from a 5-yr longitudinal study (a) rate of compliance with follow-up, (b) number of new clinically significant colorectal lesions discovered by sigmoidoscopy or colonoscopy at later examination, (c) number and causes of deaths, and (d) rate of diagnosis of new cancers among 36 asymptomatic patients with negative fecal occult blood tests in whom clinically significant colorectal lesions were found initially by 60-cm flexible sigmoidoscope. METHODS: For the 36 patients, medical records were reviewed throughout the 5-yr study period. These records included pathology reports, results from 60-cm sigmoidoscopy and colonoscopy examinations, and notations from visits to health facilities for reasons other than colorectal examinations. RESULTS: Seventy-one clinically significant lesions were removed during the 5-yr period; 58 were discovered by sigmoidoscopy and 13 by colonoscopy. Also, during the 5-yr period, noncolorectal cancer was diagnosed in six patients, and two patients died of cardiac disease. CONCLUSIONS: Patients who have clinically significant colorectal pathology found by 60-cm sigmoidoscope have a high prevalence of lesions beyond the view of this instrument. Therefore, colonoscopy should be performed when sigmoidoscopy shows clinically significant pathology. Because subsequent examinations show a high incidence of new lesions, rescreening is indicated.

Aged↗

PubMed2005

Selecting patients for flexible sigmoidoscopy. Determinants of incomplete depth of insertion.

BACKGROUND: Flexible sigmoidoscopy (FS) is an effective method to prevent and reduce mortality from colorectal carcinoma (CRC). Incomplete depth of insertion (IDI) during FS may result in missed polyps and carcinomas. To determine whether it is possible to predict IDI, the authors analyzed factors that affected the depth of insertion in FS. METHODS: For the current study, FS results were recorded prospectively over a 5-year period. A questionnaire was administered to the patient by the investigator prior to FS to collect data, including age, gender, weight, comorbid illnesses, history of prior abdominal and pelvic surgeries, family history of colon carcinoma or polyps, and prior FS or colonoscopies. The depth of insertion of the flexible sigmoidoscope from the anal verge, which was defined as the reading on the outside of the instrument at its maximal insertion, was measured in centimeters. IDI was defined as a depth of insertion < 50 cm. Classification and regression tree analysis was used to develop a model that included variables predictive of IDI. RESULTS: The best classification tree included gender, age < 69 years (in women), and a history of hysterectomy. Men had a < 5% risk of an IDI and women age < 69 years without a hysterectomy fared as well (6.6%). Older women and younger women who underwent hysterectomy had higher rates of IDI (29.2% and 22.3%, respectively.) CONCLUSIONS: The authors developed a model based on age, gender, and hysterectomy status that, after further validation, may be useful for predicting which patients likely will have an incomplete examination. In those patients who have a high probability of IDI, the choice can be made to offer colonoscopy or perform FS under sedation, with analgesia, or with the help of distraction techniques.

Age Distribution↗

PubMed1987

Complications of flexible fiberoptic sigmoidoscopy. A conceptual approach.

This paper presents an overview of the potential risks associated with the use of the flexible fiberoptic sigmoidoscope. A reasonable review of the literature on endoscopy reveals few instances of admitted complications. We draw upon a decade of personal observations and experience with over 10,000 examinations to substantiate the actual and potential hazards of flexible fiberoptic sigmoidoscopy. A conceptual approach to recognizing and avoiding the consequences of complications is presented.

Diagnostic Errors↗

PubMed1983

Experience with routine office sigmoidoscopy using the 60-cm flexible colonoscope in private practice.

Based on reported success and safety, 1121 sigmoidoscopies were performed in 964 patients seen privately by one surgeon, as a routine office screening procedure, using the flexible 60-cm sigmoidoscope instead of the rigid 25-cm instrument. The doubling of the distance that was examined doubled the diagnostic yield for neoplasia and inflammatory bowel disease, specific or nonspecific. As compared with barium-enema examinations, the yield was even greater: 5:1 for neoplasia, 7:1 for inflammation, 3:1 for polyps greater than 1 cm, and 5:1 for false-negative, false-positive, or equivocal x-ray findings. No serious complications were encountered in any of the examinations including 72 polypectomies performed in the office. The study supports flexible fiberoptic sigmoidoscopy as a major screening tool for individuals in private practice in truly evaluating the interior of the lower 60-cm of the colorectum for neoplasia and for the diagnosis and monitoring of bowel disease or neoplasia confined to that area.

Adolescent↗

PubMed2002

The PreOp flexible sigmoidoscopy trainer. Validation and early evaluation of a virtual reality based system.

AIM: To demonstrate face and construct validity of a computer based flexible sigmoidoscopy trainer. METHODS: The PreOp (Immersion Medical, USA) system is a virtual reality based flexible sigmoidoscopy simulator. The system records several performance parameters, such as percentage of colonic mucosa visualized, time taken, and pathlength of endoscope travel. Forty-five subjects were divided into three groups: novice (never performed a lower GI endoscopy), intermediate (5-50 examinations), and trained (greater than 200 examinations). After initial familiarization subjects were assessed three times on a case module. Results showed a nonparametric distribution. RESULTS: There was a significant difference between all three groups with respect to percentage of mucosa visualized (novice 71.0 +/- 3.7%, intermediate 77.3 +/- 5.6%, expert 84.8 +/- 4.6%, Kruskal-Wallis p <0.001) and efficiency ratio (%mucosa/time, novice 0.163 +/- 0.055, intermediate 0.259 +/- 0.07, expert 0.306 +/- 0.058, p <0.001). The novice group was also slower and had a lower pathlength of instrument travel compared to the others. CONCLUSION: PreOp virtual reality simulator is a valid discriminator of flexible sigmoidoscopic experience. Its effect on training needs to be explored.

Clinical Competence↗

PubMed2004

Dual endoscopic-assisted endoluminal colostomy reversal: a feasibility study.

BACKGROUND: Emergent colostomies are associated with increased morbidity related to second closure operations. The purpose of this canine pilot study was to create a minimally invasive procedure that would reduce the time interval and morbidity involved with colostomy reversals after left colon end colostomies. METHODS: Six mongrel dogs underwent modified laparoscopic Hartmann's procedures in which the stapled end of the rectal stump was approximated to the left colon proximal to the stoma. After 1 week, they underwent an endoluminal colostomy reversal with a computer-mediated, circular stapling device and varying anvil insertion methods. Variables recorded included anvil insertion technique and feasibility, OR time, complications, and number of days to first meal and bowel movement. A contrast enema performed 1 week post colostomy reversal ruled out anastomosis leaks and stenosis. The dogs were euthanized and subjected to necropsy. RESULTS: Of four anvil insertion techniques tested, the most feasible employed a large-bore needle to perforate through the stapled end of the Hartmann pouch into the lumen of the left colon. Simultaneous endoluminal views of the rectal stump with a sigmoidoscope and the left colon lumen with an endoscope permitted a controlled and safe needle puncture. Through the needle, a guide wire was inserted to withdraw the anvil via the colostomy into place. A transanally inserted stapler was then married to the anvil under fluoroscopic guidance, thus completing the anastomosis. The colostomy was then taken down and transected at the level of the colocolostomy. Average operating time was 126 min (range 90-180), diet was tolerated within 1.5 days, and average number of days to first bowel movement was 2.5. The absence of stenosis, leaks, and inadvertent visceral injuries confirmed feasibility. CONCLUSIONS: In this canine model, a dual endoscopic-assisted colostomy reversal with a computer-mediated, circular stapling device is feasible. Using this technique, colostomy reversals can possibly be performed 1 week post-colostomy without entering the peritoneal cavity, thus reducing the number of invasive operations and subsequent morbidity required to manage emergent colon perforations.

Anastomosis, Surgical↗

PubMed1992

Investigation of an outbreak of bloody diarrhea: association with endoscopic cleaning solution and demonstration of lesions in an animal model.

UNLABELLED: OUTBREAK INVESTIGATION: An outbreak of diarrhea, bloody diarrhea, and abdominal cramps occurred among persons undergoing flexible sigmoidoscopy at a branch clinic of a local health center. Illness was associated with use of sigmoidoscopes cleaned by one clinic assistant and appeared to be caused by 2% glutaraldehyde disinfectant solution left in the instruments after cleaning. ANIMAL STUDIES: In subsequent animal studies, colonic instillation of 2% glutaraldehyde solutions caused bloody diarrhea and a distinctive pattern of mucosal damage; similar changes were seen in a review of pathologic samples from other human cases of glutaraldehyde disinfectant-associated diarrhea. CONCLUSION: Our data indicate that improper endoscopic reprocessing can result in serious illness and underscore the importance of adequate training and quality control in this area.

Animals↗