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PubMed1980

Flexible fiberoptic sigmoidoscopy in a surgeon's office.

The use of the flexible fiberoptic sigmoidoscopy in an office setting in 116 consecutive patients detected 18 polyps beyond the reach of the rigid sigmoidoscope. Three of these polyps were Dukes' A lesions. Cancer surveillance and resolution of questionable x-ray findings were improved with this new instrument. Anastomoses, diverticula and inflammatory bowel disease were more easily surveyed. With the use of proper technique, the procedure is safe and well tolerated by the patient.

Adult↗
PubMed1985

Flexible fiberoptic sigmoidoscopy in the emergency department.

Endoscopic examination of the large bowel is an historically old procedure. It has become an important element in the initial evaluation of colorectal disorders. Recently the flexible fiberoptic sigmoidoscope (FFS) has displaced the rigid scope because of increased patient comfort and compliance and markedly improved accuracy in diagnosing left colon lesions. The FFS is a valuable adjunct to the routine investigation of acute and chronic colorectal complaints seen in the emergency department. It has been endorsed by the American Cancer Society and is an easily learned and safe procedure when taught properly.

Colonic Neoplasms↗
PubMedDate not supplied

The use of the 130-cm colonoscope for screening flexible sigmoidoscopy.

The 130-cm colonoscope was utilized to determine whether a deeper insertion could be accomplished after the usual enema preparation for routine flexible sigmoidoscopy and, if so, to what extent that would enhance the yield of neoplastic findings. Sixty-four patients were examined, and intubation was accomplished to the level of 69 cm compared with 48.1 cm for a matched control group that had flexible sigmoidoscopy with the 60-cm endoscope. Another 24 patients who had a barium enema prep had a significantly greater depth of insertion (81.4 cm). Only two polyps were found proximal to 60 cm. The 130-cm colonoscope does not offer any substantial advantage over the standard 60-cm sigmoidoscope unless a bowel preparation more thorough than enemas is given and then it would probably only be worthwhile using the colonoscope in patients who are above average risk for colorectal neoplasia.

Adult↗
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↗
PubMed1998

Utility of preoperative fiberoptic flexible sigmoidoscopy in the evaluation of patients with suspected gynecologic malignancy.

BACKGROUND: Fiberoptic flexible sigmoidoscopy (FFS) is routinely requested preoperatively as part of evaluation of pelvic masses to exclude colonic involvement by the tumor or concurrent colonic neoplasm. The aim of our study was to evaluate the utility of preoperative FFS in patients with suspected gynecologic malignancy. METHODS: FFS, performed using a 60 cm sigmoidoscope, evaluated (1) presence of bowel involvement by the tumor, (2) extrinsic compression by the tumor, and (3) presence of colonic neoplasms. FFS findings were correlated with surgical findings. RESULTS: A total of 107 women underwent preoperative FFS and subsequent surgery. Eleven patients (11%) had lower gastrointestinal symptoms. At surgery, 63% of pelvic tumors were malignant and 37% were benign. The most common abnormality at FFS was colonic polyps in 23 patients (21%). Colonic adenomas were found in 11 patients (10%). Extrinsic compression by the tumor without mucosal abnormalities was seen in 15 patients (14%). The most common intraoperative finding was tumor adhering to the bowel in 18 patients requiring dissection, but only 1 patient required bowel resection. Eight of these 18 patients had preoperative lower gastrointestinal symptoms. All 15 patients with extrinsic compression at FFS had tumor adhering to the bowel. CONCLUSIONS: Pelvic masses cause extrinsic compression at FFS in 14% of patients. This is suggestive of tumor adherent to the bowel at surgery. However, bowel resection is rarely required because of tumor involvement. Most patients with bowel adherence by tumor have lower gastrointestinal symptoms. Colonic adenomas are found in one tenth of patients, mostly in patients older than 50 years of age. Preoperative FFS does not change the surgical management of pelvic tumors. Screening FFS is indicated in all patients with pelvic tumors over age 50, as in persons with average risk, but is otherwise unnecessary in evaluation of pelvic masses.

Adult↗
PubMed1999

Effectiveness and patient satisfaction with screening flexible sigmoidoscopy performed by registered nurses.

BACKGROUND: Our aim was to compare the effectiveness and patient satisfaction with flexible sigmoidoscopy performed by a registered nurse, general surgeons, and gastroenterology fellows. METHODS: Consecutive outpatients referred for sigmoidoscopy were assigned to have the procedure performed by the first available provider. Depth of insertion of the sigmoidoscope, complications, duration of the procedure, and percentage of patients with adenomas were recorded. After the procedure, patients completed a validated patient satisfaction questionnaire. RESULTS: Mean depth of insertion was less for general surgeons compared with the nurse and gastroenterology fellows (50 vs 53 vs 54 cm, respectively; p = 0.01). Mean duration of procedure was longer for the nurse compared with general surgeons and gastroenterology fellows (8.3 vs 7.6 vs 6.8 min, respectively; p = 0.0001). Percentage of patients with adenomas was similar among patients who underwent sigmoidoscopy by the endoscopists (7% vs 8% vs 9%; p = 0.81). No differences were detected between endoscopists for overall satisfaction (p = 0.60), technical skills of the endoscopist (p = 0.58), communication skills of the endoscopist (p = 0.61), or interpersonal skills of the endoscopist (p = 0.59). CONCLUSION: No clinically significant differences in effectiveness or patient satisfaction were detected with flexible sigmoidoscopy performed by a registered nurse, general surgeons, or gastroenterology fellows.

Adult↗
PubMed1980

Technique of flexible fiberoptic sigmoidoscopy.

Flexible fiberoptic sigmoidoscopy allows a maximum amount of colon to be examined expeditiously and thoroughly, and it is predicted that this new instrumentation will be used with increasing frequency. Three techniques of intubation of the sigmoid with a flexible fiberoptic sigmoidoscope are discussed: elongation, looping, and "accordionization" or the "dithertorquing" technique.

Anal Canal↗
PubMed1977

A new chair support for flexible endoscopes.

A new chair support for flexible endoscopes simplifies sigmoidoscopic endoscopy. The endoscopist sits on a stool with a moveable support for the endoscope. This allows working without much fatigue and the endoscopist can insert and move the endoscope himself. We examined 50 patients in the described technique. We reached an average depth of intubation of 45-50 cm and the average examination took less than 5 minutes.

Sigmoidoscopes↗
PubMed1999

Depth of insertion at flexible sigmoidoscopy: implications for colorectal cancer screening and instrument design.

BACKGROUND AND STUDY AIMS: The depth of insertion at flexible sigmoidoscopy is variable, depending upon bowel preparation, patient tolerance and distal colonic anatomy. Many endoscopists routinely aim to insert the 60 cm flexible sigmoidoscope to the splenic flexure; however internal endoscopic markers are unreliable, making the true anatomical extent of the examination difficult to assess. The aim of this study was to assess the depth of insertion at flexible sigmoidoscopy. PATIENTS AND METHODS: Two separate studies were done. In the first (study 1), magnetic endoscopic imaging was used to determine the final depth of insertion at non-sedated, screening flexible sigmoidoscopy. In the second (study 2), "real-time" imaging was utilized to determine sigmoid looping and the anatomical location of the endoscope tip after 60 cm of instrument had been inserted during total or limited colonoscopy. A total of 117 consecutive average-risk patients, aged 55-65 years participated in study 1, and 136 patients underwent either limited, (33) or attempted total colonoscopy (103) in study 2. RESULTS: In study 1 the median insertion distance was 52 cm, range 20-58. In 61 % of patients the imaging system showed that the descending colon had not been visualized by the end of the procedure. Failure to reach the sigmoid/descending junction occurred in 29 (24%) patients. Reasons for failure included poor tolerance of the procedure due to pain (23 patients) inadequate preparation (3 patients) and, excessive looping (3 patients). In study 2, after 60 cm of instrument had been inserted, the splenic flexure or beyond was reached in 29% and the descending colon in 9%, whilst in 62 % the endoscope tip had not passed beyond the sigmoid/descending colon junction. A sigmoid loop formed in 70% of patients, and unusual loops such as the alpha, reverse alpha and reverse sigmoid spiral loop occurred more frequently in women compared to men (P = 0.0249). In those 104 patients where the splenic flexure was reached the mean maximum length of instrument inserted prior to reaching the flexure was 75.4 cm, (SD = 21.9). CONCLUSIONS: Examination of the entire sigmoid was not achieved in approximately one-quarter of patients undergoing screening flexible sigmoidoscopy, mainly because of discomfort. The descending colon is intubated in a minority of cases (using standard instruments), even after 60 cm has been inserted. Alternative instruments with different shaft characteristics (floppy, narrow calibre, 80-100 cm in length) may be necessary to ensure deeper routine intubation in nonsedated patients.

Aged↗
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

Resident participation in flexible sigmoidoscopy does not affect patient satisfaction.

OBJECTIVE: We sought to assess the effect of resident involvement in flexible sigmoidoscopy on patient satisfaction and comfort. METHODS: Adults undergoing flexible sigmoidoscopy completed a previsit questionnaire on indication for procedure, GI-related history, and functional status. Immediately after the procedure, satisfaction and procedure comfort were assessed. Additional information collected included procedure duration, depth of sigmoidoscope penetration, and visualization of diverticuli or polyps. RESULTS: Among 408 endoscopies, patient characteristics and procedure indications were similar between sigmoidoscopies done by residents (n = 111) or staff. There were no differences in patient satisfaction, procedure comfort, or willingness to undergo the procedure again in the future. Sigmoidoscopies involving residents averaged 5.6 min longer, even after adjusting for preparation quality, depth of insertion, specific endoscopist, and the presence of polyps or diverticuli. CONCLUSIONS: Patient satisfaction and comfort with flexible sigmoidoscopy was not reduced by resident involvement, though the procedure duration was slightly longer.

Female↗
PubMed2006

Endoscopic placement of flatus tube using "lasso" technique with snare wire.

A 55-year old man presented with acute sigmoid volvulus. The distal level of obstruction was above the level which could be reached by the rigid sigmoidoscope to allow decompression, and so a flatus tube was "lassoed" onto the side of a flexible endoscope which allowed accurate placement under direct vision. This technique allows accurate placement of catheters, feeding tubes and other devices endoscopically, which cannot be placed through the instrument channel of the endoscope.

Acute Disease↗
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↗
PubMed1999

[The treatment of rectorrhagia secondary to postradiation proctitis with 4% formalin].

Radiation proctitis is a common complication of radiotherapy for pelvic malignancies. In the chronic form it might lead to intractable or massive hemorrhage unresponsive to conventional therapy. In these cases surgery is associated with a high morbidity. Seven female patients previously treated with external beam radiation for carcinoma of the uterus and cervix were included. They had required multiple blood transfusions (median 2), and still had low hemoglobin rates and active hemorrhagic radiation proctitis, were treated. Therapy was accomplished by direct application of gauzes soaked in 4% formalin through the rigid sigmoidoscope or the Pratt anoscope, with the patients under peridural anesthesia. Gauzes were laid in contact with the hemorrhagic surface during 4 minutes and repeated until the bleeding ceased (median total exposure time was 26 minutes). Bleeding ceased immediately in 6 patients, one continued with minor bleeding after formalin treatment, two patients had fever during the first 24 hours which was controlled with physical measures, three patients required repeat formalin application (in external bases), after that six patients had no further bleeding nor was any blood transfusion needed, one patient presented unsuspected sigmoid bleeding stenosis. The formalin therapy is an effective, safe, simple and inexpensive treatment for rectal bleeding caused by radiation proctitis.

Administration, Rectal↗
PubMed1991

Endoscopic palliative management of rectal cancer.

Laser ablation and bipolar coagulation have been used to palliate rectal cancer and avoid surgery. Indications are distal metastatic disease, extensive local invasion, obstruction and bleeding from nonresectable rectal tumor, or refusal of surgery. From Jan 1, 1986, to Jan 1, 1989, I saw 26 patients who met those criteria; 19 already had metastatic disease and three repeatedly refused abdominoperineal resection. A two-laser approach using both CO2 and Nd:YAG lasers was used in patients with low-lying lesions; others were treated by the Nd:YAG laser only. For rectal tumors, bipolar esophageal tumor probes were used via the rigid sigmoidoscope. The number of laser sessions averaged three per patient, and the number of bipolar coagulation sessions averaged five per patient. Bleeding followed bipolar coagulation in one patient. There were no perforations in either treatment group, and no patient has required colostomy. Of the 19 patients who already had metastatic disease, 12 are still alive, the longest survival being 20 months. Of those medically unfit for surgery, three have died of coincidental disease, and one is alive with controlled rectal cancer after 16 months. All three patients who refused surgery are alive; the longest survival is 13 months.

Ambulatory Care↗
PubMed1989

Sigmoidoscopy in the practice.

This article describes the advantages of using the rigid and flexible sigmoidoscopes for diagnosis and management of large bowel disorders in the surgery. The results of our first years flexible sigmoidoscopy are discussed.

Colonic Diseases↗
PubMed1979

The pansigmoidoscope: one year's experience in a gastrointestinal diagnostic unit.

Since May 1976, the Olympus pansigmoidoscope has been available for routine use at the University of Oregon Health Sciences center. Two hundred sixty-five examinations were performed over the next year. The average distance examined was 49 cm. Time per examination ranged from 3 to 15 minutes, with an average of 8 minutes. Preparation consisted of one or two tap water enemas, except in known inflammatory bowel disease where no preparation was given. No patient received sedation and there were no complications. Small biopsy (2.8 mm), large biopsy (4.0 mm), "hot biopsy" and polypectomy were performed when indicated. The procedure was most helpful for the following indications: 1) differential diagnosis and follow-up of inflammatory bowel disease, 2) hematochezia, 3) evaluation of abnormal barium enema, 4) left-sided polypectomy, 5) diarrhea with normal barium enema, and 6) guaiac-positive stools. It was of no value in patients with abdominal pain with normal barium enema. Comparing the frequency of examinations this year with last year we found a 50% decrease in use of the rigid (25 cm) sigmoidoscope (538 to 270 exams) and a 98% decrease in use of the MB2 (100 cm) colonoscope (80 to 2 exams).

Adolescent↗