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PubMed1971

Clinical evaluation of fibreoptic sigmoidoscopy employing the Olympus CF-SB colonoscope.

Fifty-one patients with large bowel disease were examined with the Olympus CF-SB fibreoptic colonoscope. With adequate bowel preparation and employing inhalational analgesia administered by a self-demand valve the whole sigmoid colon could be examined in the majority of patients within 30 minutes. In 23% of cases (12/51) the diagnosis was either made or confirmed by this procedure alone. Fibreoptic sigmoidoscopy is especially helpful in patients with either equivocal or failed barium enemas and is indicated in patients with unexplained rectal bleeding, extending the search for polyps and cancer, and studying patients with inflammatory bowel disease.About one quarter of biopsies taken from a flat mucosal surface with the Olympus flexible biopsy forceps may be insufficient for detailed histology due to their small size. For this reason multiple biopsies may be taken. Adequate biopsies were always obtained from projecting lesions and could be very accurately sited. Colour photography employing automatic exposure control is used to supplement the information obtained. It is concluded that fibreoptic sigmoidoscopy is a valuable additional investigation in selected patients with suspected disease of the large bowel and to date has been without complications.

Anesthesia, Inhalation↗
PubMed1992

Distribution of collagenous colitis: utility of flexible sigmoidoscopy.

We investigated the distribution of the collagen band in 33 patients with collagenous colitis to estimate the likelihood of the disease being diagnosed in biopsy specimens from the left side of the colon, such as those obtained using flexible sigmoidoscopy. To be included in this study patients had a subepithelial collagen band greater than or equal to 10 microns, an increase in chronic inflammatory cells in the same specimen, and diarrhoea for which there was no other apparent cause. In 17 patients undergoing full colonoscopy with a thickened collagen band, collagenous colitis was frequently patchy, even though overall the thickened collagen band was almost equally distributed throughout the colon. Rectal biopsy specimens showed a normal collagen band in 73% of patients, while a thickened collagen band was found in 82% of patients in at least one specimen from the left side of the colon. Three patients had a thickened collagen band only in the caecum. In three of eight rectal biopsy specimens with a normal collagen band there was no mucosal inflammation to raise the possibility of proximal disease, although all but one specimen with a normal collagen band from the sigmoid and descending colon were inflamed. Rectal biopsy alone is therefore a relatively poor method of making the diagnosis. Flexible sigmoidoscopy with multiple biopsy specimens from several sites is a reasonable initial investigation but not sufficient to exclude collagenous colitis when based on the presence of a thickened collagen band alone. Should left sided biopsy specimens show a normal collagen band but an inflamed mucosa, total colonoscopy with multiple specimens including the caecum may be required to establish the diagnosis.

Adolescent↗
PubMed1998

Uptake, yield of neoplasia, and adverse effects of flexible sigmoidoscopy screening.

BACKGROUND: A multicentre randomised controlled trial to evaluate screening by "once only" flexible sigmoidoscopy (FS) for prevention of bowel cancer is in progress. AIMS: To pilot the trial protocol examining rates of attendance, yield of neoplasia, and adverse effects. SUBJECTS: A total of 3540 subjects aged 55-64 years in Welwyn Garden City (WGC) and 19,706 in Leicester (LE). METHODS: Subjects responding positively to an "interest in screening" questionnaire were randomised to invitation for screening or control arms. Small polyps were removed during screening. Colonoscopy was undertaken for high risk polyps (more than two adenomas, size at least 1 cm, villous histology, severe dysplasia, or malignancy). The remainder were discharged. RESULTS: In WGC and LE respectively, 59% and 61% indicated an interest in screening, of which 74% and 75% attended. Adenomas were detected in 10% and 9%, respectively, and cancers in 7 per 1000 (in both centres), 55% at Dukes's stage A. The colonoscopy referral rate was 6% in both centres. Mild, short lived bleeding occurred in 3%. One person died following surgery. CONCLUSIONS: Compliance rates, yield of adenomas, and referral rate for colonoscopy were as expected, but cancer detection rates were higher. Adverse effects following sigmoidoscopy or colonoscopy were mild and transient, but there was one postoperative death. A randomised trial is necessary to evaluate fully the risks and benefits of this intervention.

Adenoma↗
PubMed2000

Acceptability of flexible sigmoidoscopy screening in older adults in the United Kingdom.

OBJECTIVES: To assess the acceptability of bowel cancer screening using flexible sigmoidoscopy (FS). SETTING: Adults aged 55 to 64 recruited from general practices in Welwyn Garden City and Leicester, which were the pilot and start up centres of a multicentred randomised controlled trial of FS screening (the ICRF/MRC Flexible Sigmoidoscopy Screening Trial). METHODS: Screenees (n=4422) were sent a three month follow up questionnaire that included measures of satisfaction with information given before the test, facilities at the test unit, attitudes of the staff, and explanation of the results. Measures of pain, embarrassment, feelings of being "in control" during the test, willingness to encourage others to have the test, and gladness to have participated were also included. In addition, semistructured telephone interviews were conducted with 60 screenees, stratified by screening outcome and gender. RESULTS: The follow up questionnaire was completed by 94% of screenees. Responses indicated a high level of satisfaction with the procedure: 99% were satisfied with the information given before the test, the facilities, the attitudes of the staff, and the explanation of their results; 91% reported only mild or no pain; 97% reported little or no embarrassment; and 99% were glad they had the test. Satisfaction ratings varied little by gender or outcome group. The quantitative results were reinforced by the qualitative data, which also revealed high acceptability. CONCLUSION: In the context of a clinical trial with dedicated trial staff, FS is a well tolerated procedure. There are high levels of satisfaction with service provision and positive attitudes towards the programme.

Colorectal Neoplasms↗
PubMed2000

Predictors of attendance in the United Kingdom flexible sigmoidoscopy screening trial.

OBJECTIVE: To investigate predictors of attendance in the United Kingdom flexible sigmoidoscopy screening trial. DESIGN: Prospective design in which participants completed a postal questionnaire before being sent their invitation for screening. SETTING: Welwyn Garden City and Leicester, United Kingdom. PARTICIPANTS: A total of 2758 patients aged 55 to 64, registered with general practices in the two centres, who (a) expressed interest in having the screening test, (b) completed a postal questionnaire, and (c) were subsequently invited for screening. MAIN RESULTS: The attendance rate among questionnaire responders was 76.1%. Multiple logistic regression analysis yielded a final model that included nine independent predictors of attendance. Patients with the following characteristics were more likely to attend: men; home owners; non-smokers; those who had regular check ups at the dentist; those with better subjective health; those who minded less about having medical tests; those who said they would definitely rather than probably take up the offer of sigmoidoscopy screening; and those who perceived less barriers and more benefits to having the test. CONCLUSIONS: The findings are broadly consistent with previous studies of screening participation, although subjective health emerged as an important predictor in this study. There was no evidence for "reverse targeting": attenders were not at lower (or higher) risk for colorectal cancer compared with non-attenders. The findings relating to attitudes and beliefs could be used in efforts to improve attendance, for example by developing information leaflets that address barriers to screening. Other findings could be used to target interventions to subgroups that have relatively low rates of screening participation.

Age Factors↗
PubMed1987

Sigmoidoscopy--a necessary procedure in the routine investigation of homosexual men?

In a study to assess the value of sigmoidoscopy in the routine investigation of homosexual men, this procedure was undertaken on 1118 men who attended a sexually transmitted diseases clinic as "new" or "return new" patients. Serious rectal disease was not identified in any of the 557 men who were symptomless at the initial attendance. Though the extent of the proctitis diagnosed in 166 men would not have been defined, 99% (465) of 470 anorectal lesions would have been identified if proctoscopy alone had been performed. It is concluded that sigmoidoscopy does not have a role in the routine investigation of homosexual men.

Diagnostic Tests, Routine↗
PubMed1995

Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?

PURPOSE: To assess replacement of barium enema examination with colonoscopy in relation to age- and sex-related risk factors, place of service, physician specialty, and cost. MATERIALS AND METHODS: Between 1985 and 1992, 894,777 insurance claims for barium enema examination and lower gastrointestinal endoscopy were retrospectively examined. Changes in use were investigated. Use of proctosigmoidoscopy and flexible sigmoidoscopy, two office-based endoscopic procedures, was also examined. RESULTS: Use of diagnostic colonoscopy increased from 191 to 406 services per 100,000 persons; colonoscopy with biopsy, from 77 to 183 services; and colonoscopy with lesion removal, from 77 to 202 services. Barium enema examination use declined from 929 to 511 services per 100,000 persons; diagnostic proctosigmoidoscopy, from 854 to 193 services; and diagnostic flexible sigmoidoscopy, from 656 to 620 services. Increases in use of colonoscopy in patients aged younger than 40 years were greater than overall increases. CONCLUSION: Colonoscopy has been replacing barium enema examination as the initial colorectal examination since 1985. Increased use of colonoscopy in patients with lower risk of neoplasia suggests that indications have become overly broad.

Adult↗
PubMed2004

Patterns of use of flexible sigmoidoscopy, colonoscopy and gastroscopy: a population-based study in a Canadian province.

BACKGROUND & AIMS: Flexible sigmoidoscopy, colonoscopy and gastroscopy are important in the diagnosis and treatment of gastrointestinal (GI) diseases. Pressure on endoscopy resources is expected due to increased screening for GI cancers. The present study examined patterns of use of GI endoscopy in a Canadian province, Alberta, with universal health care insurance. METHODS: Data on physician payments from January 1, 1994 to March 31, 2002 were used to calculate age-sex adjusted rates and patterns of use. RESULTS: The gastroscopy rate increased by 17%, from 9.7 (95% CI 9.6 to 9.9) to 10.3 (95% CI 10.1 to 10.5). The colonoscopy rate increased by 105%, from 4.8 (95% CI 4.6 to 5.0) to 9.8 (95% CI 9.6 to 10.1). Flexible sigmoidoscopy rates declined by 10%, from 4.68 (95% CI 4.56 to 4.80) to 4.21 (95% CI 4.11 to 4.32). The increase in colonoscopy rates occurred in all age groups, whereas gastroscopy rates increased only in the older age groups. Regional variation in procedure rates was evident, but rural health regions did not have consistently lower rates than the large urban regions. A polypectomy was performed on 23.7% of male patients and 15.4% of female patients at time of colonoscopy. Rates of polypectomy for individual endoscopists ranged from 0% to 60%. CONCLUSIONS: There has been a marked increase in gastroscopy and colonoscopy rates, likely due to a broadening of indications rather than just increased use for cancer screening. Modest regional variation in rates exists, but there is no direct evidence of limited rural access to endoscopy. Reasonable polypectomy rates were seen but important variations between endoscopists exist.

Adult↗
PubMed1995

Prospects for the secondary prevention of colorectal cancer: screening by flexible sigmoidoscopy?

It may be useful to draw an analogy between the proposed screening programme for colorectal cancer and the cervical cancer screening programme. Both tumours show a spectrum of histological abnormalities consistent with a premalignant phase. The natural history of these premalignant lesions is poorly understood and although some will progress, if untreated, to invasive disease, most will not. Light microscopy cannot confidently distinguish which cases will progress and which will regress, and clinicians are therefore obliged to treat all. This will result in the destruction of many lesions of uncertain malignant potential. The secondary prevention of cervical cancer, although therapeutically efficacious, is inefficient. A lack of understanding of the natural history of intraepithelial neoplasia has frustrated attempts to develop rational referral criteria, and it is only now that the appropriate trials are being undertaken. The development of outpatient investigative and therapeutic procedures has resulted in many more women being referred for investigation and treatment, with predictable pressure on other services offered by gynaecologists, but no demonstrable saving of life. Similar uncertainties surround a screening programme for colorectal cancer. The principal concerns are not about the efficacy of polypectomy in interrupting the polyp cancer sequence, although uncertainties about the frequency with which cancer arises de novo do require that the effectiveness of this intervention is formally tested. Our major concerns are with compliance, and the management of the individual who tests positive--that is, who is found to have a distal polyp. Technological advances and operator enthusiasm may, as has happened with the cervical screening programme, lead to a relaxation in the indications for further investigation and treatment. Such a development would affect resources substantially if a population screening programme were in place. Nevertheless, there are grounds for believing that a screening programme for colorectal cancer, using sigmoidoscopy, might be successful in certain age groups if compliance was satisfactory. The scale of benefits may be comparable with those achieved by the breast screening programme. Our limited cost analysis, which relates to only to specific items of clinical activity, suggest that the mean cost for each case of cancer prevented will be about 8000 pounds sterling. These conclusions suggest that screening by flexible sigmoidoscopy merits serious consideration. It is also imperative, however, that consideration should be given to resolving some of the uncertainties about the clinical management and surveillance of those found to have distal polyps.

Age Factors↗
PubMedDate not supplied

Predictors of incomplete flexible sigmoidoscopy.

OBJECTIVES: Flexible sigmoidoscopy (flex sig) is an easily administered method of screening for colorectal polyps and cancer. In some patients, the depth of insertion is incomplete, which may result in missed polyps and cancers. To address the question of prospective patient selection for this procedure, we analyzed the factors affecting depth of insertion of sigmoidoscopies performed in outpatients over a 3-year period. STUDY DESIGN: The study involved retrospective chart review of procedures performed by one endoscopist over a 3-year period. OUTCOMES MEASURED: Variables that might affect the extent of depth of insertion of the flexible sigmoidoscope. RESULTS: We developed separate logistic regression models of incomplete depth of insertion for women and men because sex was an effect modifier for many factors. For women, incomplete depth of insertion was related to inadequate preparation [odds ratio (OR) 3.59; 95% confidence interval (CI), 1.66 to 7.78]. Comparisons were made with the lowest risk group-women younger than 70 years with no hysterectomy. For women younger than 70 years, those with a hysterectomy were more likely to have an incomplete examination (OR 6.89; 95% CI, 2.68 to 17.73). For women 70 years and older, the odds ratio for women with a hysterectomy (OR 2.68; 95% CI, 0.96 to 7.46) was similar to that of women without a hysterectomy (OR 4.79; 95% CI, 2.27 to 10.12). For men, incomplete depth of insertion was related to age older than 75 years (OR 6.51; 95% CI, 1.72 to 30.40), history of abdominal surgery (OR 3.15; 95% CI, 0.95 to 10.41), and weight loss (OR 9.62; 95% CI, 1.98 to 46.67). CONCLUSIONS: Our study showed a relationship between incomplete examination and increasing age, female sex (more than 75% of the incomplete examinations were in women), poor bowel preparation (in women), hysterectomy, abdominal surgery (in men) and weight loss (in men). Further research is necessary to determine whether a predictive model can be developed that would be useful to select patients most appropriate for flex sig. In those patients in whom difficulty is anticipated, the choice can be made in to perform flex sig under sedation, analgesia, with the help of distraction techniques, or offer primary colonoscopy.

Age Factors↗
PubMed1980

Screening of patients after surgery for colorectal carcinoma: value of faecal occult blood testing and flexible sigmoidoscopy.

Sixty asymptomatic patients aged less than 65 years, who had survived for more than two years after resection for colorectal carcinoma were tested for faecal occult blood loss using Hemoccult-II (six slides). In 55 patients, a double-contrast barium-enema X-ray examination was also performed, and 41 patients underwent flexible sigmoidoscopy. In two cases a positive Hemoccult result was obtained and no colonic lesion was found in one of these patients. Six patients who gave a negative Hemoccult result were found to have adenomatous polyps. Faecal occult blood testing is unsatisfactory for detection of polyps. Flexible sigmoidoscopy is a rapid and safe examination and complements radiology in the screening of patients.

Colonic Neoplasms↗
PubMed2002

Flexible sigmoidoscopy screening for colorectal neoplasia in average-risk people: evaluation of a five-year rescreening interval.

OBJECTIVE: To determine the prevalence of colorectal neoplasia detected by rescreening people with average risk five years after initial screening by flexible sigmoidoscopy. DESIGN: Prospective survey of results of a colorectal cancer screening program. PARTICIPANTS: People aged 55-64 years with no symptoms or family history of colorectal cancer who were recruited from the community for flexible sigmoidoscopy screening five years previously (July 1995 to December 1996) and had no colorectal neoplasms detected. SETTING: Fremantle Hospital, Western Australia, a community-based teaching hospital, December 2000 to June 2001. MAIN OUTCOME MEASURES: Number and size of colorectal neoplasms (adenomas or cancer) compared between rescreened patients and initial screening population (all 982 people screened between July 1995 and December 1996). RESULTS: 803 people were eligible for rescreening; 138 were no longer at the recorded address, and 361 of the remaining 665 (54%) were rescreened. Rescreening found a significantly lower prevalence of colorectal adenomas than initial screening (8% [95% CI, 5%-11%] versus 14% [95% CI, 13%-15%]; P < 0.05) and also a lower percentage of adenomatous polyps over 5 mm in diameter (32% [95% CI, 15%-49%] versus 51% [95% CI, 46%-56%]; no significant difference). CONCLUSION: Average-risk people who have been screened for colorectal neoplasms, with none found, have a low prevalence of neoplastic lesions five years later. Longer rescreening intervals need to be considered.

Ambulatory Care↗
PubMed2002

Outcome of 5,000 flexible sigmoidoscopies done by nurse endoscopists for colorectal screening in asymptomatic patients.

OBJECTIVES: There have been several studies to date establishing the efficacy of nurse endoscopists in colorectal screening. However, no such study has ever been conducted in Hawaii. Utilizing the large sample size of our study, we hope to further support endoscopy by nurses as both a safe and cost-effective means of screening for colon cancer. METHODS: This is a retrospective study of the results of more than 5,000 flexible sigmoidoscopies done by nurse endoscopists in the colorectal screening clinic at Kaiser Hospital in Honolulu, Hawaii, between November 1995 and February 2001. These results were separated into normal, non-neoplastic polyps, adenomas, and cancer. RESULTS: The rate of detection of polyps was 13.3% (non-neoplastic and adenomas). Colon cancer was detected in 15 patients (.3% detection rate), of which 8 were carcinoma in situ, 3 were Dukes A, 2 were Dukes B1/B2, and 2 were Dukes C2. Clinically significant lesions (i.e. carcinoma, large adenomas, or atypical adenomas) were found in 1.8% of all patients. There were 8 carcinoids, 1 lipoma, 2 condylomas, and 3 leiomyomas detected. For patients who underwent colonoscopy, no other significant lesions were found in the areas examined by nurse endoscopists. There were no complications, i.e. perforation, bleeding, infection, and death, in any of the patients. CONCLUSION: The results of our study emphasize the importance of being screened for colorectal cancer. Nurse endoscopists can safely and effectively perform screening flexible sigmoidoscopies. By training more nurse endoscopists, we can increase the rate of colorectal screening in a cost-effective manner.

Aged↗
PubMed1999

Colorectal cancer screening with sigmoidoscopy: primary care issues.

Colorectal cancer is the second leading cause of death from cancer in the U.S., behind lung cancer. Numerous medical societies recommend routine screening for colorectal cancer with flexible sigmoidoscopy for people 50 and over. But who will perform the procedure, and who will pay for it? The case of flexible sigmoidoscopy illustrates the economic and practical issues of introducing a screening procedure into primary care practice. This Issue Brief investigates the role of primary care physicians in providing this service as part of routine care, and identifies attitudinal and financial barriers to overcome.

Adult↗
PubMedDate not supplied

[Role of flexible sigmoidoscopy in the early detection of colorectal tumors].

In a large endoscopic population screening study for colo-rectal polyps and cancer among 2,080 average-risk asymptomatic or with minor GI symptoms, adults of both sex, average age 56.2, were submitted to flexible sigmoidoscopy 60 cm as part of a preventive medical checkup. Procedure was very effective: 349 polyps were detected in 276 patients, with a total polyp incidence of 13.3%. In 174, more than 60% of such cases, endoscopic polypectomy was performed: 118 were tubular benign adenomas, 57 hyperplastic, 7 mixed types adenomas, 3 carcinomas in situ Dukes A, 2 villous adenomas one of them malignant, one leiomyoma and one rectal carcinoid. All in situ malignant polyps were removed endoscopically with excellent results. There was a high incidence of polyps (13.04%) in group aged 40-49, therefore changes on criteria for initiating routine flexible sigmoidoscopy must be considered. FOB tests (guaiac) showed a very low specific rate for diagnosis since only 24 out of 276 polyps bearing patients showed positive results, probably due to the fact that most polyps were non-ulcerating and small lesions. One third of the total polyps were out of the reach of the rigid scope and this procedure should be excluded in all screening programs of this type. Endoscopic polypectomy should be always an early procedure. In order to decrease the number of nondetected right side colonic lesions, non accessible to the 60 cm flexible scope, at time of polypectomy a simultaneous colonoscopy should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1992

Flexible sigmoidoscopy in asymptomatic patients with negative fecal occult blood tests.

BACKGROUND: Although the American Cancer Society and others have established guidelines for colorectal cancer screening, questions of who and how to screen still exist. METHODS: A 60-cm flexible sigmoidoscopy was performed on 1000 asymptomatic patients, 45 years of age or older, with negative fecal occult blood tests, who presented for routine physical examinations. Patients with clinically significant lesions were referred for colonoscopy. The proportion of lesions that would not have been found if the 24-cm rigid or the 30-cm flexible sigmoidoscope had been used was identified. RESULTS: Using the 60-cm flexible sigmoidoscope, lesions were found in 3.6% of the patients. Eighty percent of the significant lesions were beyond the reach of the 24-cm rigid sigmoidoscope and 37% were beyond the reach of the 30-cm sigmoidoscope. Thirty-six patients with lesions were referred for colonoscopy; additional lesions were found in 14%. A total of 62 lesions were discovered, including tubular adenomas, villous adenomas, tubular villous adenomas (23 of the adenomas with atypia), and one adenocarcinoma. The highest percentage of lesions discovered were in the sigmoid colon and the second highest percentage were in the ascending colon. CONCLUSIONS: The 60-cm flexible sigmoidoscope was able to detect more lesions than either the 24-cm or 30-cm sigmoidoscope when used in asymptomatic patients, 45 years of age and over, with negative fecal occult blood tests. When significant lesions are discovered by sigmoidoscopy, colonoscopy should be performed.

Adenocarcinoma↗
PubMed1991

[The clinic diagnostic value of the rigid sigmoidoscopy].

Rigid sigmoidoscopy is beneficial as it detects rectal or distal sigmoidal lesions very efficiently and precisely. But it also has some complications, e. g. rectal injury, rectal perforation or transient bacteremia. In this prospective study, 800 cases were collected and divided into two groups. In group I, 400 O.P.D. symptomatic cases were chosen randomly and in group II 400 cases registered for routine physical examination were picked up. The positive detection rate was 7% in group I versus 2% in group II. The lesions detected in group I are 15 cases of cancer, 7 cases of polyp, 4 cases of irradiation proctitis, 2 cases of ulcerative colitis and 1 case of pseudomembranous colitis. Only 8 polyps are found in group II. The routine sigmoidoscopy is mandatory for symptomatic patients but it is not cost-effective for routine check-ups. The stool occult blood is the best screening test for detecting colorectal lesions. For routine physical examination, stool occult blood test is safe and easy to perform. If the stool occult blood test is positive, then further examinations will be necessary.

Adolescent↗
PubMed1990

Inguinal hernia complicating flexible sigmoidoscopy.

Flexible sigmoidoscopy has become part of routine preoperative workup for patients over the age of fifty who present with an inguinal hernia. A recent experience with two patients with a left inguinal hernia allowing sigmoid colon to herniate into the scrotum bring awareness of the possibility for an increased risk of perforation of the sigmoid colon during flexible sigmoidoscopy, or possible iatrogenic incarceration of the hernia. These cases are presented so this clinical entity can be recognized and the complications prevented.

Barium Sulfate↗