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PubMed2000

The impact of open access flexible sigmoidoscopy: a comparison of two services.

BACKGROUND: Open access flexible sigmoidoscopy (OAFS) is an integral part of colorectal cancer services. This study compares the impact of two types of open-access flexible sigmoidoscopy services on the utilisation of barium enema and tumour-stage migration. METHODS: This was a non-randomised comparison (over two one-year periods, four years apart) of two unselected groups of patients, with different inclusion criteria, in adjacent similarly populated health districts. One offered a nurse practitioner endoscopy service while the other had a doctor-led colorectal clinic. RESULTS: The doctor-led service with its broad inclusion criteria detected more colorectal cancers [13.2% versus 0.7%; OR = 16.05; 2.16-119.2]. Neither nurse practitioner (130 cases) nor doctor-led (262 cases) flexible sigmoidoscopy reduced the total number of barium enemas [Odds Ratio (OR) = 1.16 (95% CI 1.03-1.3)]. However, the doctor-led service did reduce the number of barium enemas requested by general practitioners (from 249 to 152). The total number of colorectal cancers (detected by all available methods) were similar [OR = 0.82 (0.53-1.25)] and both services resulted in a similar tumour-stage migration [OR = 1.39 (0.31-6.23)]. CONCLUSION: Open access flexible sigmoidoscopy services have minimal impact on the utilisation of radiology services. Broader inclusion criteria of doctor-led services produce a higher cancer-yield. Tumour-stage migration may be related to greater awareness of colorectal cancer symptoms rather than to the type of OAFS.

Barium Sulfate↗
PubMed2001

[Flexible sigmoidoscopy in Denmark. A questionnaire].

AIM: To assess the use of flexible sigmoidoscopy in Denmark in 1997. METHODS: A country wide questionnaire was mailed to all hospitals and specialists in surgery and gastroenterology. RESULTS: The response rate was 96%. Thirteen thousand one hundred and eighty-one flexible sigmoidoscopies were done. However, this number was much too small in order to examine all persons with colonic symptoms. Two severe complications were reported. CONCLUSIONS: A substantial extension of the flexible sigmoidoscopy service is needed to comply with the recommendations from the Danish National Board of Health to replace rigid proctoscopy with flexible sigmoidoscopy in the diagnostic strategy.

Abdominal Pain↗
PubMed2001

The topography of colorectal cancer varies by race/ethnicity and affects the utility of flexible sigmoidoscopy.

Colorectal cancer screening beginning at age 50 is recommended for all Americans considered at "average" risk for the development of colorectal cancer either with flexible sigmoidoscopy and fecal occult blood testing (FOBT) or with colonoscopy. Patients who elect flexible sigmoidoscopy and FOBT undergo full colonoscopy only if left-sided neoplasia is detected or if the FOBT is positive. Unfortunately in blacks and whites most right-sided colorectal lesions are unaccompanied by left-sided sentinel lesions, which leads some to prefer colonoscopic screening in these patients. The topography of colorectal cancer in Asians and Latinos is unavailable. We used 1988-1995 California Cancer Registry data to determine the topography of 105,906 consecutive colorectal cancers among Asian, black, Latino, and white patients. We found that the proportion of colorectal cancer distal to the splenic flexure and therefore detectable by flexible sigmoidoscopy varied by ethnicity: Asian (71%) > Latino (63%) > white (57%) > black (55%); P < 0.001. These differences were significant after adjusting for age and sex. The risk of distal disease relative to whites was 1.61 in Asians, 1.15 in Latinos, and 0.82 in blacks (P < 0.001). Flexible sigmoidoscopy detects a higher proportion of colorectal cancers in Asians and Latinos than in whites or blacks. Further study is needed to assess whether the topography of benign colorectal neoplasia parallels that of malignant disease. Colorectal screening recommendations may need to incorporate racial and ethnic differences in colorectal neoplasia topography.

Adenocarcinoma↗
PubMed2000

Screening sigmoidoscopy: a randomised trial of invitation style.

OBJECTIVES: To examine uptake rates for screening sigmoidoscopy and whether offering prior consultation about sigmoidoscopic screening improves the uptake rate. DESIGN: Patients between 50.5-60.5 years of age registered with one practice were identified and offered screening sigmoidoscopy. Patients were randomly allocated to one of two groups. The first group was sent an invitation to have screening sigmoidoscopy along with an explanatory leaflet. The second group was sent the same invitation and leaflet but with an added option to discuss the test in the first instance with their general practitioner. Response rates (regarding reply to initial invitation and subsequent attendance for screening) in the two groups were measured. SETTING: Urban General Practice, Dundee, Scotland, UK. RESULTS: The overall uptake rate was low at 24%. Significantly fewer people in the second group (i.e. those with the option to discuss first) replied to the initial invitation. Assessing those who did reply, there was no difference between the two groups in numbers who thereafter went on to attend for screening. Only two percent of people took up the offer to find out more about the test from their general practitioner. CONCLUSIONS: The offer of flexible sigmoidoscopy as a screening test for colorectal cancer generates little interest in this population at present and compliance rates are low. The offer of prior consultation about the procedure with a patient's own general practitioner is not sufficient to generate interest. These results highlight potential difficulties with the introduction of a mass screening program.

Family Practice↗
PubMed1992

Flexible sigmoidoscopy screening in an industrial setting.

Little is known about the yield of colorectal cancer screening programs in an industrial setting. We therefore established a flexible sigmoidoscopy screening program at a chemical manufacturing plant and offered testing to all employees over the age of 40. After a Fleet enema preparation had been administered, a digital rectal examination and sigmoidoscopy were performed on each volunteer worker in the medical office of the plant. The plant had an average census of about 650 workers; 202 were screened during a 2-yr period. The mean (+/- SEM) age of participants was 52 +/- 0.4. Sixty-four employees had polyps (31.7%); data on follow-up colonoscopy were available in 69%. Colonoscopy revealed adenomatous polyps in 23 workers (53.5%), hyperplastic polyps in 10 (23%), and no evidence of neoplasia in 10 (23%). Seven workers did not arrange for follow-up colonoscopy and 12 individuals could not be contacted. No cancers were detected. In the 40- to 50-yr age group, polyps were detected in 19.5% of employees (25% adenomatous). Incidental findings were common, and included prostatic nodules, hemorrhoids, diverticulosis, and proctitis, among others. We conclude that screening sigmoidoscopy can be conveniently and economically performed at the workplace, with a high yield and good worker acceptance. The high yield suggests a possible association between polyp formation and work in a chemical plant. The finding of adenomatous polyps in the younger patients suggests that the threshold for flexible sigmoidoscopy at age 50 needs to be reassessed.

Adult↗
PubMed1992

[Is flexible sigmoidoscopy as preventive measure for colorectal carcinoma in asymptomatic patients over 45 practicable?].

The efficacy of flexible sigmoidoscopy as a screening method for colorectal cancer is still undetermined, and a reduction in mortality due to this cancer by mass screening has not been demonstrated so far. An important precondition for the practicability of screening sigmoidoscopy is its acceptability by the persons to be screened. Acceptability was tested in 294 volunteers without abdominal symptoms from a general medical outpatients clinic. Mean age of participants was 58 years (45-86), 65% were men and 35% women. Sigmoidoscopy was judged harmless by 221 persons (75.1%), painful by 62 (21.1%), very painful by 11 (3.7%), and unacceptable by none. Every participant would have agreed to repeat the examination. In 36 patients 52 polyps were detected, comprising one carcinoma, 18 adenomas (in 15 patients), 32 hyperplastic polyps and one lipoma. We conclude that sigmoidoscopy was well accepted in this study and should be evaluated further as a mass screening method for colorectal cancer.

Aged↗
PubMed1991

The practice outcomes of a course in flexible sigmoidoscopy for primary care physicians.

A mail survey of 430 participants in a 2-day course on flexible sigmoidoscopy presented over the past 6 years was conducted to determine the extent to which flexible sigmoidoscopy was subsequently utilized in physician practice. Eighty percent of respondents performed the procedure in their practices on a regular basis. Two-thirds of the patients underwent sigmoidoscopy for screening. The course in flexible sigmoidoscopy appears to potentiate the motivation of primary care physicians to incorporate complete colorectal cancer screening in their practice.

Education, Medical, Continuing↗
PubMed1988

Use of rigid and flexible sigmoidoscopy by family physicians in the United States.

To investigate the incidence of use of the flexible and rigid proctosigmoidoscopes by family physicians, a questionnaire was mailed to 1,585 randomly selected members of the American Academy of Family Physicians. Of the total of 1,057 respondents, 48 percent performed sigmoidoscopy, with 30 percent performing flexible sigmoidoscopy, 31 percent performing rigid sigmoidoscopy, and 48 percent performing at least one of the procedures. Younger physicians were found to be more likely to perform flexible sigmoidoscopy, as were physicians who practice in communities of fewer than 500,000 population. Nationwide, more of the flexible procedures are performed in private offices than in the hospital. Physicians in communities of less than 500,000, however, are more likely to use the flexible sigmoidoscope in a hospital setting than are physicians in larger urban areas [corrected]. Board-certified physicians were more likely to perform one or both procedures than were noncertified physicians.

Family Practice↗
PubMed1988

Training primary care physicians in flexible sigmoidoscopy--performance evaluation of 17,167 procedures.

The flexible fiber-optic sigmoidoscope is rapidly replacing the rigid sigmoidoscope in routine screening for colorectal cancer. This study was undertaken to evaluate the safety, usage pattern, and efficacy of fiber-optic sigmoidoscopy by evaluating the outcome of training and the results of procedures carried out by a group of primary care physicians. Of 1,153 participants in one-day flexible sigmoidoscopy workshops, 764 (66%) returned questionnaires evaluating their experiences following this training. Of these, 438 physicians had obtained a flexible sigmoidoscope, used it frequently, and had done a total of 17,167 examinations. The average time of scope usage was nine months. Although additional supervised training was suggested at the time of the workshop, 68% of physicians began doing flexible sigmoidoscopy without it. A total of 465 polyps and 153 cancers were detected by the study group for an overall detection rate of 2.7% for polyps and 0.9% for cancers. Four complications were reported. This study indicates that the technique of flexible sigmoidoscopy is readily learned, is diagnostically productive, and is reasonably safe in the hands of primary care physicians.

Education, Medical, Continuing↗
PubMed1983

Anatomical extent of fiberoptic sigmoidoscopy.

The anatomical extent of fiberoptic sigmoidoscopy was determined by placing a clip on the colonic mucosa and subsequently locating the clip on barium enema. A 60 cm exam viewed the entire sigmoid colon in 81% of patients. Exams of 50-55 cm, 40-45 cm, and 30-35 cm extent viewed the entire sigmoid colon in 68%, 27%, and 13%, respectively. The 50-55 cm and 60 cm exams collectively viewed 90% and 95% of the sigmoid colon surface, respectively. The 30-35 cm and 40-45 cm exams collectively viewed 53% and 70% of the sigmoid colon surface respectively. The anatomical extent of fiberoptic sigmoidoscopy clearly exceeds that of rigid sigmoidoscopy. These data help to define the diagnostic potential of fiberoptic sigmoidoscopy.

Adult↗
PubMed1993

Small polyps found at sigmoidoscopy: are they significant?

In this study we prospectively examined the significance of small polyps found at screening flexible sigmoidoscopy and studied in particular, the possibility that hyperplastic polyps in the rectosigmoid can serve as potential markers for neoplastic polyps proximal to this area. During the last three years we performed sigmoidoscopy on 1500 patients. One hundred and five patients (7%) had one or more polyps in the rectosigmoid. Exclusion criteria were polyps of > 1 cm in size, a history of bleeding, inflammatory bowel disease or past polypectomy. After excluding 30 patients, 75/1500 (5%) patients with small polyps remained in the study. All these patients were submitted to total colonoscopy with removal of all polyps found. Histopathology showed that 45/75 (60%) patients had hyperplastic polyps and 30/75 (40%) had at least one adenomatous polyp. Among the 45 patients with hyperplastic polyps at flexible sigmoidoscopy, 16 (35.5%) had a more proximal adenomatous polyp. Nine of the 30 patients (30%) who had at least one adenomatous polyp in the rectosigmoid were found to have them more proximally. We conclude that a) size alone is not an accurate predictor of the histology of the polyp, b) because small polyps, either hyperplastic or adenomatous, in the rectosigmoid indicate a risk for adenomatous polyps more proximally, all patients with small polyps found during flexible sigmoidoscopy should be submitted to total colonoscopy.

Adenoma↗
PubMed1998

'One-stop' rectal bleeding clinics without routine flexible sigmoidoscopy are unsafe.

Over 90% of patients referred to surgeons for investigation of rectal bleeding have haemorrhoids, fissure-in-ano or proctitis. Full investigation of these patients to exclude colonic neoplasia or inflammatory bowel disease imposes a considerable load on a hospital's resources as well as exposing the patient to significant inconvenience and morbidity. A 'one-stop' outpatient clinic was established, with selective use of flexible sigmoidoscopy, based on the judgement and clinical findings of a single experienced surgeon. Over a 4 month period, 344 patients were assessed, and 326 were identified as not needing flexible sigmoidoscopy. At 3 and 6 monthly follow-up, 22 presented with persistent rectal bleeding and three previously unidentified cancers were found on performance of flexible sigmoidoscopy. If a 'one-stop' policy is to be used in the management of rectal bleeding, routine flexible sigmoidoscopy is essential for all patients.

Adult↗
PubMed1992

Open-access, flexible, fiberoptic sigmoidoscopy in a regional primary-care clinic.

We established an open-access, flexible, fiberoptic sigmoidoscopy service in an outpatient clinic in Kiriat-Shmona, Northern Israel. Twenty-eight general physicians in the city and in 41 surrounding rural residences (population 40,000) were encouraged to refer patients for sigmoidoscopy. In the first operative year, flexible sigmoidoscopy was performed on 255 patients (age range 10-90 years, mean 54). The male to female ratio was 123:132; women were slightly older than men (mean age 55.9 years vs. 51.1). Rectal bleeding and change in bowel habits were the most common indications. The sidmoidoscope was passed to the splenic flexure in 156 patients (61%). In five patients (2%) the instrument could not be inserted beyond the rectosigmoid junction. Excluding hemorrhoids and anal lesions, abnormalities were detected in 69 patients (27%). In 29 patients (11.4%) a cancer or polyp was found. Analysis of referral indications showed an increased positive predictive value for neoplastic lesions in patients referred for anemia (22.2%), weight loss (20.0%), abdominal pain (17.8%), and positive fecal occult blood test (15.4%). There were only two patients with polyp or cancer of 55 (3.6%) < 40 years of age, in contrast to 27 of 200 (13.5%) > 40 (p < 0.05). Sixty-six patients underwent further investigation, and 26 had positive results: colonic lesions were confirmed in 20 patients, sigmoid colon cancer was found on barium enema in one, and lesions outside the colon were detected in seven. Such open-access, flexible sigmoidoscopy gave higher yield for colorectal polyps or cancers than open-access or hospital-initiation barium enema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

Fiberoptic pansigmoidoscopy. An evaluation and comparison with rigid sigmoidoscopy.

A flexible 60-cm fiberoptic sigmoidoscope was evaluated in 139 patients. In 120 patients flexible sigmoidoscopy was compared with routine rigid sigmoidoscopy with respect to patient tolerance, distance of inspection, procedure time, and diagnostic yield. All patients were prepared with a single cleansing enema, and given no analgesia. Despite the fact that the flexible instrument was inserted nearly 3 times as far into the colon (55 cm versus 20 cm), more patients preferred the flexible examination. Significant pathological lesions were discovered by the flexible examination in 39% of patients, whereas rigid sigmoidoscopy discovered lesions in only 13%. Fluoroscopy performed during flexible sigmoidoscopy in 19 additional patients revealed that the instrument tip had reached the descending colon or beyond in 84% of patients. There were no complications. The flexible fiberoptic pansigmoidoscope offers promise as a practical diagnostic tool for a rapid and complete examination in patients with suspected colorectal diseases.

Adolescent↗
PubMed1997

A sigmoidoscopy-based case-control study of polyps: macronutrients, fiber and meat consumption.

We conducted a large, sigmoidoscopy-based case-control study to examine the relation of intake of macronutrients, meat, and fiber to occurrence of adenomas of the large bowel. Cases were subjects diagnosed for the first time with one or more histologically confirmed adenomas. Controls had no polyps of any type at sigmoidoscopy, had no history of polyps, and were individually matched to cases by gender, age, date of sigmoidoscopy, and Kaiser Center. The response rate was 84% for cases and 82% for controls. Complete dietary data for 488 matched pairs were available. All odds ratios are from matched analyses adjusted for energy. We observed positive associations with risk of adenomas for calories, animal fat, saturated fat, red meat, and the ratio of red meat to poultry and fish. Protective effects were observed for vegetable protein, carbohydrates, and dietary fiber. The fiber effects diminished after adjusting for fruits and vegetables. Results after mutually adjusting for the effects of saturated fat, fiber and the ratio of red meat to chicken and fish suggest that each of these variables has an effect on risk of adenomas that is independent of the other 2 exposures.

Aged↗
PubMed1989

The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure.

Results from the consecutive examination of 675 patients using both flexible sigmoidoscopy and a double-contrast x-ray technique were analyzed with special reference to the detection of polyps in the rectum and sigmoid colon. A total of 193 polyps were found. Histological examination of 93 polyps revealed that half of those less than 5 mm in diameter and 93.3% of those more than 6 mm in diameter were adenomas. The x-ray examination failed to detect 44% of the proven adenomas smaller than 5 mm, 35.3% of those 6-10 mm in size, and 16.7% of those larger than 11 mm in diameter. These rates were significantly higher than those of flexible sigmoidoscopy, which had corresponding miss rates of 8, 11.2, and 0%, respectively. The double-contrast barium enema (DCBE) failed to detect every second polyp in the rectosigmoid. Every second polyp in the same region proved to be adenoma. The DCBE combined with flexible sigmoidoscopy gives the most reliable and precise diagnosis of various disorders of the rectum and sigmoid colon.

Adolescent↗
PubMed1997

Screening for colorectal neoplasia with faecal occult blood testing compared with flexible sigmoidoscopy directly in a 55-56 years' old population.

Reduced mortality from colorectal cancer may be achieved by screening with faecal occult blood testing. Screening for neoplasia in the rectum and sigmoid colon with flexible sigmoidoscopy is suggested to be more effective, particular among persons between 50 and 60 years of age. A cohort of 6367 persons 55-56 years of age were randomised to screening with rehydrated Hemoccult II tests (HII group) or with flexible videosigmoidoscopy directly (FS group). In the HII group 59% (1893/3183) attended, compared to 49% (1353/3184) in the FS group. Of the 1893 persons who attended in the HII group, 4% had a positive HII test and in 13% (10/78) of them a neoplasm > or = 1 cm in the rectum or sigmoid colon was diagnosed by endoscopy. The corresponding rate in the FS group was 2.3%. Overall the number of persons with a neoplasm > or = 1 cm diagnosed in the HII group was 10 and in the FS group 31. A subgroup in the flexible sigmoidoscopy group, who also performed rehydrated HII tests, showed a sensitivity of the HII test for neoplasia > or = 1 cm of 26% and a specificity of 95.6%. To find a neoplasm > or = 1 cm in the rectum or sigmoid colon, 44 examinations were needed when using flexible sigmoidoscopy directly and 7 examinations when only those with positive HII tests were examined. In mass screening for neoplasia in the rectum and sigmoid colon, the relatively low prevalence of colorectal neoplasia at 55-56 years of age makes primary selection with rehydrated Hemoccult testing an alternative to the resource-consuming endoscopy of all invited persons.

Adenoma↗
PubMed2006

Rigid sigmoidoscopy: a potential hazard for cross-contamination.

BACKGROUND: Rigid sigmoidoscopy using a disposable or nondisposable sigmoidoscope is a common outpatient procedure. It has been assumed that the nondisposable bellows and light head of the sigmoidoscope remain free from enteric organisms so that the procedure is sterile if a disposable or nondisposable (metal) sigmoidoscope shaft is used. The aim of this study was to identify the presence of organisms within the bellows or light head of the sigmoidoscope. METHODS: Of 21 patients undergoing rigid sigmoidoscopy with a disposable instrument, bacterial cultures were taken from the inside of sterile Jackson-Pratt bulbs in 12 patients, with the bulbs being used to simulate the nondisposable insufflation bellows. In an additional nine patients, swabs were taken for culture from the inside of the nondisposable light head. RESULTS: Enteric gram-negative Escherichia coli and mixed anaerobic organisms were cultured from the Jackson-Pratt bulbs in two cases, and gram-positive organisms were cultured in another case. Gram-negative organisms, including Bacillus, Proteus mirabilis, Klebsiella, and Enterococcus faecalis, were cultured from the inside of the light head in two cases. CONCLUSION: Sigmoidoscopy using a disposable instrument is not a sterile procedure and may pose a risk of patient-to-patient cross-contamination by potentially harboring organisms in the bellows or light head.

Cross Infection↗