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PubMed1989

Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding.

Eighty-seven outpatients with non-massive rectal bleeding or asymptomatic positive fecal occult blood were evaluated with 35 cm flexible sigmoidoscopy, double contrast barium enema (DBCE) and colonoscopy. 82% had hemorrhoids and 35% harbored colorectal neoplasia. The combination of flexible sigmoidoscopy and DCBE missed none of 7 malignant lesions. However, 36% of benign polyps greater than or equal to 1 cm and 60.25% of those less than 1 cm were not detected by this combination. The presence of hemorrhoids should not prevent a search for colon neoplasia and colonoscopy is the preferred method.

Adult↗

PubMedDate not supplied

A supervised training program in flexible sigmoidoscopy: evaluating skills from residency training to clinical practice.

To assess the effectiveness of a training program in flexible sigmoidoscopy for family practice residents, we prospectively studied the performance of four residents during their training and after graduation. One hundred and four training exams performed with the assistance of an experienced gastroenterologist were compared with 118 unassisted post-training, post-residency exams. The mean depth of insertion for the post-training period was 51.1 +/- 1.2 cm, which was significantly greater (P less than .05, Student's t test) than the mean training period depth of 47.6 +/- 1.2 cm. There was no significant difference in the identification of polyps or cancer between the training and post-training periods. The mean duration of an exam was 17.3 +/- 0.6 minutes in the post-training period. No significant complications were encountered in either period. The residency trained family physicians obtained results similar to those reported by trained endoscopists in depth of examination and pathology detected, although their examinations required more time. We conclude that this model of training was effective in the development of flexible sigmoidoscopy procedural skill for family practice residents.

Clinical Competence↗

PubMed1986

AAFP--ASGE conjoint course on flexible sigmoidoscopy.

The first multidisciplinary course developed jointly by the American Academy of Family Physicians and the American Society for Gastrointestinal Endoscopy is described. This prototype program was designed to teach the skills of 35 cm flexible sigmoidoscopy (FS) to twenty family physicians. Gastroenterologist preceptors determined that all 20 family physicians could perform this procedural skill within ten supervised cases. A control group of family physicians was studied to determine flexible sigmoidoscope acquisition frequencies in separate cohorts (Continuing Medical Education (CME) versus no CME on flexible sigmoidoscopy). The study group acquired instruments more frequently (18/19 = 95%) (p less than or equal to .05) than those with previous CME on FS (8/14 = 57%) or without previous CME on FS (2/19 = 11%). Two-thirds of these physicians purchased 60-65 cm flexible instruments rather than the 35 cm instrument. Longitudinal studies will be required to determine whether or not this intervention will have a meaningful impact upon colorectal cancer screening behaviors by primary care physicians.

Education, Medical, Continuing↗

PubMed1986

The long and short of flexible sigmoidoscopy: does it matter?

Physicians performing fiberoptic sigmoidoscopy may choose between a 35 and 60 cm instrument. Confusion and dispute exist concerning the advantages of one over the other. In an effort to resolve this question, 100 consecutive symptomatic patients were examined in an outpatient sigmoidoscopy clinic. Both the Olympus OSF-30 and Olympus OSF-60 flexible sigmoidoscopes were used on each patient alternately. Mean examination time, patient tolerance, diagnostic findings, instrument cost, physician training time, and insertion length were recorded and compared. The longer scope detected five more polyps and 25 additional cases of diverticulosis which were located beyond the reach of the shorter scope. The increased number of findings with the longer scope was expected; however, the increased number of polyps was not statistically significant. The additional number of findings with the longer scope was expected and with increased number of examinations the increased number of polyps may prove to be statistically significant. Neither instrument can substitute for colonoscopy in the overall management of colorectal neoplasms. We conclude that with adequate training and cost control, either instrument can be used for screening proctosigmoidoscopy; but the trend suggests a greater number of polyps are detected with the longer instrument.

Clinical Competence↗

PubMed1984

Continued assessment of flexible sigmoidoscopy in a family practice residency.

The UCLA Family Practice Residency continues to use 60-cm flexible sigmoidoscopy in the care of patients. Between July 1980 and June 1983, 450 patients received an examination with the 60-cm flexible sigmoidoscope. One or more adenomatous polyps were detected in 21 patients. Adenocarcinoma was found in five patients. Four patients were found to have a villous adenoma, and four patients were determined to have inflammatory bowel disease. Of the 34 discrete lesions, 32 percent, 41 percent, and 27 percent were located between 0 and 20 cm, 21 and 35 cm, and 36 and 60 cm, respectively, from the anus. No complications were encountered. Sixty-four percent of the examinations were done by a family practice resident supervised by a full-time faculty member. The remaining 36 percent of the examinations were performed by full-time faculty. The overall detection rate for significant pathology was 8.0 percent. Most pathology by far was found in symptomatic patients. These results validate the safety and viability of 60-cm flexible sigmoidoscopy when performed by properly trained family physicians and family practice residents-in-training.

Adenocarcinoma↗

PubMed1978

Sigmoidoscopy as a periodic screening test.

Available data suggest that routine screening procedures and removal of benign adenomatous polyps in all asymptomatic patients over the age of 40 to 50 years may significantly reduce both mortality and morbidity rates for colorectal carcinoma. Such data show that sigmoidoscopy is a valuable part of any screening program and can be performed at low cost and with minimal risk to the patient. It is concluded that an adequate routine screening program can be achieved with annual stool guaiac examination and sigmoidoscopy every five years between ages 40 and 50, and every three years over the age of 50 in asymptomatic patients. All patients with a history of colonic lesions must be seen more frequently because of the higher risk of recurrence.

Adult↗

PubMed1995

Rational approach to small polyps found on sigmoidoscopy.

Most colorectal cancers are thought to develop from benign adenomas. Because adenomas are found in a large proportion of asymptomatic individuals, most adenomas must remain benign. Current guidelines suggest that colonoscopy is not necessary when hyperplastic polyps are found at screening sigmoidoscopy. Existing data suggest that small adenomatous polyps may also not be associated with substantial risk of current or future malignancy. We suggest that small polyps seen on flexible sigmoidoscopy require neither biopsy nor subsequent colonoscopy. Such an approach requires further study, but could result in substantial cost savings, with modest risk to patients.

Adenomatous Polyps↗

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↗

PubMed1995

Demographic differences in African-American patients with neoplastic lesions detected by flexible sigmoidoscopy.

There is a higher incidence of colorectal cancer in young African-American patients compared with white Americans. This study examines the incidence, demographic pattern, and distribution of neoplastic lesions identified by flexible sigmoidoscopy in an African-American population. A sample of charts was reviewed from an urban gastroenterology practice that serves predominantly African Americans. A total of 455 patients were found who underwent flexible sigmoidoscopy. The sample included 391 symptomatic patients and 64 asymptomatic patients. Two hundred fifty-five patients were < 50 years old and 200 patients were > or = 50 years. More neoplastic lesions were found among older patients (21 patients: 14 with polyps and 7 cancers) than among younger patients (7 patients: 3 with polyps and 4 cancers); the difference of all positive findings between the two groups was significant. However, the cancerous rate for younger patients was not statistically different from that for older patients. These findings suggest that young African-American patients with colorectal symptoms should undergo aggressive approaches to detect cancer early.

Abdominal Pain↗

PubMed1996

Four-year evaluation of a direct-access fibreoptic sigmoidoscopy service.

Over a 4-year period, a direct-access fibreoptic sigmoidoscopy service was evaluated prospectively. In all, 756 patients were referred (median age 58 years, range 18-91 years). The principal indications were rectal bleeding (45%) or change of bowel habit (28%); both features were present in 13%. Abnormalities were present in 68% of examinations. Major disease was identified in 22% (carcinoma 7.0%, adenoma 6.3%, inflammatory bowel disease 8.3%) and minor disease in 53% (haemorrhoids 36.8%, severe diverticular disease 10.9%, non-adenomatous polyp 3.4%, perianal disease 1.4%). In patients under 40 years of age, major disease was rare (one carcinoma, three adenomas). Of the patients, 21% underwent barium enema for incomplete examination or suspected additional disease. No additional major disease was identified, but one carcinoma found in a patient with stricture. These data show that a direct-access fibreoptic sigmoidoscopy service produces a high diagnostic yield and may be of value to both patients and general practitioners in expediting a clinical colorectal service.

Adolescent↗

PubMed1997

Colon cancer screening. Sigmoidoscopy or colonoscopy.

Colorectal cancer is a common neoplasia with high morbidity and mortality. With endoscopy it is possible to identify its precursor lesion, the adenoma, and early localized cancer. Early detection and removal of adenomas can reduce the incidence and mortality of this disease. Studies using fecal occult blood testing (FOBT) and sigmoidoscopy for screening asymptomatic patients demonstrate a reduction in mortality from colorectal cancer. Colonoscopy, however, has the highest yield for detecting polyps. Most authorities and organizations now recommend screening the asymptomatic population over age 50 for colorectal neoplasia. The estimated cost of colon cancer screening is well within the benchmark figure of $40,000 per year of life saved, which is considered by the government to be cost effective. Controversies still exist regarding which colon cancer screening strategy is the most sensitive, specific, acceptable to the population, and cost effective. The American Cancer Society recommends a combination of FOBT and flexible sigmoidoscopy, but some experts believe that a one-time colonoscopy at age 60 may be a more cost-effective method. If the costs of colonoscopy are reduced, it is more cost effective than other techniques. Colonoscopy also may help to stratify at-risk patients, and those with negative initial colonoscopy may not need further screening. Advances in molecular biology may provide markers for screening or identifying people who are at high risk for colorectal neoplasia. This development may allow screening to be directed at high-risk groups.

Colonic Neoplasms↗

PubMed1999

Sigmoidoscopy. Is it a general practice procedure?

Sigmoidoscopy can readily be learnt and practised by a general practitioner interested in looking after patients with colorectal problems. Examination with a rigid sigmoidoscope has advantages over use of the flexible instrument for the frequent user. Details of the equipment needed for sigmoidoscopy as well as a method, precautions and some typical findings are described.

Colorectal 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

Barium enema versus colonoscopy for patients with polyps found during flexible sigmoidoscopy.

This prospective study compares the accuracy of barium enema examination performed by experienced radiologists to colonoscopy performed by experienced gastroenterologists blinded to the radiographic findings to detect proximal, synchronous lesions in patients with polyps detected during fiberoptic sigmoidoscopy. Three thousand six patients were examined, of whom 147 (5%) had polyps larger than 0.5 cm in diameter. Of 114 patients who completed the protocol, 46 patients (40%) had synchronous, proximal colonic lesions. There were no radiographic false positives, but the single-contrast barium enema missed polyps in 13 while detecting polyps in 2 patients (sensitivity = 13%). The double-contrast barium enema missed proximal polyps in 23 patients while detecting them in 8 (sensitivity = 26%). We conclude that patients with neoplastic polyps found during fiberoptic sigmoidoscopy should have colonoscopy without barium enema. If the entire colon cannot be examined at colonoscopy, we advise double-contrast barium enema.

Adenocarcinoma↗

PubMed1985

Physician compliance with colorectal cancer screening (1978-1983): the impact of flexible sigmoidoscopy.

Physician compliance with widely recommended colorectal cancer screening methods was studied over a five-year period in a university-based family medicine residency program. Indicated examinations were being avoided in symptomatic as well as asymptomatic patients aged over 50 years. The introduction of flexible sigmoidoscopy created significant change in previously documented poor resident and faculty compliance. Baseline measurement of outcomes was noted by audit of 189 adult medical records (year 1). Educational reemphasis by lecture and intragroup commitment produced no change by the end of year 2 (n = 189). Introduction of the flexible sigmoidoscope yielded a sevenfold increase in physician compliance in year 3 (n = 192). This compliance increased as measured by chart audit in years 4 (n = 166) and 5 (n = 190). All audited groups were mutually exclusive. The documented diagnostic superiority of this instrument was readily obtainable by family physician faculty and residents in training. With Papanicolaou smear activity serving as a control group, the findings indicated a significant and sustained effect. Two additional primary care training programs were audited during the final year of the study period. These control audits revealed continued poor compliance with rigid sigmoidoscopy. The flexible sigmoidoscope is an important addition to the diagnostic and screening armamentarium of a family medicine residency program.

Adult↗

PubMed1983

Flexible versus rigid sigmoidoscopy: a comparison using an inexpensive 35-cm flexible proctosigmoidoscope.

Seventy-one patients with symptoms of colorectal disease were evaluated with the rigid 25-cm sigmoidoscope and an inexpensive 35-cm flexible proctosigmoidoscope (American Optical FPS-2) to determine if the latter is a diagnostically reliable alternative for routine sigmoidoscopy. Examination time was comparable, 3.6 min for the rigid and 4.2 min for the flexible sigmoidoscope. Average insertion length was 21 cm for the rigid and 29.5 cm for the flexible instrument. Forty-two patients had more discomfort during the rigid versus nine during the flexible examination. Significant lesions were documented in eight patients with the rigid and 13 with the flexible sigmoidoscope. One rectal carcinoma and seven polyps were detected with both instruments, while an additional nine polyps were documented only with the flexible instrument. The 35-cm flexible proctosigmoidoscope may be a feasible alternative for routine sigmoidoscopy.

Colonic Diseases↗

PubMed1987

The role of flexible sigmoidoscopy in the preoperative screening of patients with inguinal hernia. A high yield of neoplasms.

Disagreement persists as to whether all patients with inguinal hernia should undergo screening examinations for colorectal cancers before hernia repair. The purpose of this study was to prospectively evaluate the effectiveness of flexible sigmoidoscopy (FS) as a screening examination for these patients. In an 18-month period, 110 patients with inguinal hernia (99% men) with an average age of 63 +/- 10 years underwent FS. Diverticulosis was found in 36% of the patients, colorectal polyps in 26%, and colorectal cancers in 3.6%. Occult blood was found in the stool of only 11% of these patients and, thus, was an ineffective screening test. These results suggest that FS is an effective means of screening for premalignant and malignant colorectal lesions in patients with inguinal hernias.

Colonic Neoplasms↗

PubMed1981

Outpatient flexible fibreoptic sigmoidoscopy, diagnostic yield and the value of glucagon.

One hundred patients had flexible fibreoptic sigmoidoscopy in an outpatient clinic after preparation with a phosphate enema but without sedation. Patients were randomized to receive 1 mg of glucagon intravenously or a matching placebo. The discomfort of the patients and the ease of the procedure were similar in both groups. Nine patients were excluded from the final analysis as they had low rectal or anal lesions. In the remaining 91 patients, abnormalities were found in 27 (29.6 per cent) including 16 adenomatous polyps and 1 carcinoma. Only 3 lesions were below 20 cm and might have been easily visualized using a rigid sigmoidoscope.

Clinical Trials as Topic↗