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PubMed1988

Short chain fatty acid distributions of enema samples from a sigmoidoscopy population: an association of high acetate and low butyrate ratios with adenomatous polyps and colon cancer.

We investigated the distribution of short chain fatty acids (SCFA) in enema samples taken from subjects before sigmoidoscopy as an indicator of possible microbial community differences between subjects subsequently diagnosed as normal or having colonic disorders. The major SCFA in all groups were acetic, propionic, and butyric acids. A significantly higher ratio of acetate to total SCFA and lower ratio of butyrate to total SCFA was found for polyp-colon cancer subjects than for normal subjects. There were no significant differences in the ratios of acetate, propionate, or butyrate between the diverticulosis or inflammatory bowel groups and the normal group. There were no significant sex differences nor were there correlations with the ratios of acetate, propionate or butyrate and age, subject weight, or dry weights of samples. Significant differences in concentrations of individual acids were found between normal and certain diagnostic groups. The difference in proportions of individual SCFA between groups suggest differences in fermentation patterns of the colonic microflora.

Acetates↗
PubMed2001

Flexible sigmoidoscopy and the changing distribution of colorectal cancer: implications for screening.

BACKGROUND AND AIMS: There has been a significant proximal shift in the distribution of colorectal cancer (CRC) in Northern Ireland over recent decades. The aim of this study was to investigate the potential implications of this proximal shift in CRC distribution on the efficacy of flexible sigmoidoscopy (FS) as a screening tool. PATIENTS AND METHODS: The site distribution of 5153 CRCs was available from the Northern Ireland Colorectal Cancer Register for the period 1990-1997. Similar data on 1241 CRCs between 1976 and 1978 were available from a previous study. Data on the site reached by FS were obtained from a prospectively collected endoscopy database at one of Northern Ireland's main teaching hospitals for the period 1993-1998. RESULTS: There was a significant proximal shift in CRC distribution between the two periods (23.5% proximal to the splenic flexure between 1976 and 1978 v 36.7% between 1990 and 1997; p<0.001). The descending colon was visualised during 74.4% of FS examinations. By combining the observed extent of FS examination with CRC site distribution, it was calculated that FS could have visualised 68.8% of CRCs between 1976 and 1978 but only 56.0% between 1990 and 1997. Extrapolating these data to a Northern Ireland screening programme involving FS and faecal occult blood testing suggests that significantly more CRCs could have been detected between 1976 and 1978 than between 1990 and 1997 (51.7% v 48.2%, respectively; p=0.03). CONCLUSIONS: This study confirms the previously documented left to right shift in CRC distribution in Northern Ireland and demonstrates that if this shift continues, FS will become less successful as a screening tool than is currently predicted.

Colorectal Neoplasms↗
PubMed1999

Estimating time and travel costs incurred in clinic based screening: flexible sigmoidoscopy screening for colorectal cancer.

OBJECTIVES: To identify the characteristics of mode of travel to screening clinics; to estimate the time and travel costs incurred in attending; to investigate whether such costs are likely to bias screening compliance. SETTING: Twelve centres in the trial of flexible sigmoidoscopy screening for colorectal cancer, drawn from across Great Britain. METHOD: Analysis of 3525 questionnaires completed by screening subjects while attending clinics. Information supplied included sociodemographic characteristics, modes of travel, expenses, activities foregone owing to attendance, and details of companions. RESULTS: More than 80% of subjects arrived at the clinics by car, and about two thirds were accompanied. On average, the clinic visit involved a 14.4 mile (22.8 km) round trip, requiring 130 minutes. Mean travel costs amounted to 6.10 Pounds per subject. The mean gross direct non-medical and indirect cost per subject amounted to 16.90 Pounds, and the mean overall gross cost per attendance was 22.40 Pounds. Compared with the Great Britain population as a whole, non-manual classes were more strongly represented, and the self employed less strongly represented, among the attendees. CONCLUSIONS: In relation to direct medical costs, the time and travel costs of clinic based screening can be substantial, may influence the overall cost effectiveness of a screening programme, and may deter potential subjects from attending.

Aged↗
PubMed2001

Design of a multicentre randomised trial to evaluate flexible sigmoidoscopy in colorectal cancer screening.

A randomised, controlled trial in progress in 14 United Kingdom and six Italian centres is evaluating screening for colorectal cancer using a single flexible sigmoidoscopy (FS) at around the age of 60 with removal during FS of all small adenomas, and colonoscopy for "high risk" polyps. The regimen aims to ensure that 95% of people (with either no polyps or only low risk polyps) complete the entire screening process in a single visit. This paper describes the rationale and design of the trial. Participants were patients aged between 55 and 64 on the lists of designated general practitioners (GPs) who were not excluded by their GP. A two stage recruitment procedure was employed to raise compliance rates in the intervention group. Potentially eligible persons were sent an "interest in screening" questionnaire; those who responded positively were randomised to the intervention or control groups. The trial is sufficiently large to estimate within narrow confidence intervals the magnitude of benefit and the duration of effect and optimum age for a single screen. It also examines the feasibility and acceptability of the screening regimen, and will identify training and quality assurance issues. Recruitment and screening are now complete and all baseline data have been collected. The first analysis of the effect on colorectal cancer incidence and mortality rates and suitability for a national screening programme can be expected in 2004.

Age Factors↗
PubMed1990

Enema or Picolax as preparation for flexible sigmoidoscopy?

Two preparations for outpatient flexible sigmoidoscopy, Picolax and Klyx enemas, have been compared in a randomized controlled trial. There was no difference in efficacy between the two preparations, but patients preferred Picolax.

Adolescent↗
PubMed2001

Colorectal cancer screening: video-reviewed flexible sigmoidoscopy by nurse endoscopists--a Canadian community-based perspective.

BACKGROUND: Colorectal cancer (CRC) is the third most common incident cancer and the second most fatal cancer in Canada. Flexible sigmoidoscopy (FS) is one of the modalities under consideration for CRC screening. The present series reports on a screening program of FS performed by nonphysician endoscopists in a Canadian community setting, with video review of procedures by physicians and recommendation of follow-up colonoscopy where polyps are identified. RESULTS: Five hundred twenty-five, average-risk, asymptomatic patients were examined. After exclusion of inappropriate referrals, 488 remained for analysis. The duration and extent of examination were comparable with those of previous studies elsewhere. Compliance with suggested follow-up was 97.3%. Polyps were identified at FS in 15.4% of examinees. In 8.2% of patients, the polyps were neoplastic at subsequent histology. Four malignant lesions were detected, all at an early stage. There were no complications of FS. INTERPRETATION: This report shows that FS can be carried out safely and effectively by nonphysician personnel in a community setting in Canada. The manpower cost for nonphysician operators is considerably less than that for specialist physician endoscopists. This approach deserves consideration in cost effectiveness analyses of CRC screening.

Aged↗
PubMed2002

Sigmoidoscopy-assisted colostomy--an adapted trephine stoma formation.

BACKGROUND/AIM: The purpose of this article was to report an adapted colostomy procedure that can be used on patients with multiple morbidities requiring fecal diversion. METHODS: An adapted colostomy was performed on a patient needing fecal diversion who had multiple surgical and medical complications. RESULTS: Thirteen weeks after colostomy placement, the patient's colostomy functioned well and was viable throughout his course without related complications. CONCLUSION: The method of sigmoidoscopy-assisted colostomy described here can be beneficial to the complicated patient needing fecal diversion but unable to tolerate a laparotomy or laparoscopy.

Aged↗
PubMed1988

The double contrast barium enema in the identification of proximal colonic adenomas and carcinomas beyond the limits of fiberoptic sigmoidoscopy.

Eight hundred and twenty patients were examined by fiberoptic sigmoidoscopy (SIG) and double contrast barium enema (DCBE) to detect colonic cancers or adenomas. Cancer or adenoma in the bowel tract proximal to the upper limit of SIG insertion was detected in 4 patients and in 12 on DCBE. The DCBE detection rate of proximal colonic lesions varied according to the hemoccult (HO) outcome. This was 1.16% for cancer and 2.03% for adenoma in HO+ patients and null for cancer and 1.23% for adenoma in HO- patients. The detection rate of proximal adenomas was higher in patients who presented adenomas on endoscopy in the distal bowel (SIG+), 2.46% as compared to 0.48% in SIG- patients, independent of the HO reports. Routine DCBE is practically useless in HO-SIG- patients and questionable in HO-SIG+ patients since improvement of the detection rate is null for cancer and moderate for adenoma. It is recommended for HO+ patients because it increases the colonic cancer detection rate (10.5% in this study).

Adenoma↗
PubMed1996

Screening for colorectal cancer by once only sigmoidoscopy: a feasibility study in Turin, Italy.

OBJECTIVES: To assess the impact on compliance of three invitation methods, as well as the acceptability and efficacy of two bowel preparation regimens, for endoscopic screening in the general population. METHODS: 1170 subjects (men and women aged 55 to 59, in the rosters of a sample of general practitioners (GPs) in Turin), were randomly allocated to one of three invitation groups (A: personal letter, signed by GP, with a pre-fixed appointment; B: same as for A + letter supporting the study by a well known scientist; C: letter signed by the study coordinator, NS) and two preparation regimens (i: one enema, self administered at home two hours before the test; ii: two enemas, administered the night before and two hours before the test). A postal reminder was mailed to non-attenders. A sample of non-responders was contacted for a telephone interview by a trained nurse. Written consent was obtained from all subjects undergoing the test. RESULTS: A total of 278 subjects attended for sigmoidoscopic screening. An invitation from the GP alone produced the highest response rate (compliance: A = 29.3%; B = 24.9%; C = 26.8%). A single enema was as effective as two enemas in achieving satisfactory preparation for the test: the proportion of subjects invited to repeat the test was 8.1% in the single enema group, and 9.6% in the group receiving two enemas. CONCLUSIONS: Compliance with this screening procedure tends to be low. One enema, self administered two hours before sigmoidoscopy, can ensure a satisfactory bowel preparation.

Colorectal Neoplasms↗
PubMed2005

Acceptance of flexible sigmoidoscopy and colonoscopy for screening and surveillance in colorectal cancer prevention.

OBJECTIVES: To study an individual's experience of either flexible sigmoidoscopy (FS) or colonoscopy in a colorectal cancer prevention programme. METHODS: Consecutive individuals in a Bowel Cancer Prevention Programme, who had either an unsedated FS or a colonoscopy with sedation, participated in a prospective cross-sectional questionnaire-based study. RESULTS: A total of 447 responses were obtained for 256 colonoscopies and 191 FSs (200 men [45%] and 247 women [55%]). The overall experience of colonoscopy was more comfortable than FS (75% versus 18%; P<0.001). Embarrassment was low for both procedures (8%). There was no pain associated with colonoscopy and most individuals had a pain score of less than 3 (11-point scale) for FS: 72% of men, 55% of women (P<0.001). Most individuals did not have a gender preference for the endoscopist. For colonoscopy, the worst part of the procedure was the preparation (78%) and for FS the preparation and the procedure ranked equally worst (30%). CONCLUSIONS: We have shown that colonoscopy with sedation is a very comfortable procedure. FS is more uncomfortable than colonoscopy; however, for the majority it is a tolerable experience. Women found FS only slightly more painful than men. The worst part of either procedure was the preparation. Embarrassment with either procedure was minimal. Both procedures are well tolerated and suitable for colorectal cancer screening.

Colonoscopes↗
PubMed2004

Underuse of screening sigmoidoscopy and colonoscopy in a large cohort of US adults.

OBJECTIVES: We examined the prevalence of endoscopy (sigmoidoscopy or colonoscopy) by indication and by demographic and lifestyle factors. METHODS: We analyzed cross-sectional data collected in 1997 from participants aged 50 years and older in the Cancer Prevention Study (CPS) II Nutrition Cohort. RESULTS: Fifty-eight percent of men and 51% of women reported ever having undergone endoscopy; only 42% of men and 31% of women reported endoscopy for screening rather than for disease diagnosis or follow-up. Prevalence varied by demographic and lifestyle factors. CONCLUSIONS: Efforts to increase colorectal cancer screening need to target women, all persons aged 50-64 years, and those with colorectal cancer risk factors. Future studies should distinguish endoscopy for screening from procedures for disease diagnosis and follow-up to avoid overestimating screening compliance.

Aged↗
PubMed1999

Flexible sigmoidoscopy. Illuminating the pearls for passage.

As efforts to improve screening for colon cancer have increased, so has the importance of routine flexible sigmoidoscopy. However, the procedure is still underused, and about half of primary care physicians who recommend it refer their patients to other physicians. Increased use of this valuable screening tool is an important goal in primary care practice. Drs Davis and Stanfield discuss the indications, contraindications, and goals of the procedure as well as special techniques and maneuvers that ensure its safety and efficiency.

Anti-Bacterial Agents↗
PubMed2004

Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior.

BACKGROUND: Poor patient attendance to scheduled flexible sigmoidoscopy or colonoscopy may contribute to deficient colorectal cancer screening. OBJECTIVE: To examine the association of physician appointment-keeping behavior with attendance to scheduled endoscopic studies of the colon. DESIGN: Retrospective cohort. SETTING: 23 sites performing endoscopic procedures in a health care system. PATIENTS: 11 803 patients scheduled for a first colon study with 3 or more scheduled physician visits from June 1999 through November 2001. MEASUREMENT: 2 outcomes from health system computerized records: 1) attendance at the first scheduled colon study and 2) among nonattendees, attendance at the study rescheduled within 6 months. Physician visit adherence was defined as the proportion of physician visits kept, grouped by quartile. Adjusted associations were examined in conditional logistic regression. RESULTS: Of 11 803 patients, 62% attended the first colon study. Of the 4496 nonattendees, 2739 (61%) rescheduled and, of these, 64% kept that appointment. Compared with the highest quartile of physician visit adherence (>85%), the adjusted odds ratio of attending the first colon study decreased as physician visit adherence decreased: Adjusted odds ratios were 0.94 (95% CI, 0.89 to 1.00) for 76% to 85% adherence, 0.87 (CI, 0.81 to 0.92) for 66% to 75% adherence, and 0.79 (CI, 0.73 to 0.85) for adherence of 65% or less. Among nonattendees who rescheduled, the lowest quartile of physician visit adherence (< or =65%) was the only statistically significant predictor of attending the rescheduled study (adjusted odds ratio, 0.87 [CI, 0.78 to 0.98]). LIMITATIONS: The adherence measure applies only to patients with at least 3 scheduled visits. Persons having a colon study outside of the system could have been misclassified. CONCLUSION: Physician appointment-keeping behavior predicted attendance to colorectal endoscopic studies in this cohort and may help identify persons who need interventions to promote adherence.

Aged↗
PubMed1997

Flexible sigmoidoscopy screening: patient acceptance.

Although compelling evidence is available that screening can reduce the risk of death from colon cancer, patient compliance with screening in the United States is poor. The objective of this study is to describe a program that uses patient education to improve patient acceptance of flexible sigmoidoscopy screening. Our program provides multiple opportunities for patients to ask questions and to receive information. Preliminary data show that this approach has resulted in a procedure acceptance rate of 81% of those referred in the first year of the program. Future research needs to focus on evaluating factors associated with noncompliance in colorectal cancer screening programs.

Appointments and Schedules↗
PubMed1987

Flexible fiberoptic sigmoidoscopy. Logistics and economics of office use.

Early detection of colorectal cancer, followed by surgical excision, can effect a cure in 50% of patients. The flexible fiberoptic sigmoidoscope enables identification of lesions in the premalignant or early malignant stages. Its use is cost-effective in any practice that includes more than 200 to 300 patients over age 50, and the procedure is well accepted by patients. Available options for learning the technique are listed, along with their approximate fees. The author explores all considerations pertinent to instituting this screening procedure and suggests the best way to introduce sigmoidoscopy into the established office routine.

Adult↗
PubMed1999

Once-only sigmoidoscopy.

The rationale for infrequent screening for colorectal cancers by sigmoidoscopy of the general population around age 60 is reviewed. A progress report for a trial to evaluate this approach is also presented.

Adenoma↗
PubMed2000

[Prevention of colorectal carcinoma. Annual hemoccult test and sigmoidoscopy every 5 years].

The slow development of colorectal carcinoma from adenoma over dysplastic state to malignancy within 10-15 years results in a long preclinical phase during which the tumor is readily detectable and curable. Therefore and because of the lack of early alerting signs colorectal cancer is highly suited to screening. The faecal occult blood test has been added to the yearly program of cancer prevention for each individual age 45 and higher. This test has been evaluated in controlled prospective trials. For several reasons the combination of faecal occult blood test with flexible sigmoidoscopy at five year intervals is recommended. Concerning colonoscopy as a screening test to date no data from controlled trails are available. Virtual colonoscopy and gene-based screening which are currently being developed may be future options.

Aged↗