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PubMed2001

Flexible sigmoidoscopy.

Flexible sigmoidoscopy remains a common tool used for the periodic screening of colorectal cancer. Most organizations recommend screening at three- to five-year intervals beginning at age 50 for persons with average risk. Extensive training in endoscopic maneuvering, colorectal anatomy and pathologic recognition is required. Most physicians report comfort performing the procedure unsupervised after 10 to 25 precepted sessions. The procedure involves the insertion of the sigmoidoscope through the anus and distal rectum and advancement of the scope tip to an average depth of 48 to 55 cm in the sigmoid colon. Once the sigmoidoscope has been appropriately advanced, the scope is slowly withdrawn, allowing for the inspection of colon mucosa during withdrawal. Polyps less than 5 mm in diameter should be biopsied. Polyps 5 to 10 mm or greater can be assumed to be adenomatous, and follow-up colonoscopy for complete polypectomy is required. Diverticulosis, hemorrhoids, nonspecific colitis and pseudomembranes may also be encountered during inspection. Use of preprocedural benzodiazepines can be helpful in reducing patient discomfort. 2001;63:1375-80,1383-4,1385-8.)

Age Factors↗

PubMedDate not supplied

Subjects older than 60 years with negative findings on sigmoidoscopy should still undergo colonoscopy.

BACKGROUND/AIMS: The objective of this study was to evaluate the impact of age on the prevalence of proximal clinically important lesions in subjects without any rectosigmoid neoplasm. METHODOLOGY: The present study involved 497 patients (aged > or = 50 years old) who underwent a colonoscopy because of abdominal symptoms or positive fecal occult blood test. A proximal colon was defined as one proximal to a sigmoid colon. Clinically important lesions were defined as adenocarcinoma, tubular adenoma > or = 1 cm in diameter, or adenoma with villous histology or high-grade dysplasia. RESULTS: Of the 497 patients, 83 had clinically important lesions in the proximal colon. Of those 83, 53 patients had no neoplasm in the distal colon or rectum. In patients with no distal neoplasm, the prevalence of proximal clinically important lesions in subjects over 60 years old significantly exceeded that in patients aged 50-60 (39/105 vs. 14/125; P < 0.0001). In patients with distal neoplasm, the prevalence of proximal clinically important lesions in subjects over 60 was similar to that in 50 to 60-year-old subjects (16/119 vs. 14/148; P = 0.406). CONCLUSIONS: Results suggest that subjects older than 60 years old should still undergo a colonoscopy even if they have no neoplasm on sigmoidoscopy.

Adenoma↗

PubMed2003

Diagnostic yield in a biennial Hemoccult-II screening program compared to a once-only screening with flexible sigmoidoscopy and Hemoccult-II.

BACKGROUND: Flexible sigmoidoscopy (FS) has a higher degree of sensitivity for detecting colorectal neoplasia in the left side of the colon than Hemoccult (H-II). However, no randomized controlled trial has compared a single FS screening with a H-II screening program (annual or biennial) despite the well-documented mortality reduction from colorectal cancer (CRC) in the latter. The aim was to compare the diagnostic yield of colorectal neoplasia in two aged-matched groups from two different randomized screening trials; one group screened by a single FS+H-II, the other with biennial H-II over the course of 16 years. METHODS: 24,465 persons invited to participate in the Funen biennial H-II screening program were compared with 4,460 similar persons invited to another Funen trial using a single FS+H-II. RESULTS: Compliance in the biennial H-II program was 65.5% during the first screening round compared to 39.8% for FS+H-II. The cumulative number of persons with positive tests was 8.2% (positive H-II) in the biennial H-II program during 16 years and 20.3% (polyps > 3 mm in diameter seen at FS or positive H-II) for once-only FS+H-II. The diagnostic yield of CRC per 1,000 screened was 9.9 in the biennial H-II program and 6.6 after FS+H-II (6.5 and 2.7 per 1,000 invited). The yield of advanced adenomas (> or = 10 mm and/or villous structure and/or severe dysplasia) was 2.3% in the H-II program and 3.3% after FS+H-II among the screened persons, but this difference disappeared when persons invited, but not necessarily screened, were compared (1.5% versus 1.3%). CONCLUSION: Screening with H-II in a biennial screening program during 16 years detected more CRCs than a single screening with FS+H-II and a similar number of advanced adenomas.

Adenoma↗

PubMedDate not supplied

The current state of flexible sigmoidoscopy training in family medicine residency programs.

BACKGROUND AND OBJECTIVES: The US Preventive Services Task Force has recommended that adults ages 50 and over be screened for colorectal cancer. Flexible sigmoidoscopy (FS) is one available screening option. This study determined the current state of FS training in US family medicine residencies. METHODS: Directors of the Accreditation Council for Graduate Medical Education-accredited family medicine residencies were surveyed regarding FS training. RESULTS: Of 486 mailed surveys, 370 (76%) were completed and returned. Fifty-two percent of responding residency programs trained at least one resident in FS in 2003. Residents in these programs performed a mean of 20.1 +/- 1.2 FSs during their training. In 2003, 44% of family medicine graduates from these programs were certified by their programs as competent to perform FS. Fewer residents were certified in FS by programs in the eastern versus western United States. Military programs certified more residents than did nonmilitary programs. CONCLUSIONS: More than half of programs offered FS training, but less than half of family medicine graduates were certified by their programs as competent. There were significant differences for FS training by region and program type.

Clinical Competence↗

PubMedDate not supplied

Examining bowel preparation before flexible sigmoidoscopy.

AIM: To investigate bowel preparation for a flexible sigmoidoscopy, particularly the procedure for the administration of a phosphate enema and patient expectation to 'wait as long as they can' before the urge to rush to the toilet. METHOD: A survey approach was used with a questionnaire recording the time to toilet after the enema and level of bowel clearance. RESULTS: Over half of participants (24 of 40) chose to use the toilet immediately. Bowel clearance was reported as good in 32 of the 40 participants and side-effects were reduced. CONCLUSION: Giving patients choice when to visit the toilet after an enema improved their experience and achieved good bowel clearance for the procedures. Further research should be undertaken due to the small size of the study.

Adult↗

PubMed1990

Office proctology and sigmoidoscopy.

Proctoscopy and sigmoidoscopy are readily acquired skills and should be routine office procedures for general practitioners. Correct positioning of the patient is of utmost importance to a successful examination.

Family Practice↗

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↗

PubMedDate not supplied

Sensitive sigmoidoscopy: a straight sigmoid technique.

Colorectal cancer prevention requires screening more sensitive than standard colonoscopy in cost, convenience, comfort, and safety, and it requires screening more sensitive epidemiologically than occult blood, radiography, or standard sigmoidoscopy to detect small polyps throughout the colon. Using a 65-cm videosigmoidoscope and no sedation, this family doctor reached the ascending colon (95 percent of polyps) in 81 percent of 78 private practice patients not having prior intraperitoneal surgery (compared with 57 percent of 35 patients with abdominal surgery), mostly by gentle scope rotation for many minutes at 12-20 cm insertion to gather folds and keep the sigmoid colon straight.

Adult↗

PubMed1988

Procedural skills in flexible sigmoidoscopy and colonoscopy for the family physician.

Procedural skills in flexible sigmoidoscopy and colonoscopy are widely accepted as diagnostic and therapeutic tools that assist physicians as they attempt to understand the biological and behavioral elements of undifferentiated gastrointestinal illness. Data support the ability of family physicians to perform and teach some of these endoscopic skills. Although one major contribution of these procedures is in the prevention of premature colorectal cancer mortality, other important patient care benefits are emerging for the office-based physician. Breadth of care enhances our most important therapeutic tool--the doctor/patient relationship. Unnecessary referral contributes to fragmentation and depersonalization of the health care system. Family physicians are urged to examine and acquire new procedural skills appropriate for their community. The process of privileges is discussed.

Colonoscopy↗

PubMedDate not supplied

Flexible fiberoptic sigmoidoscopy: its use in family medicine.

Flexible fiberoptic sigmoidoscopy (FFS) can be both learned and taught by family physicians. The patient benefits because unnecessary referral is reduced. The physician benefits by offering more comprehensive services to the patient and by demonstrating expertise in the procedure. In a collaborative study involving family physicians performing more than 1,500 FFS examinations, both the 35-cm scope and the 65-cm scope were effective instruments, but most physicians who had experience with both scopes preferred the longer one. In addition, the results of this study support a significant advantage in pathology detection for the 65-cm scope compared with the 35-cm scope.

Choice Behavior↗

PubMed1986

Continuing medical education for flexible sigmoidoscopy--toward a conceptual model for procedural skills training.

Participants in two one-day continuing medical education courses on flexible sigmoidoscopy were surveyed before, immediately after and ten months after the courses. 52 (29.5% of 176) participants completed all three survey forms. Before the course 32 (61.5%) expected to immediately use the flexible sigmoidoscope without further training. Ten months after the course 33 (63.4%) were using the flexible sigmoidoscope; four additional respondents were expecting to begin using the instrument. Twenty three of these (69.7%) had only attended the course without additional training. Those who found the instrument more difficult to use, or decided immediately after the course that more education was necessary, were less likely to use the instrument. Those not using the instrument also were older, more likely to be in solo practice and more likely to be surgeons. The course altered the educational plans of 23.1% of the respondents. This one-day format combining didactic and laboratory work with the instrument proved to be an efficient and effective means of education for using the instrument.

Adult↗

PubMed1987

An evaluation of a direct access flexible fibreoptic sigmoidoscopy service.

During a 3 year period 146 general practitioners referred 630 patients to a direct access flexible sigmoidoscopy clinic. The yield was 53.3% with significant colonic or rectal pathology in 30%. Twenty six cancers, 4 Dukes' A, and 38 patients with symptomatic adenomatous polyps were detected. Five further cancers were detected by subsequent barium enemas. The service reduced delay in diagnosing colorectal pathology but did not reduce the number of barium enemas requested by general practitioners. It is suggested that where facilities are already available, such a service to investigate rectal bleeding in patients over 40 years is of benefit both to patients and general practitioners.

Adolescent↗

PubMed1986

Flexible sigmoidoscopy in the primary care setting.

Flexible sigmoidoscopy has been universally endorsed for use by primary care physicians for early diagnosis of colorectal cancer. Patient selection, preparation, and procedure are discussed in this article.

Adult↗

PubMed1985

Second-generation video sigmoidoscopy.

A newly developed 60-cm video sigmoidoscope has no image bundle or eyepiece. During scope manipulation, the instrument provides a real-time color endoscopic image on a video monitor as well as a permanent videotape record of the procedure. In a series of examinations performed by residents in family medicine, no complications occurred and patient acceptance was good. Consultations can be obtained using the videotapes. The video recording format overcomes many of the teaching limitations of conventional fiberoptic sigmoidoscopy and may play a role in documentation of procedures as well as certification of competence.

Family Practice↗

PubMed1985

Flexible sigmoidoscopy: safety and usefulness in the geriatric patient.

The flexible sigmoidoscope is clearly the best available screening tool for colorectal cancer. It is superior to rigid sigmoidoscopy in that the flexible scope can examine longer lengths of bowel and yields a larger number of pathologic findings. The majority of colon cancers lie beyond the view of the rigid scope, which detects only about 30% of all malignant lesions.

Aged↗

PubMed1974

Sigmoidoscopy.

Sigmoidoscopy is the most important gastrointestinal procedure and is essential for the correct interpretation of lower bowel symptoms. The indications are many and there are no contraindications. If done with care it is safe and inexpensive and within the capability of all practising physicians.Consideration for the patient's comfort and dignity, correct positioning, and advancement of the instrument only under direct vision should ensure a satisfactory examination.

Adult↗

PubMed1984

Barium enema after flexible sigmoidoscopy: is delay necessary?

There exists a traditional belief that sigmoidoscopy immediately prior to barium enema produces excessive gas and irritability, which subsequently interfere with performance and interpretation of the barium enema study. A survey was initiated to determine whether primary care physicians are generally advised not to perform barium enema examination immediately following proctosigmoidoscopy on the same day. Almost two thirds (56/89) of the physicians indicated that delaying barium enema examination was standard practice in their community. A prospective study was performed on 16 subjects who were examined by a 60-cm flexible sigmoidoscope and then sent for air-contrast barium enema. Ninety-four percent (15/16) of the subjects completed radiologic examinations with no increase in technical difficulty or patient discomfort. One subject was considered to have excessive gas on scout film and was rescheduled for barium enema examination on another day. This preliminary study supports the hypothesis that the majority of patients can sequentially receive both examinations on the same day. For appropriate patients this scheduling would represent a great savings in time, effort, and exposure to bowel preparation protocols.

Attitude of Health Personnel↗

PubMed1984

Flexible fiberoptic sigmoidoscopy in family medicine.

Flexible fiberoptic sigmoidoscopy is easily mastered by family physicians. Self-study, along with a minimal amount of supervision, seems to provide adequate training. Patient preparation is essential and is best accomplished with enemas "until clear" rather than with the standard two enemas. Patients prefer the flexible sigmoidoscope to the rigid instrument, and the greater depth of penetration achieved with the former--even with the 35-cm sigmoidoscope--enables the physician to detect significantly more pathologic lesions.

Colonic Polyps↗