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PubMed1983

Aortic thrombosis during sigmoidoscopy in Behçet's syndrome.

A patient with Behçet's syndrome suffered acute paraparesis during sigmoidoscopy. An aortogram demonstrated thrombosis of the distal abdominal aorta just above the bifurcation; thrombectomy resulted in complete return of neurologic function. Examination of the clot disclosed a preponderance of polymorphonuclear granulocytes. We propose that mechanical trauma from this otherwise benign procedure caused the vascular lesion. Patients with a similar predisposition to arterial or venous thrombosis may, in unusual circumstances, be jeopardized by proctosigmoidoscopy.

Aorta, Abdominal↗
PubMed1993

Flexible fibreoptic sigmoidoscopy. Safe and effective for family practice.

Flexible fibreoptic sigmoidoscopy can detect malignancy, polyps, and other common diseases of the large bowel when they are distal to the splenic flexure. The procedure is safe and not painful when correctly performed. Family physicians could play an important role in the earlier diagnosis and prevention of colorectal cancer by adding the procedure to their repertoire.

Attitude of Health Personnel↗
PubMedDate not supplied

Investigation of colonic symptoms: the value of flexible sigmoidoscopy.

Colonic symptoms and large-bowel disease are common in elderly people, but the optimum investigative schema is not well established. Double-contrast barium enema (DCBE) and full colonoscopy share several drawbacks; both require colonic preparation which at best causes stool frequency and urgency, at worse dehydration and hypovolaemia. Many physicians feel that in the elderly this represents such a risk that inpatient preparation is preferred. Both investigations may involve much discomfort and distress. Rigid sigmoidoscopy is the traditional first colonic examination in patients with colonic symptoms, but will detect fewer than 10% of significant colonic lesions. Further investigation is almost always needed in elderly patients.

Adolescent↗
PubMed1993

A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation.

One hundred thirteen patients were randomized to receive either oral sodium phosphate (Fleet Phospho-Soda), lemon-flavored castor oil (Purge), or standard polyethylene glycol-based lavage solution (GoLYTELY) before elective colonoscopy. The study purpose was to confirm the efficacy of oral sodium phosphate and extend observations to include castor oil. Overall, patients reported that sodium phosphate and castor oil were easier to complete (p < 0.05). Scores for cleansing the entire colon as determined by endoscopists who were blinded to the cathartic agent were highest in patients receiving sodium phosphate (p < 0.02). Scores of left-colon cleansing for flexible sigmoidoscopy were equally high for the three methods. Scores for taste and symptom side effects were similar for each preparation. There were no recognized signs or symptoms of hypocalcemia in the sodium phosphate group. Because of the low cost of oral sodium phosphate combined with the lowest repeat endoscopy rate for inadequate cleansing, patient savings were projected to be $5000 per 100 patients at this center. Oral sodium phosphate is a cost-effective colonoscopy preparation that is better tolerated and more effective than the polyethylene glycol-electrolyte lavage solution or castor oil.

Administration, Oral↗
PubMedDate not supplied

[Early detection of adenomas in asymptomatic subjects: flexible sigmoidoscopy or colonoscopy].

OBJECTIVE: The aim of this study was to determine the frequency of adenomas as well as sensitivity, specificity, positive and negative predictive values of FS for polyp screening in two groups of asymptomatic individuals using colonoscopy (CP) as the gold standard. BACKGROUND: Flexible sigmoidoscopy (FS) is the screening procedure of choice for polyps and colorectal carcinoma (CRC) in asymptomatic individuals. However, the validity of this approach has been questioned, specially in subjects with a family history of CRC. METHODS: A total of 92 asymptomatic individuals were included in two groups: group A: with a family history (1st or 2nd degree relatives) of polyps or CRC (fifty-eight), and group B: without a family history and > 50 years (thirty-four). FS was simulated with the videocolonoscope until 60 cm, and was continued into the cecum. The number, type and localization of polyps were noted for each, FS and CP. The values mentioned previously were calculated according to established formulas. Comparisons were performed using Chi square test. RESULTS: Adenomas were found in twenty individuals in group A (34.4%) and 7 in group B (20.5%), p = NS. Sensitivity for FS in group A was 42% vs 71% in group B, with a negative predictive value of 44.5 and 93%, respectively. CONCLUSION: Colonoscopy is probably the screening procedure of choice in individuals with a family history of polyps or CRC. The utility of FS for screening purposes in asymptomatic individuals without a family history seems adequate, although more studies are required in different populations in our country.

Adenoma↗
PubMed1996

Sigmoidoscopy.

The use of a rigid sigmoidoscope, a skill any GP can easily acquire, may save a patient the inconvenience and expense of the more complex procedures of flexible colonoscopy or barium enema. Most colonic pathology occurs within reach of a 25 cm sigmoidoscope. Rigid sigmoidoscopy can be quickly and safely performed in most cases without bowel preparation and in the GP's office.

Colonic Diseases↗
PubMed1996

Screening for colonic neoplastic lesions using flexible sigmoidoscopy in employees of a nuclear research center and members of collective settlements.

It has been shown that screening of average risk individuals reduces the incidence of colorectal cancer. The most effective method for screening has yet to be determined in terms of cost-effectiveness, but approximately two-thirds of colorectal neoplastic lesions are within the reach of the flexible sigmoidoscope. It has been estimated that a single such examination at the end of the sixth decade may reduce the colorectal cancer incidence by 60%. As part of a screening program for colon cancer, short colonoscopy was performed on 399 employees of a nuclear research center and 228 members of a collective settlement (kibbutz). The examinations were carried out on individuals aged > or = 40 years by two experienced endoscopists. The splenic flexure or transverse colon was reached in 95% of the procedures. Neoplastic lesions were found in 24 (6.0%) and 8 (3.5%) screenees (not significant) in the Nuclear Research Center and kibbutz populations respectively. Polyps <1 cm in diameter were significantly more common in the Nuclear Research Center population but larger polyps and cancers were not. In 47 Nuclear Research Center screenees with a family history positive in a first-degree relative, findings increased to 14.9% (P = 0.016). A family history of malignancy was found in 33.8% of kibbutz members but in only 11.8% of Nuclear Research Center employees. There was no evidence to suggest that working at the Nuclear Research Center increased the risk of colonic neoplasms. We conclude that flexible sigmoidoscopy is a valuable screening tool, especially for individuals with a first-degree relative with cancer. The yield of neoplastic lesions in the Israeli Nuclear Research Center and kibbutz populations is similar to that of the general population in the western world. Compliance rates are high in well-defined populations.

Adult↗
PubMed1997

Prevention of colorectal cancer. Costs and effectiveness of sigmoidoscopy.

There is increasing evidence that endoscopic polypectomy is a very effective means of preventing colorectal cancer. The feasibility of population-wide endoscopic screening is not established, however. The appearance of adenomatosis around the age of 60 in one-third of the population, many years prior to the manifestation of significant numbers of colorectal cancers, and the observation that the risk of developing metachronous adenomas correlates with pre-existing numbers of adenomas per colon suggest that a baseline endoscopy at 60 years with minimal follow-up may be a feasible screening strategy with a high rate of primary prevention in average risk individuals. Projections were made of the costs and benefits of various scenarios. A key element of this analysis was the assessment of probabilities to develop metachronous adenomas as a function of prior adenoma status by a mathematical approach using autopsy data. A screening strategy consisting of a baseline sigmoidoscopy at 60 years with follow-up restricted to 6% of the population was estimated to prevent 50% of colorectal cancers occurring after 60 years. A range of alternative scenarios, giving rates of primary prevention of colorectal cancer from 40 to 70%, had costs which were comparable to those of breast-cancer screening, but was far superior considering effectivity.

Adenomatous Polyposis Coli↗
PubMed1997

Establishing proficiency in flexible sigmoidoscopy in a family practice residency program.

BACKGROUND AND OBJECTIVES: Fiberoptic flexible sigmoidoscopy (FFS) is widely used by family physicians to evaluate abdominal problems and screen for colorectal cancer. We evaluated data on exams performed by family practice residents to determine the number of supervised procedures needed for technical proficiency at FFS. METHODS: We reviewed data recorded from all FFS procedures done at a family practice residency from October 1986-July 1994. RESULTS: A total of 262 exams were performed by 55 residents at the Family Practice Center. There was modest correlation between increasing numbers of exams and increased unassisted depth of insertion (UDI). Maximum UDI was achieved after 10-15 supervised exams. Factors such as patient gender, prior surgery, and preparation quality were also significantly correlated with UDI. Significant differences in training experience and patient selection were seen between male and female residents. CONCLUSIONS: Maximal UDI is reached after 10-15 procedures. Differences in training experiences and successful UDI based on resident gender should be studied further.

Adolescent↗
PubMed1997

Randomized trial of the addition of flexible sigmoidoscopy to faecal occult blood testing for colorectal neoplasia population screening.

BACKGROUND: Published data suggest that screening might reduce the mortality rate from colorectal neoplasia. Faecal occult blood (FOB) testing suffers from poor sensitivity and significant numbers of interval cancers, both of which should be improved by the addition of flexible sigmoidoscopy (FOS). METHODS: This prospective, randomized study aimed to assess the compliance and neoplasia yield of FOB testing and FOS compared with that of FOB testing alone. From general practitioner registers, 6371 asymptomatic patients (3124 men, 3247 women; age range 50-74 years) were invited for screening by means of FOB testing (3128 patients) performed at home, or a combination of FOB testing and FOS (3243 patients). RESULTS: Compliance with FOB testing alone was 50 per cent. In the FOB testing/FOS group, 48 per cent returned the FOB test but only 20 per cent went on to FOS. Despite the poor compliance, the neoplasia yield was four times greater in the FOB testing/FOS group. CONCLUSION: FOS increase the neoplasia yield but strategies to improve compliance must be identified for this to become a population screening test.

Aged↗
PubMedDate not supplied

A combined flexible sigmoidoscopy and double-contrast barium enema service: initial experience.

BACKGROUND: A service has been instituted offering a combined single-stage procedure of flexible sigmoidoscopy and double-contrast barium enema (FS/DCBE). The results have been reviewed in the first 80 patients to undergo this examination (45 male: 35 female; mean age 61.4 years). METHODS: Indications for investigation were abdominal pain or suspected diverticular disease (22 patients), altered bowel habit (19), rectal bleeding (17), iron deficiency anemia (6), and miscellaneous (16). FS was followed immediately by DCBE. Radiographs were reviewed by two radiologists unaware of the FS findings. RESULTS: The extent of FS was to the proximal sigmoid or sigmoid descending colon or splenic flexure in 12.5%, and mid or distal sigmoid in 37.5%. Biopsies were performed at FS in 26 patients (33%). In 67 (84%) of DCBEs the barium coating was assessed as satisfactory or better. FS yielded pathological findings not seen at DCBE in 21 patients (26%). DCBE demonstrated additional abnormalities within the range of the FS examination in 15 patients (19%), almost entirely due to its increased sensitivity for diverticular disease. CONCLUSION: FS/DCBE is feasible as a one-stage combined procedure. The quality of DCBE following FS is satisfactory, and the extra yield of FS and its potential for biopsy make the combined FS/DCBE a useful technique in the investigation of large bowel disease.

Adult↗
PubMed1998

Utility of preoperative fiberoptic flexible sigmoidoscopy in the evaluation of patients with suspected gynecologic malignancy.

BACKGROUND: Fiberoptic flexible sigmoidoscopy (FFS) is routinely requested preoperatively as part of evaluation of pelvic masses to exclude colonic involvement by the tumor or concurrent colonic neoplasm. The aim of our study was to evaluate the utility of preoperative FFS in patients with suspected gynecologic malignancy. METHODS: FFS, performed using a 60 cm sigmoidoscope, evaluated (1) presence of bowel involvement by the tumor, (2) extrinsic compression by the tumor, and (3) presence of colonic neoplasms. FFS findings were correlated with surgical findings. RESULTS: A total of 107 women underwent preoperative FFS and subsequent surgery. Eleven patients (11%) had lower gastrointestinal symptoms. At surgery, 63% of pelvic tumors were malignant and 37% were benign. The most common abnormality at FFS was colonic polyps in 23 patients (21%). Colonic adenomas were found in 11 patients (10%). Extrinsic compression by the tumor without mucosal abnormalities was seen in 15 patients (14%). The most common intraoperative finding was tumor adhering to the bowel in 18 patients requiring dissection, but only 1 patient required bowel resection. Eight of these 18 patients had preoperative lower gastrointestinal symptoms. All 15 patients with extrinsic compression at FFS had tumor adhering to the bowel. CONCLUSIONS: Pelvic masses cause extrinsic compression at FFS in 14% of patients. This is suggestive of tumor adherent to the bowel at surgery. However, bowel resection is rarely required because of tumor involvement. Most patients with bowel adherence by tumor have lower gastrointestinal symptoms. Colonic adenomas are found in one tenth of patients, mostly in patients older than 50 years of age. Preoperative FFS does not change the surgical management of pelvic tumors. Screening FFS is indicated in all patients with pelvic tumors over age 50, as in persons with average risk, but is otherwise unnecessary in evaluation of pelvic masses.

Adult↗
PubMed2002

Flexible sigmoidoscopy in general practice.

OBJECTIVE: Flexible sigmoidoscopy (FS) is increasingly being accepted as the method of choice for initial investigation of rectal bleeding and other lower gastrointestinal symptoms. The aim of this study was to assess the feasibility of FS in general practice and to compare the yield, cost and efficiency of a service provided by a consultant surgeon and a General Practitioner (GP). SUBJECTS AND METHODS: A prospective study of FS was undertaken on 430 unsedated patients with symptoms suggestive of lower bowel disease in two general practices. RESULTS: The yield was comparable to hospital based data. Fifteen (3.5%) cancers were detected, of which 40% were Dukes A, and 46 (10.7%) adenomatous polyps. Cost per patient examination by a GP including capital costs, depreciation of equipment, and training was calculated to be cheaper or at least equivalent to a hospital-based service but inefficient due to the low numbers examined per month. There were no complications and no missed cancers after a minimum follow up of 2 years. CONCLUSIONS: The results suggest that FS can be safely performed by a suitably trained GP in health centres, but better utilization of equipment and value for money would be obtained by providing the service for a group of practices rather than a single practice as in this study.

Journal Article↗
PubMed1986

Sigmoidoscopy with flexible electronic endoscopy: a preliminary experience in Hong Kong.

Eighty-two cases of electronic flexible sigmoidoscopy were performed from October 1984 to October 1985 in a rural hospital in Hong Kong. The scope is a relatively new type of flexible endoscope, which has no optical fibre bundle for imaging. The image is taken with a solid state television camera and relayed via a videoprocessor to a television monitor. The image quality and ease of handling were satisfactory. Acceptance by the endoscopy team and the patients was good. The differences in comparison with conventional fibrescopes and television systems are discussed.

Gastrointestinal Hemorrhage↗
PubMed2004

Screening flexible sigmoidoscopy using an upper endoscope is better tolerated by women.

BACKGROUND: Flexible sigmoidoscopy (FS) is a commonly used method for colorectal cancer screening. Women are more likely than men to have a FS with a limited depth of insertion, in part due to differences of anatomy and perception of pain. AIM: The objective of this prospective single-blinded randomized clinical study is to assess satisfaction in women undergoing screening FS using an upper endoscope (E, diameter 9.8 mm) versus a standard sigmoidoscope (S, diameter 13.3 mm) as measured by pain and discomfort and overall satisfaction using a validated survey instrument. Secondary endpoints of FS efficacy included the depth of insertion of the instrument, frequency of polyp detection, and complication rate. RESULTS: A total of 160 asymptomatic women undergoing screening FS were entered over a 4-month period (July through November 2002). All procedures were performed by two experienced physician assistants. The two groups were of similar age (E = 57.5, S = 58.2, p= 0.579) and had a similar rate of previous abdominal surgery (E = 51.2%, S = 45.0%, p= 0.428) or hysterectomy (E = 34.2%, S = 26.3%, p= 0.274). Depth of insertion of the scope was 54.5 cm (+/-9.2 cm) with the E and 51.6 cm (+/- 10.3 cm) with the S (p= 0.058). Polyps were found more frequently in the study group (18.3%) compared with the control group (p= 10.2%) though this did not reach statistical significance (p= 0.131). Overall satisfaction with FS was similar in both groups (p= 0.694) but pain and discomfort were less in the patients undergoing FS using the E (p= 0.006). Controlling for age and previous surgery the differences in pain scores remained significant (p= 0.035). Endoscopist assessment of procedure difficulty (p= 0.726) and complication rates (p= 0.614) was equivalent. Controlling for the presence of polyps, the total duration for the procedure was 7.2 min in the E group and 5.7 min in the S group (p= 0.008). There were no significant differences between women with and without hysterectomy on either overall satisfaction or pain and discomfort. CONCLUSION: Screening FS in women using an upper endoscope is a feasible approach to colorectal cancer screening. Patients screened with an upper endoscope reported less pain and discomfort compared to standard sigmoidoscope while overall satisfaction did not differ. The trend toward increased polyp detection in patients undergoing FS with an upper endoscope may be related to a more thorough examination due to less patient discomfort and/or an increased depth of insertion of the upper endoscope. Thinner, more flexible endoscopes should be considered when performing screening FS in women.

Aged↗
PubMed1984

Flexible sigmoidoscopy: diagnostic yield in 1015 patients.

The purposes of our study were to 1) identify the number of neoplastic lesions (adenomatous polyps and cancer) diagnosable by flexible sigmoidoscopy (FS) in patients with symptoms of colorectal disease and 2) determine the age distribution of patients in whom neoplastic lesions are detected by FS. A total of 1015 patients, ages 20-89 years, underwent FS because of the following indications: rectal bleeding, occult blood loss, anemia, change in bowel habit, weight loss, and abdominal pain. FS examined a mean distance of 49 +/- 2 cm (SEM) in an average time of 11.5 min. A bowel preparation of 2 Fleet enemas was adequate in 95% of patients and the examination was well tolerated by all age groups. There were no complications encountered. Eight-five neoplastic lesions were identified in 78 patients. Fifty-four percent of all adenomatous polyps and 61% of the cancers were detected beyond 20 cm. Neoplastic lesions were identified in all adult decades studied, ranging from 3.2% of patients aged 20-40 years, 8.0% for patients between 40 and 60, and 10.1% from 60 to 80; with a peak yield of 11.2% in the 7th decade. Cancer was diagnosed only in patients more than 40 years; 3.3% of patients over 60 had carcinoma compared to 0.8% in patients less than 60. These data provide evidence for the value of FS as a safe initial diagnostic procedure to detect neoplastic lesions in symptomatic patients of all adult age groups.

Adult↗