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PubMed1994

Preliminary experience with a double-illumination technique for laparoscopic left colectomy.

This report describes our technique and initial experience with total intraabdominal laparoscopic left colectomy on 3 patients. Three consecutive patients, 2 females and 1 male, underwent laparoscopic left colectomy due to sigmoid volvulus and villous adenoma, respectively. The technique described herein helps to locate the intracolonic lesion, enables en bloc resection, shortens the operation time, and reduces the cost. Because the procedure is minimally invasive, patient recovery is remarkable compared with the conventional technique. All of the patients in this report were discharged on postoperative day 4 without any morbidity.

Adenoma, Villous↗
PubMed1987

Outcomes following continuing medical education on flexible sigmoidoscopy.

Ninety-four out of 114 physicians who took part in a continuing medical education course on flexible sigmoidoscopy were contacted 12 to 18 months later. Ninety per cent (85) were now using flexible sigmoidoscopy in their office practice. Complete demographic and procedure-outcome information (number of procedures performed, average depth of insertion, time required for procedure, complications) was acquired from 78 of these physicians. Using a randomly chosen comparison group of 87 physicians matched for sex and specialty, the likelihood of similar continuing medical education during the study period was obtained. Thirty-two physicians had obtained this training and 69% (22 of 32) currently used flexible sigmoidoscopy. Utilization of the method was 9% (four of 45) among physicians who had not obtained this continuing education. Continuing medical education was significantly associated (P less than 0.05) with the acquisition and utilization of flexible sigmoidoscopy. The study group reported 5467 procedures, resulting in one bowel perforation. The utilization of sigmoidoscopy in primary care was significantly greater (P less than 0.05) in the post-continuing education period. After 10 to 20 procedures, insertion depths and procedure times were similar to those reported in other published primary care series.

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↗
PubMed1999

Flexible sigmoidoscopy by paramedical personnel.

Screening sigmoidoscopy is associated with a 45% to 80% reduction in colorectal cancer mortality. Although less than 50% of eligible Americans have been screened with flexible sigmoidoscopy (FS), the use of this procedure is rising rapidly. By the year 2000, as many as 10 million screening FS per year could be performed. To accommodate the increased demand, many medical centers have trained paramedical personnel (i.e. physician assistants, nurses, and gastroenterology technicians) to perform FS. However, as a result of the paucity of research about this practice, only physicians receive a professional fee for performing screening FS. Many state Boards of Nursing explicitly prohibit registered nurses (RNs) from performing this procedure. This review outlines research about the effectiveness of paramedical endoscopists, medico-legal and reimbursement issues, and outlines a training program in FS for paramedical personnel.

Allied Health Personnel↗
PubMed1991

Flexible sigmoidoscopy as a screening procedure in rural patients.

In this study of flexible sigmoidoscopy as a screening procedure for rural, impoverished patients, 16% of asymptomatic patients who were screened by sigmoidoscopy and 23% of patients with a positive test for fecal occult blood were found to have a polyp or carcinoma. Flexible sigmoidoscopy appears to be an important part of the physical examination of patients older than 50. It is a test that can readily be done by primary care physicians in a rural setting.

Adenocarcinoma↗
PubMed1998

Flexible sigmoidoscopy as a mass screening tool.

Endoscopic removal of premalignant adenomas from the distal bowels of the entire population, 3 to 5-yearly from age 50, is advocated in the US as a feasible method of reducing colorectal cancer mortality rates. In the UK, a single flexible sigmoidoscopy (FS) is regarded as a more cost-effective option. Although more acceptable than colonoscopy, FS and polypectomy are expensive and invasive procedures carrying a small risk of serious harm. We believe that, before implementing mass screening, precise estimates are required of the magnitude of the reduction in mortality and costs (financial, physical and emotional). Several randomized trials, including a large British study, are currently evaluating these aspects.

Adenoma↗
PubMed2001

Open-access versus hospital-initiated flexible sigmoidoscopy: a comparative audit of efficacy.

BACKGROUND AND AIMS: There is a continuing demand for the provision of open-access endoscopy services. While open-access gastroscopy is now a well-established practice in most hospitals, open-access flexible sigmoidoscopy (OAS) is not yet available to the same extent. We present our early experience with OAS, a new service provided by our unit. PATIENTS, METHODS AND RESULTS: Over a 12-month period, 255 flexible sigmoidoscopies were carried out (139 OAS and 116 hospital-initiated sigmoidoscopies, HIS). Referral criteria for sigmoidoscopy were similar in both groups, with rectal bleeding and change in bowel habit being the most frequent. RESULTS: The two groups were comparable with regards to age and gender, but patients referred for OAS had symptoms for shorter duration than those referred for HIS (30 +/- 5.6 months v. 101 +/- 28 months, P < 0.00001). The diagnostic yield for OAS was 44% and for HIS 29% (P= 0.01). Significant pathology (colorectal cancer, polyps and newly diagnosed inflammatory bowel disease, colonic strictures) was detected in 31 patients (22%) in the OAS group and 12 patients (10%) in the HIS group (P = 0.02). Six cancers were diagnosed (5 OAS, 1 HIS), all staged Duke A. The waiting times for OAS and HIS were 3.1 +/- 0.3 weeks and 11.4 +/- 1.2 weeks, respectively (P = 0.0001). The diagnostic yield of fibre-optic endoscopy was independent of duration of symptoms, although patients referred for OAS with rectal bleeding and/or diarrhoea had a higher diagnostic yield (55/125, 44%). CONCLUSION: OAS is feasible and effective, with a high diagnostic yield. Such service can usually be provided with minimal added resources.

Adult↗
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↗
PubMed2007

The use of a dedicated rectosigmoidoscope for ultrasound staging of tumours of the upper and middle third of the rectum.

OBJECTIVE: Tumours of the upper rectum, and many in the middle third, are not accessible to endorectal ultrasound staging because of the difficulty in reaching all sites of the rectum with a rigid probe. The aim of this prospective study was to assess whether using a dedicated rectosigmoidoscope, endorectal ultrasonography (ERUS) can accurately stage any rectal lesion irrespective of its distance from the anal verge. METHOD: A total of 173 consecutive patients with a primary rectal tumour were included. A rotating, high multifrequency (5.0-10 MHz) endoprobe was introduced through a dedicated rectosigmoidoscope and advanced above the lesion. A computer allowed for three-dimensional (3D) reconstruction of 2D images. Treatment was selected on the basis of 3D-ERUS findings. ERUS staging was correlated with pathological staging. RESULTS: The depth of invasion was correctly determined by 3D-ERUS in 78.2% of tumours of the lower rectum, 76.4% of tumours extending between the lower and middle third of the rectum, 80.9% of tumours of the middle third of the rectum, 78.5% of tumours extending between the middle and upper third of the rectum and 78.9% of tumours of the upper rectum. The accuracy for the absence of lymph node metastases was 81.2% for tumours of the lower rectum, 78.5% for tumours extending between the lower and middle third of the rectum, 85.7% for tumours of the middle third of the rectum, 83.3% for tumours extending between the middle and upper third of the rectum and 78.5% for tumours of the upper rectum. Analysis showed that there was no difference between the various tumour sites. CONCLUSION: Our findings indicate that using a dedicated proctosigmoidoscope, tumours of the upper and middle third of the rectum are equally accessible to ultrasonographic evaluation. The distance of the tumour from the anal verge does not influence the accuracy of examinations considered adequate by the operator.

Adult↗
PubMed1998

Audio and visual stimulation reduces patient discomfort during screening flexible sigmoidoscopy.

OBJECTIVE: Despite current recommendations calling for regular screening flexible sigmoidoscopies over the age of 50, only a small percentage of the population have regular examinations. Improving patient tolerance of flexible sigmoidoscopies could therefore increase patient compliance with these recommended guidelines. The aim of this study was to determine whether audio and visual stimulation reduces discomfort during flexible sigmoidoscopy and whether the effects of the stimulation are secondary to distraction. METHODS: A total of 37 patients undergoing routine screening flexible sigmoidoscopy were randomized to receive no intervention, audio stimulation alone, or audio and visual stimulation. Patient discomfort ratings and affect states were measured prior to and immediately following flexible sigmoidoscopy using a visual analogue scale and the Stress Symptom Ratings (SSR) ratings. RESULTS: Patients receiving audio and visual intervention had lower abdominal discomfort ratings (7.1 +/- 1.4) than patients receiving audio stimulation (9.5 +/- 1.3) or no intervention (10.8 +/- 1.6) (p < 0.05). Patients receiving audio and visual intervention also had higher arousal (7.3 +/- 0.4) and attention (9.2 +/- 0.2) ratings than patients receiving no intervention (6.1 +/- 0.4 and 6.2 +/- 0.7, respectively) (p < 0.05). Anxiety and anger ratings, on the other hand, were significantly lower in patients receiving audio and visual intervention (2.5 +/- 0.4, 1.4 +/- 0.3, respectively) than patients receiving no intervention (4.4 +/- 0.6, 3.6 +/- 0.7). CONCLUSION: Audio and visual stimulation reduces abdominal discomfort associated with flexible sigmoidoscopy. This effect appears to be due to distraction.

Abdominal Pain↗
PubMed1998

Prospective evaluation of a teaching model to determine competency in performing flexible sigmoidoscopies.

OBJECTIVE: There are limited objective criteria for determining competency in performing flexible sigmoidoscopies. The authors developed a teaching model using eight objective criteria that measured both cognitive and technical skills in performing flexible sigmoidoscopies. The objective was to determine whether the teaching model was a valid method and then to compare it to a commonly used Overall Competence Score or independent observer method. METHODS: A total of 120 procedures with 10 residents were evaluated using the two methods. Eight objective parameters had been determined before validating the teaching model. Preset criteria determined competency on a single procedure, and competent performance on five procedures in a row determined certification to independently perform procedures. The teaching model was separately tested for validity and then compared with the independent observer method. RESULTS: A total of 120 procedures were graded using the teaching model method: 73 competent and 47 incompetent. Six of the seven objective parameters were associated with competency in the teaching model method. The eighth objective parameter was excluded because of lack of variation. Fifty of the 120 procedures were graded using the independent observer method: 36 competent and 14 incompetent. Two of the seven objective parameters were associated with competency in the independent observer method. Comparison of the two methods revealed seven discrepancies regarding competent and incompetent procedures. The correlation between the two methods was 0.71. CONCLUSION: The teaching model method offers objective criteria to evaluate skill in performing flexible sigmoidoscopies.

Clinical Competence↗