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PubMed1986

Flexible sigmoidoscopy: primary care outcomes after two types of continuing medical education.

The office impact of two types of continuing medical education on flexible sigmoidoscopy were compared. Measured office outcomes included sigmoidoscopy utilization rates, depth of insertion, time required to perform the procedure, biopsy rates, acquisition of further training, use of electrocautery, performance of polypectomy, complication rates, and general satisfaction with office flexible sigmoidoscopy. A matched control group was randomly selected and polled for previous flexible sigmoidoscopy continuing medical education and current flexible sigmoidoscopy utilization. Outcomes as they relate to different types of course design were discussed and compared. Procedure times and depth of insertion were comparable to published studies from tertiary care centers. In the faculty intensive course, trainees utilized less procedure time for their initial 10-20 procedures. Attitudes in practice were positive with 68% of all physicians performing biopsy. A 60-cm scope length was chosen by 87% of physicians. Physicians in faculty intensive courses were more likely to obtain additional training and less likely to initiate higher risk procedures such as electrocautery, polypectomy, and colonoscopy.

Education, Medical, Continuing↗
PubMedDate not supplied

[New models of endoscopes (EGDB-VO-4, SK-VO-4)].

Two new flexible endoscopes (EGDB-VO-4, SK-VO-4) designed for examinations and intracavitary interventions in the upper and lower portions of the digestive tract are described. Specifications are given with special references to the design features as compared to the earlier models.

Duodenoscopes↗
PubMed1985

Does bacteremia occur during flexible sigmoidoscopy?

Up to 10% of patients may have bacteremia after rigid sigmoidoscopy. The aim of our study was to determine the frequency of bacteremia accompanying flexible sigmoidoscopy. Blood samples for aerobic and anaerobic cultures were obtained before, during, and after flexible sigmoidoscopy in 100 patients who were examined a mean distance of 49.5 cm, range 15-60 cm, after a bowel preparation of two Fleet enemas. In one patient, a transient bacteremia with Streptococcus intermedius was documented and was attended by no associated clinical manifestations. This organism has been previously isolated from patients with endocarditis, peritonitis, emphysema, and hepatic and appendiceal abscesses. There was no association in our study with bacteremia and such factors as length of bowel examined and duration of procedure, the presence of bowel pathology, performance of endoscopic biopsies, liver disease, and portal hypertension or poor bowel preparation. We conclude that the extremely low incidence of significant bacteremia with flexible sigmoidoscopy may be related to the smaller diameter of the instrument and provides further support for the routine use of flexible rather than rigid sigmoidoscopy.

Adult↗
PubMed1985

[Is rigid rectoscopy obsolete?].

Flexible fiberoptic sigmoidoscopy more and more replaces sigmoidoscopy with a rigid tube. In a retrospective series of 152 rigid sigmoidoscopies we analysed depth of endoscopy and findings. In 36% of patients without anaesthesia endoscopy had to be stopped at 15 cm and in further 31% at 20 cm leading to a highly significant difference to the anesthetized patients (p less than 0.0005). A good history of the present illness allows separating of bleeding carcinoma and polyps proximal to the sigmoid colon which have to be examined by colonoscopy. In routine screening for blood loss per anum it is desirable to achieve in all patients a maximal security not to overlook a finding, because of the medical costs. We have enlarged the list of indications for the rigid sigmoidoscopy by Marks et al. as a practical compromise: delineation of rectal lesions, side localization and critical rectal measurements, surveillance of disease states or anastomoses within its reach, for performing rectal biopsy and rectal polypectomy, in patients with possible contamination of the instrument, endoscopy in the anesthetized patient before a proctological operation if case history excludes a higher sited lesion. In all other cases there is an indication for colonoscopy or barium contrast enema. It is stressed that in patients with blood loss per anum the search for the source always is done by flexible fiberoptic sigmoidoscopy.

Adult↗