SEARCH · PubMed Health

Results for “Sigmoidoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 865 records · Page 48Linked to original sources

PubMed2003

Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer.

BACKGROUND: Colonoscopic screening for colorectal cancer has been suggested because sigmoidoscopy misses nearly half of persons with advanced proximal neoplasia. OBJECTIVE: To create a clinical index to stratify risk for advanced proximal neoplasia and to identify a subgroup with very low risk in which screening sigmoidoscopy alone might suffice. DESIGN: Cross-sectional study. SETTING: A company-based program of screening colonoscopy for colorectal cancer. PATIENTS: Consecutive persons 50 years of age or older undergoing first-time screening colonoscopy between September 1995 and June 2001. MEASUREMENTS: A clinical index with 3 variables was created from information on the first 1994 persons. Points were assigned to categories of age, sex, and distal findings. Risk for advanced proximal neoplasia (defined as an adenoma 1 cm or larger or one with villous histology, severe dysplasia, or cancer) was measured for each score. The index was tested on the next 1031 persons from the same screening program. RESULTS: Of 1994 persons, 67 (3.4%) had advanced proximal neoplasia. A low-risk subgroup comprising 37% of the cohort had scores of 0 or 1 and a risk of 0.68% (95% CI, 0.22% to 1.57%). Among the validation group of 1031 persons, risk for advanced proximal neoplasia in the low-risk subgroup (comprising 47% of the cohort) was 0.4% (upper confidence limit of 1.49%). Application of this index detected 92% of persons with advanced proximal neoplasms and, if applied following screening sigmoidoscopy, could reduce the need for colonoscopy by 40%. The marginal benefit of colonoscopy among low-risk persons was small: To detect 7 additional persons with advanced proximal neoplasia, 1217 additional colonoscopies would be required. CONCLUSIONS: This clinical index stratifies the risk for advanced proximal neoplasia and identifies a subgroup at very low risk. If it is validated in other cohorts or groups, the index could be used to tailor endoscopic screening for colorectal cancer.

Age Distribution↗

PubMed2000

Validity of self-reported colorectal cancer screening behavior.

End points for trials promoting cancer screening are often based on self-reported screening behavior. This study was designed to evaluate and optimize the reliability of a computer-assisted telephone interview for collecting self-reported colorectal cancer screening behavior. Cases who had received a fecal occult blood test (FOBT), flexible sigmoidoscopy, and/or colonoscopy, and controls who had no record of colorectal screening were identified among 40-75-year-old members of the Denver Kaiser Permanente Health Care Program and were contacted by telephone. Sensitivities and specificities of self-reported screening were calculated by comparison of subjects' recall with Kaiser Permanente records. The questionnaire was revised based upon results of the pilot phase of the study. Using the revised questionnaire, the sensitivity of self-reported screening was 96.2% for the FOBT, 94.9% for flexible sigmoidoscopy, 88.7% for colonoscopy, and 96.2% for either endoscopic screening test. The specificity of self-reported screening was 85.9% for the FOBT, 92.2% for flexible sigmoidoscopy, 96.8% for colonoscopy, and 92.0% for either endoscopic screening test. No marked differences in the accuracy of the self-reports were detected as a function of gender, age, ethnicity, or family history of colorectal cancer of the participants. Self-reports of colon cancer screening behavior can be reliably used as end points for intervention trials when carefully phrased questions are used.

Adult↗

PubMed2001

Experience with a one-stop colorectal clinic.

BACKGROUND AND OBJECTIVE: Colorectal services have traditionally been arranged for the convenience of hospitals rather than patients. This model is not ideal, particularly for minor interventions and diagnostic procedures. In order to address this a one-stop colorectal clinic was set up. PATIENTS AND METHODS: Weekly clinics ran from 6.00 to 9.30 p.m. on Wednesdays for a period of 6 months. Patients with rectal bleeding, altered bowel habit, anorectal symptoms and those requesting screening advice were seen by a consultant or specialist registrar. Patients were asked to fill in a questionnaire at the end of their clinic attendance. RESULTS: 197 patients were seen in 17 clinics; 134 underwent proctoscopy, 72 had a rigid sigmoidoscopy and 85 had a flexible sigmoidoscopy carried out. Twenty-four patients subsequently had a barium enema and 3 were listed for colonoscopy. The main diagnosis was haemorrhoids (n = 104); 14 colorectal neoplasms were discovered (5 cancers and 9 polyps). During the study period the number of patients waiting for lower gastrointestinal endoscopy fell from 119 to 63; 2 months after ending the pilot scheme, the number had risen to 108. CONCLUSION: The clinic was found to have significantly improved patient care. The majority of patients were satisfied with an evening clinic. Flexible sigmoidoscopy without sedation was well tolerated and the ability to perform this at initial assessment had a marked effect on the number of patients awaiting lower gastrointestinal endoscopy.

Ambulatory Care Facilities↗

PubMed2003

Colorectal cancer screening among African Americans: the importance of physician recommendation.

INTRODUCTION: African Americans have higher colorectal cancer incidence and mortality rates than whites. They are also more likely to be diagnosed with late-stage disease and less likely to survive for at least five years after diagnosis. Lack of adherence to colorectal cancer screening recommendations has previously been found to be associated with lower income, lower educational level, and racial/ethnic minority status. METHODS: One hundred-fifty African-American patients (aged 50-79 years) of an inner city hospital, were surveyed by mail and telephone in early 2002. Seventy-six patients completed the survey, and data from 74 surveys were analyzed. RESULTS: Approximately one-half (55%) of the respondents reported having received a fecal occult blood test (FOBT) in the last 12 months, sigmoidoscopy in the last five years, or colonoscopy in the last 10 years. Thirty-nine percent of the survey participants reported never having received a physician recommendation for FOBT, 60% reported never having received a recommendation for sigmoidoscopy, and 57% reported never having received a recommendation for colonoscopy. Previous physician recommendation was strongly associated (p < 0.001) with levels of FOBT, sigmoidoscopy, and colonoscopy use. DISCUSSION: Future studies should examine factors that influence primary care physicians' decision-making about ordering colorectal cancer screening tests, as well as patients' decision-making regarding adherence to physician recommendations.

Black or African American↗

PubMed1991

The sentinel hyperplastic polyp: a marker for synchronous neoplasia in the proximal colon.

We prospectively screened 129 asymptomatic subjects (mean age 64 yr) with flexible sigmoidoscopy. Colonoscopy was performed at a later date, regardless of the sigmoidoscopic result. Our intent was 1) to establish the prevalence of proximal neoplasms in patients with and without hyperplastic polyps within reach of the 60-cm sigmoidoscope and 2) to determine whether a distal (sentinel) hyperplastic polyp predicts the presence of synchronous neoplastic polyps higher up in the colon. Our results show that 15% of asymptomatic adult subjects without polyps on sigmoidoscopy have adenomas in proximal colonic segments that can be diagnosed only by colonoscopy. By comparison, proximal neoplasms were detected in 32% (p less than 0.05) and 37% (p less than 0.05) of patients when hyperplastic or adenomatous polyps, respectively, were present on the sigmoidoscopic examination. This finding suggests that a distal (sentinel) hyperplastic polyp by itself may be a marker for neoplastic polyps in proximal colonic segments. Also, the "index" adenoma and "sentinel" hyperplastic polyp may be equivalent for predicting the presence of proximal neoplasms. The observed detection rates for these polyps were both significantly higher than expected when compared to patients who did not have polyps in the distal colon or rectum. If these results can be confirmed by a larger prospective trial, then full colonoscopy for detection of proximal neoplasms may be indicated when either an index adenoma or sentinel hyperplastic polyp is detected by sigmoidoscopy.

Aged↗

PubMed1990

Evaluation of the occult blood test in screening for colorectal neoplasms. A prospective study using flexible endoscopy.

Survival rates from colorectal cancer will rise only when polyps and cancers are found at an earlier, curable stage. Consequently, the purpose of the present study was to compare the yield of colonic neoplasms from flexible sigmoidoscopy and colonoscopy with that from occult blood testing. Results from 474 flexible sigmoidoscopies and 1,115 colonoscopies were prospectively recorded during a four-year study period. Colorectal polyps were found in 111 (23.4%) patients undergoing flexible sigmoidoscopy and 325 (29.1%) patients undergoing colonoscopy. Among the 436 patients with polyps, the occult blood test was negative in 282 (64.7%). Among the 51 patients with colorectal cancers, the occult blood test was negative in 20 (39.1%). Thus, testing for occult blood missed the majority of polyps and a large percentage of the carcinomas. These data indicate that lower gastrointestinal endoscopy is superior to occult blood testing as a screening test for detecting colorectal polyps or cancers. Furthermore, given the high incidence of neoplasia in this patient population, the authors suggest that colonoscopy become the screening test of choice for colorectal cancer.

Colonic Polyps↗

PubMed1989

A cost analysis of screening methodology for family members of colorectal cancer patients.

First-degree relatives of colorectal cancer patients are at increased risk for this malignancy which, in certain families, has right-sided predilection. For both these reasons, some clinicians recommend colonoscopy as the initial screening examination for these relatives. We used the results of a screening program of families of colon cancer patients to determine whether the tumor yield and costs justified this recommendation. Our study included 468 asymptomatic, first-degree relatives of large bowel neoplasia patients. Of these, 429 had only one relative with colorectal neoplasia and 39 had two or more such relatives. Persons with one affected relative were screened by fecal occult blood and flexible sigmoidoscopy, followed by colonoscopy if either test was positive, whereas colonoscopy was used as the primary screening test for those with two or more relatives with colorectal neoplasia. The comparison group included 452 persons without this family history of large bowel neoplasia. They were screened with fecal occult blood tests and flexible sigmoidoscopy. Based on a range of costs in the United States, and taking into account the hypothetical increased yield of screenees with neoplasia detected if colonoscopy was used as the primary screening examination, calculations of costs indicate that screening asymptomatic adults by colonoscopy is markedly (4-fold) more cost-effective if they have two or more first-degree colon cancer relatives. Otherwise, screening families with only 1 affected relative by flexible sigmoidoscopy, together with fecal occult blood, would seem the most economic method.

Adult↗

PubMedDate not supplied

Cancer screening services for the elderly.

The reported practices and recommendations of primary care physicians with regard to cancer screening of elderly patients (65 years and older) were studied in a 1987 survey of 400 Maryland physicians. More than 90 percent of physicians in four specialties studied reported providing digital rectal examinations, physical breast examinations, and mammography to the elderly. However, only 54 percent of obstetrician-gynecologists and 68 percent of general practitioners provided sigmoidoscopy, 70 percent of obstetrician-gynecologists provided stool guaiac slide tests, 74 percent of general practitioners provided breast self-exam instruction, and 79 percent of internists provided Pap tests. Physicians were asked what screening intervals they recommended for each test for asymptomatic elderly patients. These reports were compared with current American Cancer Society (ACS) recommendations. Large proportions of physicians in four specialties recommended sigmoidoscopy and mammography less often than the ACS recommended. More than 20 percent of physicians in the four specialties believed the elderly do not need routine sigmoidoscopy. Most physicians (90 percent or more) recommended Papanicolaou tests more often than the ACS recommended. Specialty and young physician age were the best predictors of physicians' overall adherence to ACS recommendations for cancer screening schedules.

Aged↗

PubMed1989

Synchronous large bowel cancer: a series of 47 cases.

The incidence of synchronous cancer has been reported to be 1.5% to 7.6%. A retrospective review of all colorectal cancer patients was conducted to determine the incidence of synchronous cancers. 47 synchronous cancers were identified in an operative series of 2586 patients with an incidence of 1.8%. The patients were divided into two groups based on preoperative diagnostic examinations. The first group included 1608 patients examined by double contrast x-ray barium enema (1141) and/or single contrast barium enema (381) and/or rigid sigmoidoscopy (112). The second group included 978 patients examined by double contrast barium enema (459) and/or flexible sigmoidoscopy (631) and/or colonoscopy (389). The incidence of synchronous tumors was 1.6% for patients evaluated only with double contrast roentgenographic study and 4.1% for patients who underwent preoperative colonoscopy. Fifty percent of synchronous cancers detected by colonoscopy were missed at double contrast x-ray barium enema. While twenty two percent of synchronous tumors detected by barium enema were located in different surgical segments and were all "advanced" tumors, when preoperative colonoscopy was performed, 56.2% of synchronous tumors were not located in the same surgical segment, and 66.7% of these were "early" cancers. None of the patients who underwent preoperatively colonoscopy developed a metachronous tumor within 3 years. One percent of patients undergoing flexible sigmoidoscopy or double contrast barium enema developed a second tumor 3 years after surgery. An extended use of preoperative colonoscopy in the diagnosis of colorectal cancers, to increase the detection od synchronous tumors and to decrease the incidence of the so-called "early" metachronous cancers, is stressed.

Adult↗

PubMedDate not supplied

The flexible sigmoidoscope as a potential vector of infectious disease, including suggestions for decontamination of the flexible sigmoidoscope.

The flexible fiberoptic sigmoidoscope has gained widespread acceptance as a diagnostic tool in the detection and diagnosis of colorectal disease. Since its introduction nearly a decade ago, studies have thus far indicated that in the hands of experienced physicians, flexible sigmoidoscopy is a safe procedure affording greater patient comfort, greater depth of insertion, and a higher yield of neoplastic lesions than rigid sigmoidoscopy, with surprisingly few associated risks. Although reported infrequently, infection is an acknowledged risk of flexible sigmoidoscopy and other endoscopic procedures. The most efficient means of preventing endoscopy-associated infection is uncompromising aseptic practice. Clinical and experimental data obtained from studies designed to investigate endoscopic transmission of infectious organisms and from our own and others' experiences are reviewed. Guidelines for achieving high-level disinfection of the flexible fiberoptic sigmoidoscope are included.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Routine pretreatment evaluation of patients with gynecologic cancer.

We evaluated the usefulness of the routine pretreatment performance of a chest x-ray, intravenous pyelogram (IVP), cystoscopy, barium enema, and sigmoidoscopy in patients presenting with endometrial and cervical carcinoma by reviewing the results of these tests in 231 patients. In no patient with cervical or endometrial carcinoma was tumor involvement of the large bowel mucosa found by the use of sigmoidoscopy and barium enema. Two percent of the cervical patients and none of the endometrial patients had bladder mucosal involvement discovered by using cystoscopy. Ureteral obstruction was seen by the IVP in 9% of the cervical patients and 1% of the endometrial patients. All of the women with cervical carcinoma who had bladder mucosal invasion or ureteral obstruction were already stage III before these tests. The chest x-rays showed a 0.7 and 3% incidence of tumor involvement in cervical and endometrial patients, respectively. The final stage differed from the initial stage in seven of the cervical patients and in two of the endometrial patients, but only in three of these nine were the changes based on the findings of the routine pretreatment evaluation. We conclude that routine cystoscopy, barium enema, and sigmoidoscopy in all patients with early stage cervical or endometrial carcinoma is not necessary, that a routine chest x-ray is still indicated in all patients with these malignancies, and that IVP should be performed routinely in all patients with cervical carcinoma but only if clinically indicated in patients with endometrial carcinoma.

Barium Sulfate↗

PubMed1994

Acceptance and outcome of endoscopic screening for colonic neoplasia in patients undergoing clinical rehabilitation for gastrointestinal and metabolic diseases.

Our purpose was to study the acceptance and the outcome of endoscopic screening investigations of the colon in patients between 50 and 60 years of age in a clinical rehabilitation center. A total of 1,166 patients (m = 691, f = 475) entered the study. After guaiac testing all patients for fecal occult blood loss (FOBT), 667 patients (57%; m = 407, 61%; f = 260, 39%; n.s.) accepted a sigmoidoscopy. Of 658 (m = 403, f = 255) patients with complete investigation, 153 (23%) (m = 104, 26%; f = 49, 19%; n.s.) had a total of 272 neoplastic polyps, including 1 carcinoma. Adenomas = /> 10 mm were found exclusively in male patients (n = 25, p < 0.001). In comparing patients aged 50-55 years (n = 386) with those aged 56-60 years (n = 272), prevalences of neoplasia were found to be 19%/29% (p < 0.01), and prevalences of adenomas = /> 10 mm were 2%/10% (p < 0.05). The acceptance of a colonoscopy in patients with neoplastic polyps at sigmoidoscopy was 116/153 (m = 78, 75%; f = 38, 78%; n.s.). In 39 of these patients (34%) (m = 31, 40%; f = 8, 21%; p < 0.05), 68 further adenomas were detected but no carcinoma or adenoma with severe dysplasia. Multiple adenomas in the proximal colon were seen in 17 cases (15%) (m = 16, 21%; f = 1.3%; p < 0.01). The FOBT was positive in 10/658 patients, including the case with a carcinoma, but only in 4/25 with adenomas = /> 10 mm. In 5 cases with positive FOBT sigmoidoscopy and complementary colonoscopy did not reveal any pathology.

Colonic Neoplasms↗

PubMedDate not supplied

[The value of rectosigmoidoscopy and the bacteriologic culture of colon biopsies in the etiologic diagnosis of acute diarrhea of adults. A prospective study of 65 patients].

The goal of this study was to evaluate the contribution of sigmoidoscopy with bioptic microbiology to the etiologic diagnosis of acute diarrhea in adults. Patients and methods. Sixty-five patients with acute diarrhea were included prospectively from February 1993 to November 1994. Ages ranged from 17 to 83 years. In each patient, two stool samples were cultured and three examined for parasites. Clostridium difficile toxin was looked for in the 18 patients who had taken antimicrobials before onset of the diarrhea. Sigmoidoscopy with collection of biopsy specimens for bacteriologic cultures was performed routinely. Results. A pathogenic organism was identified in 35 patients (54%). Eighteen patients (28%) had positive stool cultures. Clostridium difficile toxin was detected in six patients. Colonic biopsy cultures were positive in 26 patients (40%). Endoscopic findings established the diagnosis of pseudomembranous colitis with negative tests for C. difficile toxin in two patients, diverticulitis in one, ischemic colitis in two, and cryptogenic colitis in seven. Conclusions. Sigmoidoscopy ensured the diagnosis in over 72% of cases of acute diarrhea. This investigation complements stool cultures and should be done routinely in adults with severe acute diarrhea.

Acute Disease↗

PubMed1997

Iron deficiency anaemia in general practice: presentations and investigations.

Twenty-six patients over the age of 50 years with proven iron deficiency anaemia were identified, investigated and followed up in general practice over a five-year period. The anaemia was symptomatic in 50% of patients but only 20% had symptoms related to the gut. Faecal occult blood testing was positive in five patients only and negative tests occurred in three patients with significant disease, including one caecal carcinoma. All patients agreed to oesophagogastroduodenoscopy (OGD) and fibreoptic sigmoidoscopy carried out on the same occasion. In eight patients, significant abnormalities were found on OGD and in two patients on sigmoidoscopy. Four patients declined barium enema examinations, two of whom had significant OGD abnormalities. Barium enema examination of the other 22 patients showed polyposis of the colon and a caecal carcinoma and initially missed one carcinoma of the caecum which was found subsequently. The likelihood of finding significant disease in iron-deficient patients over 50 years of age is high and should be assumed to be due to blood loss into the gut. Investigation by OGD, sigmoidoscopy and barium enema in the first instance seems warranted and is a condition that can be safely managed by the GP.

Aged↗

PubMed1997

Family physician perception of economic incentives for the provision of office procedures.

BACKGROUND AND OBJECTIVES: The influence of capitation versus fee-for-service reimbursement for services provided by primary care physicians is an important topic as capitation becomes increasingly prevalent. This study ascertained whether family physicians perceive an economic incentive to perform flexible sigmoidoscopy, colposcopy, and vasectomy under capitated versus fee-for-service payment structures. METHODS: In May 1995, questionnaires were mailed to 592 randomly selected physician "diplomates" of the American Board of Family Practice in California, Florida, Texas, Virginia, and Minnesota. Nonrespondents received an additional mailing in July 1995. RESULTS: The return rate was 62%. Of 336 responses: 1) 177 (52%) provide flexible sigmoidoscopy; 68 (20%) think capitation and 173 (51%) think fee for service provide sufficient reimbursement to make this procedure profitable. 2) 69 (20%) provide colposcopy; 50 (16%) think capitation and 99 (30%) think fee for service provide sufficient reimbursement to make this procedure profitable. 3) 91 (27%) provide flexible sigmoidoscopy; 36 (11%) think capitation and 84 (25%) think fee for service provide sufficient reimbursement to make this procedure profitable. CONCLUSIONS: A significant number of family physicians provide these three procedures in their offices. Most physicians view fee-for-service payment as providing an economic incentive to provide these procedures. Capitation was less frequently perceived as providing sufficient reimbursement to make the provision of these procedures profitable.

Capitation Fee↗

PubMed1976

Volvulus of the sigmoid colon.

A 30-year experience with sigmoid volvulus from the City of Memphis Hospital is presented with 121 cases. Differentiating viable from gangrenous sigmoid volvulus is difficult from history, physical examination, or laboratory data and one must rely on sigmoidoscopy. Sigmoidoscopy with insertion of a colon tube is the initial management with operative detorsion only if sigmoidoscopy fails. Elective sigmoid resection is advocated in view of the high recurrence rate. In gangrenous sigmoid volvulus, a Hartmann's procedure is preferred. There is a significant rate of "recurrent sigmoid volvulus" after elective resection.

Colonic Diseases↗

PubMed1997

Patient preferences and quality of life associated with colorectal cancer screening.

OBJECTIVES: The goal of this study was to describe the attitudes of patients toward colorectal cancer screening, colon cancer, and colostomy. METHODS: Using the time trade-off technique, we interviewed four groups of patients at a veterans' hospital: 1) 46 patients with colorectal cancer, 2) 24 patients undergoing screening sigmoidoscopy, 3) 114 subjects participating in a screening colonoscopy study, and 4) 62 patients who have never undergone endoscopic screening for colorectal cancer. Using this technique, we measured quality of life for six scenarios pertaining to screening for colorectal cancer, the patient's current health, colorectal cancer, and colostomy. RESULTS: Unscreened patients were willing to give up significantly more time to avoid screening sigmoidoscopy and colonoscopy (median 91 days and 183 days, respectively) than were patients undergoing screening sigmoidoscopy (median 0 days and 7 days, respectively), screening colonoscopy (median 0 days and 0 days, respectively), or patients with colorectal cancer (median 0 days and 0 days, respectively). Cancer patients rated their current health state lower than volunteers for screening. Colon cancer and colostomy were rated similarly by all four groups. Substantial variation in patient attitudes was present in all groups. CONCLUSIONS: Patients are generally very accepting of endoscopic screening for colorectal cancer. However, decisions regarding recommendations for colorectal cancer screening must take into account the variability in patient preferences. Effective alternative strategies should be available for those whose preferences do not comply with standard recommendations. The effect of patient education and physician recommendations on subjects' attitudes toward screening warrants further investigation.

Aged↗

PubMed1997

[Value of rectosigmoidoscopy with bacteriological culture of colonic biopsies in the diagnosis of post-antibiotic hemorrhagic colitis related to Klebsiella oxytoca].

UNLABELLED: We report 7 cases of antibiotic-associated and hemorrhagic colitis due to Klebsiella oxytoca. The diagnosis was performed by sigmoidoscopy with bacteriological biopsy culture. PATIENTS AND METHODS: Nine patients, aged 25-83 years, were hospitalized from February 1993 to October 1995 with hemorrhagic acute diarrhea following antibiotic treatment: amoxicillin (n = 3). amoxicillin-clavulanic acid (n = 4), cephalosporine (n = 2). All patients have had two stool samples cultures including Clostridium difficile toxin detection. Sigmoidoscopy with collection of biopsy specimens for bacteriological cultures was performed routinely. RESULTS: Endoscopic findings established the diagnosis of colitis in all cases: rectitis (n = 1), diffuse left colitis (n = 4), segmental left colitis (n = 4). The lesions were erythematous and purpuric (n = 5) or ulcerative (n = 4). Stool culture was normal in all cases but Klebsiella oxytoca was isolated in 7 cases (78%). CONCLUSIONS: Sigmoidoscopy and bioptic microbiology ensured the diagnosis of antibiotic-associated hemorrhagic colitis due to Klebsiella oxytoca.

Adult↗