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Canadian Family Physician Medecin de... Sep 1993Flexible fibreoptic sigmoidoscopy can detect malignancy, polyps, and other common diseases of the large bowel when they are distal to the splenic flexure. The procedure... (Review)
Review
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.
Topics: Attitude of Health Personnel; Clinical Competence; Colorectal Neoplasms; Contraindications; Family Practice; Humans; Patient Acceptance of Health Care; Patient Education as Topic; Sigmoidoscopes; Sigmoidoscopy
PubMed: 8219841
DOI: No ID Found -
Journal of Medical Screening Jun 2020Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopy at age 60 in a... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopy at age 60 in a population being offered biennial faecal occult blood test screening from age 50. This randomized controlled trial assessed if flexible sigmoidoscopy would be an effective adjunct to faecal occult blood test.
METHODS
In the Scottish Bowel Screening Programme between June 2014 and December 2015, 51,769 individuals were randomized to be offered flexible sigmoidoscopy instead of faecal occult blood test at age 60 or to continue faecal occult blood test. Those not accepting flexible sigmoidoscopy and those with normal flexible sigmoidoscopy were offered faecal occult blood test. All with flexible sigmoidoscopy-detected neoplasia or a positive faecal occult blood test result were offered colonoscopy.
RESULTS
Overall flexible sigmoidoscopy uptake was 17.8%, higher in men than women, and decreased with increasing deprivation (25.7% in the least to 9.2% in the most deprived quintile). In those who underwent flexible sigmoidoscopy, detection rate for colorectal cancer was 0.13%, for adenoma 7.27%, and for total neoplasia 7.40%. In those who underwent colonoscopy after a positive flexible sigmoidoscopy, detection rate for colorectal cancer was 0.28%, adenoma 8.66%, and total neoplasia 8.83%. On an intention to screen basis, there was no difference in colorectal cancer detection rate between the study and control groups. Adenoma and total neoplasia detection rate were significantly higher in the study group, with odds ratios of 5.95 (95%CI: 4.69-7.56) and 5.10 (95%CI: 4.09-6.35), respectively.
CONCLUSIONS
In a single screening round at age 60, there was low uptake and neoplasia detection rate. Flexible sigmoidoscopy detected significantly more neoplasia than faecal occult blood test alone.
Topics: Adenoma; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Occult Blood; Patient Acceptance of Health Care; Sex Factors; Sigmoidoscopy
PubMed: 31690179
DOI: 10.1177/0969141319879955 -
The British Journal of Surgery Nov 2012Colorectal cancer is a significant cause of death. Removal of precancerous adenomas, and early detection and treatment of cancer, has been shown to reduce the risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Colorectal cancer is a significant cause of death. Removal of precancerous adenomas, and early detection and treatment of cancer, has been shown to reduce the risk of death. The aim of this review and meta-analysis was to determine whether flexible sigmoidoscopy (FS) is an effective population screening method for reducing mortality from colorectal cancer.
METHODS
MEDLINE (1946 to December 2012) and Embase (1980-2012, week 15) were searched for randomized clinical trials in which FS was used to screen non-symptomatic adults from a general population, and FS was compared with either no screening or any other alternative screening methods. Meta-analysis was carried out using a random-effects Mantel-Haenzsel model.
RESULTS
Twenty-four papers met the inclusion criteria, reporting results from 14 trials. Uptake of FS was usually lower than that for stool-based tests, although FS was more effective at detecting advanced adenoma and carcinoma. FS reduced the incidence of colorectal cancer after screening, and long-term mortality from colorectal cancer, compared with no screening in a selected population. Compared with stool-based tests in a general population, FS was associated with fewer interval cancers.
CONCLUSION
FS is efficacious at reducing colorectal cancer mortality compared with no screening. It is more effective at detecting advanced adenoma and carcinoma than stool-based tests. FS may be compromised by poorer uptake. Introduction of FS as a screening method should be done on a pilot basis in populations in which it is not currently used, and close attention should be paid to maximizing uptake. The relative risk of adverse events with FS compared with stool-based tests should be quantified, and its real-world effectiveness evaluated against the most effective stool-based tests.
Topics: Adenoma; Colorectal Neoplasms; Early Detection of Cancer; Humans; Immunologic Tests; Occult Blood; Patient Acceptance of Health Care; Randomized Controlled Trials as Topic; Sigmoidoscopy
PubMed: 23001715
DOI: 10.1002/bjs.8882 -
The Surgical Clinics of North America Oct 1957
Topics: Humans; Sigmoidoscopy
PubMed: 13467698
DOI: 10.1016/s0039-6109(16)35285-9 -
The American Journal of Gastroenterology Oct 2017Cecal intubation rate (CIR) is an important metric for colonoscopy quality. Guidelines propose a minimum CIR of 90% for all indications, and 95% in screening procedures....
Cecal intubation rate (CIR) is an important metric for colonoscopy quality. Guidelines propose a minimum CIR of 90% for all indications, and 95% in screening procedures. In this issue, a study of three UK teaching hospitals demonstrated one-third of endoscopists inappropriately converted colonoscopies to flexible sigmoidoscopies, and several endoscopists only reached the 90% CIR benchmark because of these inappropriate conversions. Our professional societies and healthcare organizations must continue to work to improve the accurate assessment of colonoscopy quality in order to identify underperforming clinicians who should be provided with additional training for the benefit of their patients.
Topics: Clinical Competence; Colonic Diseases; Colonoscopy; Humans; Intubation, Gastrointestinal; Quality Improvement; Quality Indicators, Health Care; Sigmoidoscopy; United Kingdom
PubMed: 28978953
DOI: 10.1038/ajg.2017.258 -
Journal of Clinical Gastroenterology Mar 1999Screening sigmoidoscopy is associated with a 45% to 80% reduction in colorectal cancer mortality. Although less than 50% of eligible Americans have been screened with... (Review)
Review
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.
Topics: Allied Health Personnel; Clinical Competence; Colorectal Neoplasms; Education, Nursing, Graduate; Fiber Optic Technology; Gastroenterology; Humans; Licensure; Sigmoidoscopes; Sigmoidoscopy; United States
PubMed: 10078817
DOI: 10.1097/00004836-199903000-00006 -
Acta Gastro-enterologica Belgica 2005Flexible sigmoidoscopy (FS) is one of the screening modalities for colorectal cancer. The rationale for screening with flexible sigmoidoscopy is that it provides direct... (Review)
Review
Flexible sigmoidoscopy (FS) is one of the screening modalities for colorectal cancer. The rationale for screening with flexible sigmoidoscopy is that it provides direct visualisation of the colon, and suspicious lesions can be biopsied. The most obvious disadvantage is that it examines only the lower third of the colon. The technical aspects of FS are sufficiently clear to enable us to define what FS can and cannot do. From the point of view of screening, FS clearly cannot completely exclude the presence of colon cancer in all asymptomatic people. A distinction must be made between screening the general population and testing the individual seeking screening. For the former, obtaining the greatest mortality benefit safely and at an acceptable cost to the nation is the crux of the matter. Recently published data indicate that FS is a cost-effective screening strategy, although colonoscopy and annual fecal occult blood test avert a greater number of cancer deaths. The results of randomised controlled trials of screening FS and colonoscopy, currently being conducted, will allow us to make a more accurate comparison with the established data regarding fecal occult blood test. In conclusion, flexible sigmoidoscopy every 5 years with or without FOBT is one of the screening methods recommended by major professional organizations. It identifies 50 to 70% of the advanced neoplasms, if any discovery of a distal neoplasia is followed up with a total examination of the colon by colonoscopy.
Topics: Age Factors; Aged; Belgium; Case-Control Studies; Cohort Studies; Colorectal Neoplasms; Early Diagnosis; Female; Fiber Optic Technology; Humans; Male; Mass Screening; Middle Aged; Risk Assessment; Sex Factors; Sigmoidoscopes; Sigmoidoscopy; Survival Analysis
PubMed: 16013644
DOI: No ID Found -
Endoscopy Mar 1999
Topics: Clinical Competence; Colorectal Neoplasms; Humans; Sigmoidoscopy
PubMed: 10344434
DOI: 10.1055/s-1999-13681 -
Clinical Privilege White Paper Aug 2010
Topics: Clinical Competence; Colorectal Neoplasms; Credentialing; Education, Medical, Continuing; Gastroenterology; Humans; Joint Commission on Accreditation of Healthcare Organizations; Medical Staff Privileges; Sigmoidoscopy; Societies, Medical; United States
PubMed: 20726161
DOI: No ID Found -
BMC Research Notes Apr 2020Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in... (Observational Study)
Observational Study
OBJECTIVE
Flexible sigmoidoscopy is useful to look for an underlying aetiology in fistula-in-ano. This study was aimed to assess the yield of routine flexible sigmoidoscopy in patients presenting with fistula-in-ano. A retrospective analysis of 159 consecutive patients with fistula-in-ano who underwent routine flexible sigmoidoscopy was performed. Sigmoidoscopy findings were recorded on a standard uniform format using a computer database. Those with a known aetiology were excluded.
RESULTS
The median age was 39 (range: 14-74) years and the majority were males (n = 128, 80.5%). Forty-nine patients (30.8%) presented with a recurrent fistula-in-ano. On flexible sigmoidoscopy, internal opening was seen in only 23 patients (14.4%). Furthermore, incidental findings of haemorrhoids (n = 5, 3.1%) and polyps (n = 7, 4.4%) were found. One patient (0.6%) had a healed anal fissure, 5 patients (3.1%) had inflamed mucosa and 2 patients (1.3%) had ulcers. Only two patients with inflamed mucosa were diagnosed to have Crohn's disease on histology. Therefore, flexible sigmoidoscopy was not helpful in the majority to locate the internal opening. Only two patients had evidence of an underlying aetiology, which was Crohn's disease. However, they had recurrent complex fistulae and other associated symptoms. Therefore, flexible sigmoidoscopy may be reserved for selected group of patients with symptoms of an underlying aetiology.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Rectal Fistula; Retrospective Studies; Sigmoidoscopy; Young Adult
PubMed: 32295638
DOI: 10.1186/s13104-020-05066-6