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Journal of Internal Medicine Apr 2021Colorectal cancer (CRC) is, besides breast, prostate, lung and skin cancers, the most common cancer worldwide and is suitable for screening. The incidence of CRC varies... (Review)
Review
Colorectal cancer (CRC) is, besides breast, prostate, lung and skin cancers, the most common cancer worldwide and is suitable for screening. The incidence of CRC varies considerably in different parts of the world: in well-developed countries, the incidence is between 30 and 70 per 100 000 inhabitants, whereas in less-developed countries such as sub-Saharan Africa, it is 10-20/100 000 inhabitants. Women have a lower incidence of CRC, which is usually one-third of total incidence. Several studies have shown that it is possible to decrease mortality from CRC with about 20%, which is evidenced through the data from countries with screening programmes. Though the method of choice to identify blood samples in faecal matter is under debate, the most feasible way is to perform colonoscopy. Other methods include more advanced faecal analyses, testing for mutations from CRC, sigmoidoscopy, CT colonoscopy or optical colonoscopy. Colonoscopy is in most countries not available in sufficient amount and has to be carried out with great accuracy; otherwise, lesions will be missed to identify, thus leading to complications. Gender is an issue in CRC screening, as women have about 20% fewer colorectal adenomas and CRCs, but they also have more right-sided lesions, which are more difficult to detect with tests for faecal blood since they create less blood in faeces. Thus, other strategies may have to be developed for women in order for screening to have the same effect. It is essential to introduce colorectal cancer screening in all countries together with other clinical pieces of advice such as information on smoking, obesity and exercise in order to reduce one of the most dangerous cancers.
Topics: Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 32929813
DOI: 10.1111/joim.13171 -
PloS One 2023Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose....
INTRODUCTION
Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters.
METHODS
A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies.
RESULTS
Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics.
CONCLUSION
The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
Topics: Humans; Early Detection of Cancer; Sigmoidoscopy; Cost-Benefit Analysis; Colonoscopy; Colorectal Neoplasms
PubMed: 37594967
DOI: 10.1371/journal.pone.0290353 -
BMJ Clinical Evidence Jun 2007Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000... (Review)
Review
INTRODUCTION
Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000 deaths each year in the UK, and 60,000 each year in the USA.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of screening for colorectal cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: colonoscopy, computed tomography colography, double contrast barium enema, faecal occult blood testing, flexible sigmoidoscopy.
Topics: Colonoscopy; Colorectal Neoplasms; Evidence-Based Medicine; Humans; Incidence; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 19454089
DOI: No ID Found -
Radiology Mar 2018Purpose To compare the acceptability of computed tomographic (CT) colonography and flexible sigmoidoscopy (FS) screening and the factors predicting CT colonographic... (Comparative Study)
Comparative Study Randomized Controlled Trial
Purpose To compare the acceptability of computed tomographic (CT) colonography and flexible sigmoidoscopy (FS) screening and the factors predicting CT colonographic screening participation, targeting participants in a randomized screening trial. Materials and Methods Eligible individuals aged 58 years (n = 1984) living in Turin, Italy, were randomly assigned to be invited to screening for colorectal cancer with FS or CT colonography. After individuals who had died or moved away (n = 28) were excluded, 264 of 976 (27.0%) underwent screening with FS and 298 of 980 (30.4%) underwent CT colonography. All attendees and a sample of CT colonography nonattendees (n = 299) were contacted for a telephone interview 3-6 months after invitation for screening, and screening experience and factors affecting participation were investigated. Odds ratios (ORs) were computed by means of multivariable logistic regression. Results For the telephone interviews, 239 of 264 (90.6%) FS attendees, 237 of 298 (79.5%) CT colonography attendees, and 182 of 299 (60.9%) CT colonography nonattendees responded. The percentage of attendees who would recommend the test to friends or relatives was 99.1% among FS and 93.3% among CT colonography attendees. Discomfort associated with bowel preparation was higher among CT colonography than FS attendees (OR, 2.77; 95% confidence interval [CI]: 1.47, 5.24). CT colonography nonattendees were less likely to be men (OR, 0.36; 95% CI: 0.18, 0.71), retired (OR, 0.31; 95% CI: 0.13, 0.75), to report regular physical activity (OR, 0.37; 95% CI: 0.20, 0.70), or to have read the information leaflet (OR, 0.18; 95% CI: 0.08, 0.41). They were more likely to mention screening-related anxiety (mild: OR, 6.30; 95% CI: 2.48, 15.97; moderate or severe: OR, 3.63; 95% CI: 1.87, 7.04), erroneous beliefs about screening (OR, 32.15; 95% CI: 6.26, 165.19), or having undergone a recent fecal occult blood test (OR, 13.69; 95% CI: 3.66, 51.29). Conclusion CT colonography and FS screening are well accepted, but further reducing the discomfort from bowel preparation may increase CT colonography screening acceptability. Negative attitudes, erroneous beliefs about screening, and organizational barriers are limiting screening uptake; all these factors are modifiable and therefore potentially susceptible to interventions. RSNA, 2017 Online supplemental material is available for this article.
Topics: Colonography, Computed Tomographic; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Italy; Male; Middle Aged; No-Show Patients; Patient Acceptance of Health Care; Patient Participation; Patient Satisfaction; Self Report; Sigmoidoscopy
PubMed: 29040021
DOI: 10.1148/radiol.2017170228 -
Annals of the Royal College of Surgeons... Nov 2020The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study...
INTRODUCTION
The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure.
MATERIALS AND METHODS
A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy.
RESULTS
All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes.
CONCLUSIONS
There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.
Topics: Acute Disease; Aftercare; Aged; Aged, 80 and over; Colonoscopy; Diverticulitis, Colonic; Female; Humans; Male; Middle Aged; Retrospective Studies; Sigmoidoscopy; Tomography, X-Ray Computed
PubMed: 32820657
DOI: 10.1308/rcsann.2020.0181 -
Saudi Journal of Gastroenterology :... 2022Although the efficacy of water-assisted colonoscopy is well established, the role of water immersion sigmoidoscopy (WIS) remains unclear. We compared WIS with carbon...
BACKGROUND
Although the efficacy of water-assisted colonoscopy is well established, the role of water immersion sigmoidoscopy (WIS) remains unclear. We compared WIS with carbon dioxide insufflation sigmoidoscopy (COS) on patient outcomes.
METHODS
We conducted an analysis of prospectively collected data from a single-center quality improvement program about patients undergoing unsedated screening sigmoidoscopy (WIS and COS) between May 2019 and January 2020. Outcomes studied included the following: Rates of severe pain <17% (score of ≥7 on a numeric rating scale of 0-10, and on a Likert scale), willingness to repeat the procedure without sedation, adequate bowel cleanliness >75% (proportion of Boston Bowel Preparation Scale score: 2-3) and adenoma detection rate (ADR).
RESULTS
In total, 234 patients (111 WIS; 123 COS) were included. All patients were aged 58 years and 58.9% were female; baseline characteristics were comparable between groups. There were no significant differences in rates of severe pain (WIS: 16.5%, COS: 13.8%; P = 0.586), willingness to repeat the unsedated procedure (WIS: 82.3%, COS: 84.5%; P = 0.713), adequate bowel cleanliness (WIS: 78.4%, COS: 78%, P = 0.999) or ADR (WIS: 25.2%, COS: 16.3%; P = 0.106) between groups. However, average procedure times were longer with WIS (9.06 min) compared to COS (6.45 min; P < 0.001). Overall, 29.6% of women reported that they would repeat sigmoidoscopy only if sedated.
CONCLUSIONS
WIS does not ameliorate tolerance to and quality of sigmoidoscopy screening measured by several scores. When offered a choice, the women's willingness to repeat WIS or COS without sedation was poor and raises concern on the opportunity of screening sigmoidoscopy without sedation in these subjects.
Topics: Cohort Studies; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Immersion; Insufflation; Middle Aged; Sigmoidoscopy; Water
PubMed: 34494603
DOI: 10.4103/sjg.sjg_198_21 -
Medicina (Kaunas, Lithuania) May 2020: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible...
: colonic ischemia (CI) after ruptured abdominal aortic aneurysm (rAAA) repair is associated with increased morbidity and mortality. CI may be detected by using flexible sigmoidoscopy, but routine use of flexible sigmoidoscopy after rAAA is not clearly proven. The objective of this study was to evaluate the efficacy of routine flexible sigmoidoscopy in detecting CI after rAAA repair, and to identify potential hemodynamic, biochemical, and clinical variables that can predict the development of CI in the patients who underwent rAAA surgery. : we retrospectively included all rAAA cases treated in Viborg hospital from 1 April 2014 until 31 August 2017, recorded the findings on flexible sigmoidoscopy, and the incidence of CI. We collected specific hemodynamic, biochemical, and clinical variables, measured pre- and perioperatively, and the first three postoperative days. The association between CI and possible predictors was analyzed in a logistic regression model. : a total of 80 patients underwent open rAAA repair during the study period. Flexible sigmoidoscopy was performed in 58 of 80 patients (73.5%) who survived at least 24 h after open rAAA surgery. Perioperative variables lowest arterial pH ( = 0.02) and types of operations-aortobifemoral bypass vs. straight graft ( = 0.04) showed statistically significant differences between CI groups. The analysis of the postoperative variables showed statistically significant difference in highest lactate on postoperative day 1 ( = 0.01), and lowest hemoglobin on postoperative day 2 ( = 0.04) comparing CI groups. Logistic regression model revealed that postoperative hemoglobin and lactate turned out to be independent risk factors for the development of CI (respectively OR = 0.44 (95% CI = 0.29-0.67) and OR = 1.91 (95% CI = 1.2-3.05)). : flexible sigmoidoscopy can identify patients being at higher risk of mortality after open rAAA repair. The postoperative lactate and hemoglobin were found to be independent risk factors for the development of CI after open rAAA repair. Further larger studies are warranted to demonstrate these findings.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Rupture; Case-Control Studies; Colon; Female; Humans; Intestinal Mucosa; Ischemia; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Sigmoidoscopy
PubMed: 32403234
DOI: 10.3390/medicina56050229 -
Canadian Journal of Gastroenterology &... Jan 2014Although colorectal cancer is a leading cause of death in Canada, it is curable if detected in the early stages. Flexible sigmoidoscopy has been shown to reduce the...
Although colorectal cancer is a leading cause of death in Canada, it is curable if detected in the early stages. Flexible sigmoidoscopy has been shown to reduce the incidence and mortality of colorectal cancer in patients who are at average risk for this disease and, therefore, is an appropriate screening intervention. Moreover, it may be performed by nonphysicians. A program to enable registered nurses to perform flexible sigmoidoscopy to increase colorectal cancer screening capacity in Ontario was developed. This program incorporated practical elements learned from other jurisdictions as well as specific regional considerations to fit within the health care system of Ontario. The nurses received structured didactic and simulation training before performing sigmoidoscopies on patients under physician supervision. After training, nurses were evaluated by two assessors for their ability to perform complete sigmoidoscopies safely and independently. To date, 17 nurses have achieved independence in performing flexible sigmoidoscopy at 14 sites. In total, nurses have screened >7000 Ontarians, with a cancer detection rate of 5.1 per 1000 screened, which is comparable with rates in other jurisdictions and with sigmoidoscopy performed by gastroenterologists, surgeons and other trained nonphysicians. We have shown, therefore, that with proper training and program structure, registered nurses are able to perform flexible sigmoidoscopy in a safe and thorough manner resulting in a significant increase in access to colorectal cancer screening.
Topics: Clinical Competence; Colorectal Neoplasms; Curriculum; Early Detection of Cancer; Humans; Incidence; Nurse Practitioners; Ontario; Sigmoidoscopy
PubMed: 24416735
DOI: 10.1155/2014/561749 -
Modern Pathology : An Official Journal... Jan 2015The introduction of bowel cancer screening, in the United Kingdom, United States of America, and many other Western countries, has provided considerable interest and no... (Review)
Review
The introduction of bowel cancer screening, in the United Kingdom, United States of America, and many other Western countries, has provided considerable interest and no little diagnostic consternation for pathologists. In the United Kingdom, the universal introduction of bowel cancer screening, initially by fecal occult blood testing and more recently by the introduction of flexible sigmoidoscopy, has provided four main areas of pathological diagnostic difficulty. This is the biopsy diagnosis of adenocarcinoma, serrated pathology, the diagnosis and management of polyp cancer, and, finally, the phenomenon of pseudoinvasion/epithelial misplacement (PEM), particularly in sigmoid colonic adenomatous polyps. The diagnostic difficulties associated with the latter phenomenon have provided particular problems that have led to the institution of a UK national 'Expert Board', comprising three pathologists, who adjudicate on difficult cases. The pathological features favoring PEM are well recognized but there is no doubt that there can be profound mimicry of adenocarcinoma, and, as yet, no adjunctive diagnostic tools have been developed to allow the differentiation in difficult cases. Research in this area is proceeding and some methodologies do show promise in this difficult diagnostic area.
Topics: Colonic Polyps; Early Detection of Cancer; Humans; Intestinal Neoplasms; Mass Screening; Neoplasm Invasiveness; Sigmoidoscopy
PubMed: 25560603
DOI: 10.1038/modpathol.2014.138 -
Cancer Epidemiology Oct 2022High participation rates are important for a colorectal cancer (CRC) screening programme to be effective. Having a long travelling distance to screening centres may... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
High participation rates are important for a colorectal cancer (CRC) screening programme to be effective. Having a long travelling distance to screening centres may impede participation.
METHODS
We analysed the association between driving time from home address to screening centre and participation among individuals invited to screening with faecal immunochemical test (FIT) (n = 68,624) or sigmoidoscopy (n = 46,076) in a randomized trial in Norway in 2012-17. Two screening centres were involved. We fitted multiple logistic regression models, adjusted for demographic, socioeconomic and health characteristics, and reported odds ratios (OR) with 95% confidence intervals (CI).
RESULTS
Participation rates were 58.9 % (n = 40,445) for FIT and 51.9 % (n = 23,911) for sigmoidoscopy. In sigmoidoscopy, participation was 56.9 % and 47.9 % in those living < 20 and > 60 min by car from the screening centres, respectively. For each 10 min driving time increase, OR for participating in sigmoidoscopy screening was 0.93 (95 % CI 0.91-0.95). There was a significant difference between the two screening centres (p-value for heterogeneity <0.001). Participation in FIT screening were 61.2 % and 57.1 % in those with < 20 and > 60 min driving time, respectively, and the OR was 0.98 (95 % CI 0.96-0.99) for each 10 min increase (heterogeneity between screening methods, P-value <0.001). Among those with a positive FIT, compliance to colonoscopy was higher in those living < 20 compared to > 60 min from the centres (95.1 % vs. 92.9 %, respectively, OR 0.86; 95 % CI 0.77-0.93 for each 10 min increase).
CONCLUSIONS
Driving time to screening centre was a significant predictor of participation, mainly in sigmoidoscopy. There were local differences in the impact of driving time on participation. Driving time also affected compliance to colonoscopy after a positive FIT. When planning a CRC screening programme, one should consider offering people living far from screening sites special assistance to facilitate their participation.
Topics: Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Hematologic Tests; Humans; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 36057171
DOI: 10.1016/j.canep.2022.102244