Comparison of flexible sigmoidoscopy with other diagnostic techniques in the diagnosis of rectocolon neoplasia

Abstract

Flexible sigmoidoscopy was compared to rigid sigmoidoscopy in the detection of colorectal neoplasia in a select group of patients. A distance of 30 cm or greater was obtained by flexible sigmoidoscopy in 94% of patients and a distance of 50 cm or greater in 46% of patients. A significant number of cancers and adenomas detected by flexible sigmoidoscopy were not detected by rigid sigmoidoscopy. Flexible sigmoidoscopy was tolerated better than rigid sigmoidoscopy but required twice the time. Flexible sigmoidoscopy could be combined with air-contrast barium enema the same day with the one preparation and did not interfere with the x-ray examination. All cancers and a significant number of adenomas detected subsequently on colonoscopy were detected by the combination of flexible sigmoidoscopy and air-contrast barium enema. Although the combination of flexible sigmoidoscopy and air-contrast barium enema is not adequate for thorough diagnostic evaluation of patients with a positive screening test, it may be of value in other select clinical situations. Flexible sigmoidoscopy has the potential for higher yield and better patient tolerance as compared to rigid sigmoidoscopy. This warrants further evaluation.

A combined flexible sigmoidoscopy and double-contrast barium enema service: initial experience

“…In suspected inflammatory bowel disease, FS allows biopsy of the distal colon and rectum, thus facilitating the diagnosis of even macroscopically occult disease. On the other hand, DCBE is more sensitive than endoscopy in the diagnosis of diverticular disease [9,10].…”

“…Previous authors have reported success in performing FS and DCBE as a one-stage procedure with a single bowel preparation [9,10,[12][13][14]. We have instigated a combined FS/DCBE service within our radiology department and report here our initial experience in our first 80 patients.…”

“…Nevertheless in appropriate age groups, it is important to detect small polyps in order to facilitate the secondary prevention of colorectal carcinoma, since about 60% of polyps, 5 mm or less, are adenomatous [8]. On the other hand, DCBE is more sensitive than endoscopy in the detection of diverticular disease [9,10]. A combination of proctosigmoidoscopy and DCBE is of acceptable accuracy in depicting inflammatory bowel disease [l 1].…”

Diagnostic Value of Fiberoptic Sigmoidoscopy: Evaluation of the Anatomical Extent

“…respec tively) [21]. Radiology should be always performed in the case of a negative endoscopic investigation as well as in the case of malignant or precancerous lesions in the area explored.…”

“…13, 15. 17,[19][20][21][22] as the first diagnostic tool in: (a) the routine examination of patients with symptoms due to disorders of the large bowel (first of all rectal bleeding): (b) the screening for carcinoma in asymptomatic but high-risk patients; (c) the solution of diagnostic doubts posed by double contrast barium enemas; (d) the follow-up of patients with inflammatory bowel diseases (ulcerative colitis); (e) the re-inspection of endoscopically removed but cancerized polyps, and (0 the follow-up of patients who had undergone surgery for cancer of the left colon and rectum.Some authors [4,5], after having inserted the fiberop tic sigmoidoscope to its full length of 60 cm, only on the basis of the endoscopic findings, have expressed them selves in positive terms towards the possibility of explor ing with the same tool at least the whole sigma as far as the sigmoid-descending colon junction. Our experience has gradually confirmed how inappropriate the word 'fi beroptic sigmoidoscope' is, referring to an instrument which allows us to study areas beyond the sigma.…”