Depth of Insertion At Flexible Sigmoidoscopy: Implications for Colorectal Cancer Screening and Instrument Design

Painter, John; Saunders, D. B.; Bell, G. D.; Williams, C. B.; Pitt, Rachel; Bladen, John S.

doi:10.1055/s-1999-13673

Cited by 77 publications

(52 citation statements)

References 8 publications

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“…In the main analysis presented in this article, distal colon was conservatively defined as sigmoid colon or rectum because >50% of flexible sigmoidoscopic examinations reach only the junction of the sigmoid and descending colon (12,13). Ideally, flexible sigmoidoscopy would reach the splenic flexure.…”

Section: Methodsmentioning

confidence: 99%

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study

Brenner¹,

Chang‐Claude

Seiler

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

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We aimed to estimate the proportions of colorectal cancer cases that might be prevented by sigmoidoscopy compared with colonoscopy among women and men. In a populationbased case control study conducted in Germany, 540 cases with a first diagnosis of primary colorectal cancer and 614 controls matched for age, sex, and county of residence were recruited. A detailed lifetime history of endoscopic examinations of the large bowel was obtained by standardized personal interviews, validated by medical records, and compared between cases and controls, paying particular attention to location of colorectal cancer and sex differences. Overall, 39%, 77%, and 64% of proximal, distal, and total colorectal cancer cases were estimated to be preventable by colonoscopy. The estimated proportion of total colorectal cancer cases preventable by sigmoidoscopy was 45% among both women and men, assuming that sigmoidoscopy reaches the junction of the descending and sigmoid colon only and findings of distal polyps are not followed by colonoscopy. Assuming that sigmoidoscopy reaches the splenic flexure and colonoscopy is done after detection of distal polyps, estimated proportions of total colorectal cancer preventable by sigmoidoscopy increase to 50% and 55% (73% and 91% of total colorectal cancer preventable by primary colonoscopy) among women and men, respectively. We conclude that colonoscopy provides strong protection against colorectal cancer among both women and men. The proportion of this protection achieved by sigmoidoscopy with follow-up colonoscopy in case of distal polyps may be larger than anticipated. Among men, this regimen may be almost as effective as colonoscopy, at least at previous performance levels of colonoscopy. (Cancer Epidemiol Biomarkers Prev 2007;16(3):494 -9)

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Section: Methodsmentioning

confidence: 99%

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study

Brenner¹,

Chang‐Claude

Seiler

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…FS is not always complete and the descending colon may be intubated in no more than 46% even after 60 cm has been inserted [17,18]. However, the presence of neoplasia within the reach of FS has some predictive value for neoplasia in the right site, whereas the opposite does not seem to be true.…”

Section: Flexible Sigmoidoscopy (Fs)mentioning

confidence: 99%

Screening for colorectal cancer

et al. 2005

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“…Stewart et al 6 suggest a 25% incomplete examination rate and technical difficulty in up to one third of the cases. Painter et al 7 found that in up to a quarter of the patients, the descending colon was not intubated. Using radiopaque clips, Lehman et al 8 noted that a 60-cm examination reached the splenic flexure in only 33% of patients, a 50-to 55-cm examination reached the sigmoid/ descending colon junction in most instances, a 40- to 45-cm examination the mid to upper sigmoid, and a 30-to 35-cm examination the lower to mid sigmoid.…”

mentioning

confidence: 99%

Predictors of Incomplete Flexible Sigmoidoscopy

Ramakrishnan¹,

Scheid²

2003

The Journal of the American Board of Family Medicine

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Objectives: Flexible sigmoidoscopy (flex sig) is an easily administered method of screening for colorectal polyps and cancer. In some patients, the depth of insertion is incomplete, which may result in missed polyps and cancers. To address the question of prospective patient selection for this procedure, we analyzed the factors affecting depth of insertion of sigmoidoscopies performed in outpatients over a 3-year period.Study Design: The study involved retrospective chart review of procedures performed by one endoscopist over a 3-year period.Outcomes Conclusions: Our study showed a relationship between incomplete examination and increasing age, female sex (more than 75% of the incomplete examinations were in women), poor bowel preparation (in women), hysterectomy, abdominal surgery (in men) and weight loss (in men). Further research is necessary to determine whether a predictive model can be developed that would be useful to select patients most appropriate for flex sig. In those patients in whom difficulty is anticipated, the choice can be made in to perform flex sig under sedation, analgesia, with the help of distraction techniques, or offer primary colonoscopy. Most colorectal cancers arise from adenomatous polyps.1 Their long asymptomatic phase allows for timely screening and adequate treatment of these premalignant lesions. Although screening colonoscopy is regarded as the ideal mechanism of detecting polyps because of its completeness and therapeutic potential, significant logistic barriers prevent its widespread implementation. Studies evaluating colonoscopy have suggested that screening flexible sigmoidoscopy (flex sig) using the 60-cm instrument has the capability of detecting 65% to 75% of polyps and 40% to 65% of colorectal cancers. 2-4The procedure can be performed by many physicians and physician extenders with relatively less investment in training and equipment. Hence, flex sig remains an important means of screening a major segment of the population at risk for colorectal cancer.Incomplete examination is an unfortunate drawback of flex sig, because the procedure is routinely offered without sedation or analgesia for simplicity and ease of administration. Olynyk et al 5 noted that 30% of patients had a depth of insertion of less than 50 cm. Stewart et al 6 suggest a 25% incomplete examination rate and technical difficulty in up to one third of the cases. Painter et al 7 found that in up to a quarter of the patients, the descending colon was not intubated. Using radiopaque clips, Lehman et al 8 noted that a 60-cm examination reached the splenic flexure in only 33% of patients, a 50-to 55-cm examination reached the sigmoid/ descending colon junction in most instances, a 40-

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Depth of Insertion At Flexible Sigmoidoscopy: Implications for Colorectal Cancer Screening and Instrument Design

Cited by 77 publications

References 8 publications

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study

Screening for colorectal cancer

Predictors of Incomplete Flexible Sigmoidoscopy

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