Extended flexible sigmoidoscopy performed by colonoscopists for colorectal cancer screening: a pilot study

Abstract

SUMMARY BackgroundCaecal intubation can be achieved by extended flexible sigmoidoscopy in 32% of patients.

Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening

“…A number of US clinicians have proposed options besides routine sedation [4][5][6][10][11][12][13][14][15][16][17][18][19] . Scheduled, unsedated colonoscopy is acceptable to patients who value communication with the colonoscopist, or when they lack an escort [4][5][6][10][11][12][13][14][15][16][17][18][19] . Nonetheless sedation remains the dominant practice [1] and for colonoscopists' efficiency and economic reasons [20] deep sedation is gaining support in the US [21] .…”

“…In a recent editorial [5] , the implication has been extended to lessening the time burden [2] of screening for colorectal cancer. One practical approach is to present the option as an extended sigmoidoscopy [14,15,51] . Sigmoidoscopy for colorectal cancer screening is supported by evidence from case controlled studies [52] , although it is not the preferred method in many countries because 40% of all colorectal neoplasia would be overlooked.…”

“…Sigmoidoscopy is performed without sedation coverage. Extended sigmoidoscopy is performed with the aid of a colonoscope after full bowel preparation by oral purgative [15] . Without the use of medications, both extended sigmoidoscopy and unsedated colonoscopy obviate nursing cost for monitoring and recovery [4,5,15] , the risk of complications [57] and patient burden [2] inherent in sedation.…”

“…Extended sigmoidoscopy also leaves the option to accept full colonoscopy without sedation to the patient based on tolerable abdominal discomfort [15] . Until unsedated colonoscopy sheds its negative image [46][47][48][49] or acceptance of sedation-risk-free options as a quality indicator [50] is achieved, discussions directed toward encouraging unsedated extended flexible sigmoidoscopy [14,15,51] appear to be a prudent approach to optimize screening and minimize burden. After detailed explanation, if patients and providers accept unsedated flexible sigmoidoscopy as the screening modality, any additional examination of the colon performed during the same session (extended flexible sigmoidoscopy) can benefit the patients.…”

The water method—untapped potential in extended flexible sigmoidoscopy for colorectal cancer screening?

“…Recently I began offering motivated patients at average risk for colon cancer the option of an extended flexible sigmoidoscopy 1 . Patient are prepped for a colonoscopy but do not have the option of receiving sedation.…”