Proctosigmoidoscopy in the General Physical Examination

Abstract

Since the purpose of the physical examination is to discover disease, it would seem logical to stress those techniques which detect the most frequent and most serious diseases in their earliest stages. An exception to this generally accepted approach is the relative neglect of the proctosigmoidoscopic examination.In a recent study of a large tumor registry,1 carcinoma of the rectum and colon was the most frequently encountered cancer. It has been amply demonstrated that these often develop from adenomatous polyps and that from two-thirds to three-fourths of these cancerous and precancerous lesions occur within reach of the 25 cm. sigmoidoscope. In spite of the significance of this well-documented knowledge, we believe proctosigmoidoscopy is the most neglected of the simple diagnostic procedures.The technique of this simple procedure is seldom taught to medical students. Interns and residents who display remarkable erudition of the more glamorous radioisotopes, cardiac catheterization, and flame photometers have often never seen or done a simple proctosigmoidoscopic examination.To be sure, routine digital examination of the rectum has been taught for more than two generations, but, for the proper exam¡nation of this area, the finger is an inade¬ quate instrument.Surgeons and gastroenterologists have recognized the importance of proctosigmoidoscopy for more than two decades. Indeed, a slogan of the American Cancer Society is "Polyp detection is cancer prevention." Nevertheless, internists and general practioners, upon whom early diagnosis often depends, continue to neglect it. Many out¬ standing medical centers still do not include the procedure as an integral part of the general physical examination.It is the purpose of this paper to demon¬ strate statistically that, in the adult male, rectosigmoidal polyps are common; that polyp detection is frequently cancer de¬ tection; that polyp detection is more fre¬ quently cancer prevention when the adenomatous polyps are removed; that the only accurate method of polyp detection is proctosigmoidoscopy, and that this pro¬ cedure should be a part of every complete physical examination. Materials and MethodsThe Greenbrier Clinic is a diagnostic medical clinic. Approximately two-thirds of the patients are examined under company-sponsored executive health programs. A proctosigmoidoscopic examina¬ tion has been a part of the general physical ex¬ amination of male patients since the clinic was founded. It is apparent that this approaches a truly unselected group, since these are not hospital patients, nor have they consulted a physician be¬ cause of symptoms.Proctosigmoidoscopy is performed by the in¬ ternist at the time of the physical examination. Most examinations are in the morning. If the patient has had a morning bowel movement, fre¬ quently no further preparation is needed. If feces are encountered, a low enema of sodium biphosphate and sodium phosphate (Phospho-Soda) solu-