Rigid or Flexible Sigmoidoscopy in Colorectal Clinics? Appraisal Through a Systematic Review and Meta-analysis

Ahmad, Nasir Zaheer; Ahmed, Aftab

doi:10.1089/lap.2012.0087

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…24 Rigid proctoscopic examination could also be added for accurate distance localisation from the anal verge because measurements with a flexible endoscope may be inaccurate. 28,29 We hope that this study has increased awareness of the need for tattooing and comprehensive documentation in order for accurate localisation of colorectal lesions.…”

Section: Discussionmentioning

confidence: 95%

“…Colonoscopy reporting should clarify size of the lesion, distance from anal verge if relevant, tattoo location and technique, in order to prevent unnecessary repeat procedures, and to minimize delays in curative resection 24 . Rigid proctoscopic examination could also be added for accurate distance localisation from the anal verge because measurements with a flexible endoscope may be inaccurate 28,29 …”

Section: Discussionmentioning

confidence: 99%

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A single centre audit: repeat pre‐operative colonoscopy

Chen

Nair

Saboo

et al. 2022

ANZ Journal of Surgery

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Background: Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. Methods: A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. Primary outcomes: changes in operative approach and delays to operation. Secondary outcomes: reasons for a repeat colonoscopy and complications from repeat colonoscopy. Results: A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p = 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p = 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. Conclusion: There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p = 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

A single centre audit: repeat pre‐operative colonoscopy

Chen

Nair

Saboo

et al. 2022

ANZ Journal of Surgery

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“…Sigmoidoscopy is the oldest and most thoroughly researched of the endoscopic methods. Rigid sigmoidoscopy has existed for a century and flexible sigmoidoscopy for about half as long [ 48 ]. Its chief advantages are its simplicity and wide availability [ 49 ].…”

Section: Endoscopic Screeningmentioning

confidence: 99%

Developments in Screening Tests and Strategies for Colorectal Cancer

Sovich

Sartor

Misra

2015

BioMed Research International

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Background. Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening. Methods. We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News. Results. Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising “third-eye retroscope.” Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market. Conclusions. Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities.

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“…The low predictive value of symptomatic rectal bleeding for underlying pathology, including that of malignancy 2 , often leads to referral to Gastroenterology for assessment. The diagnostic yield and low complication rates of flexible sigmoidoscopy (FS) have made it an appealing modality for assessing symptomatic patients 3 4 . Direct to procedure clinics with flexible sigmoidoscopy (DTP-FS) have been used to address this type of referral.…”

Section: Introductionmentioning

confidence: 99%

Two-year retrospective analysis of patients undergoing direct to procedure flexible sigmoidoscopy investigation with rectal bleeding as a primary complaint

et al. 2018

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Background and aims Rectal bleeding affects ~15 % of the general population and is a common reason for referral to gastroenterologists by primary care physicians. Direct to procedure flexible sigmoidoscopy is an appealing modality to investigate rectal bleeding due its diagnostic yield, safety profile, and accessibility. Patients referred on a routine basis for direct to procedure clinic by primary care physicians with the sole complaint of rectal bleeding have not previously been studied. Our study aims to explore the spectrum of diagnoses and evaluate for potential clinical predictors of underlying pathology in this specific patient population. Methods In total, 528 charts of patients referred to the Kingston General Hospital and Hotel Dieu Hospital endoscopy units (Kingston, Canada) with the sole complaint of rectal bleeding were reviewed. All of these patients were referred on a routine basis to direct to procedure clinic from primary care physicians. The performance of various clinical variables in predicting significant pathology was assessed by univariate analysis. Results The diagnostic spectrum of the cohort studied included hemorrhoids (75.5 %), anal fissures (4 %), ulcerative colitis (3.2 %), Crohn’s disease (1.1 %), indeterminate proctitis/colitis (1.7 %), and colorectal malignancy (2.7 %). Of the various clinical variables assessed, only male sex predicted significant pathology (25.2 % of males vs 17.6 % of females, P < 0.05). Conclusion Our study highlights the need for a thorough investigation of rectal bleeding given the lack of clinical predictors. Future prospective studies with more patients are needed to fully assess the utility of various clinical variables in predicting pathology in this patient population. This would allow for more effective triaging of a routine rectal bleeding, a very common reason for patient referral to gastroenterologists by primary care physicians. Flexible sigmoidoscopy was not associated with complications or missed diagnosis in our study. As such, the technique appears to be a suitable initial investigative modality for patients with rectal bleeding.

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Rigid or Flexible Sigmoidoscopy in Colorectal Clinics? Appraisal Through a Systematic Review and Meta-analysis

Cited by 5 publications

References 31 publications

A single centre audit: repeat pre‐operative colonoscopy

A single centre audit: repeat pre‐operative colonoscopy

Developments in Screening Tests and Strategies for Colorectal Cancer

Two-year retrospective analysis of patients undergoing direct to procedure flexible sigmoidoscopy investigation with rectal bleeding as a primary complaint

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