Rigid Sigmoidoscopic Examination, an Investigation Down but Not Out: A 5-Year Single-Center Experience on 9418 Patients

Abstract

Background: Rigid sigmoidoscopy (RS) in the present era of flexible sigmoidoscopies is falling out of favor although it continues to be used in some centers as an outpatient (OP) department procedure. Aims: This study aims to determine the utility of RS for diagnosis of rectosigmoidal pathologies in the OP setting with emphasis on neoplastic lesions. Methods: We retrospectively studied the RS records and histopathology reports (HPRs) of 5 years (July 2013–June 2018) done in the Department of Gastroenterology at Medical College Calicut. Results: During the study period, 9418 RS examinations were done, and a total of 6921 abnormalities were picked up, giving a diagnostic yield of 73.5%. Most common indication was bleeding per rectum (PR) (51%), followed by constipation (29%). The most common lesion found was hemorrhoids 39.8% followed by proctitis 13.7%, neoplasms 9.7%, and others 10.3% while 26.5% studies were normal. HPRs showed 7.7% to be malignant, 5.8% were adenoma, 12.2% were inflammatory bowel disease ulcerative colitis (IBD UC), 2.2% were solitary rectal ulcer syndrome, 1.2% nonspecific colitis, 1.7% nonneoplastic polyps, 2.7% were normal, and 1.4% were inconclusive. Of the 4812 patients with complaints of bleeding PR, 4739 (98.5%) had a diagnosis after RS, of which hemorrhoids (72.7%) was the most common cause followed by proctitis (14.2%), neoplasm (9%), and others (4.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of RS in detecting neoplasia was 98.2%, 96.8%, 66.1%, and 99.9%, respectively, when HPR was gold standard. RS was found to be effective for assessing activity in IBD UC. Conclusion: RS is a simple, cheap, and effective tool for diagnosing various rectosigmoid pathologies. RS can be used as an effective screening test for rectosigmoid pathologies, especially neoplasia and IBD UC.

Rigid Sigmoidoscopic Examination for Rectosigmoid Lesions: The Older the Fiddle, the Sweeter the Tune

“…In the current issue of the Journal of Digestive Endoscopy, an article reminds me of this proverb. [1] In this study from southern India on a large number of patients (n = 9418) undergoing rigid sigmoidoscopic examination for bleeding per rectum (51%) and chronic constipation (21%) and sigmoidoscopic assessment of ulcerative colitis, the diagnostic yield of proctosigmoidoscopy was as high as 73.5%. [1] Although such a high yield of a limited sigmoidoscopic examination is quite encouraging, it does raise several issues, which are being discussed below.…”

“…In the current series, the diagnostic yield of rigid sigmoidoscopy in patients with bleeding per rectum was very high to the tune of 98.5% of whom 72.7% had hemorrhoids. [1] This may suggest that in patients with bleeding per rectum, the rigid sigmoidoscopic examination is very useful. In fact, in practice, most of us working in big university hospitals have seen that patients with ulcerative colitis presenting with bleeding per rectum had surgery for piles, albeit inappropriately, in a community care setting, which could be obviated by a rigid sigmoidoscopic examination.…”

“…[5] 26.5% of patients had a negative sigmoidoscopic examination. [1] However, were these true-negative results? Is it possible that a full-length colonoscopy might have yielded positive results in some of them?…”

“…[4] examination for lower GI diseases hardly adds much novel information, it does have important clinical implication. [1] In countries such as India with superspecialty healthcare facilities that are unlikely to match the vast and ever-growing population, simple, cheap, widely available technologies such as rigid sigmoidoscopy may diagnose several anorectal diseases that may be of great help for the treatment of these patients. In fact, the saying that "half a loaf is better than none" does apply here.…”