Self-Administered Disposable Micro-Enemas before Outpatient Sigmoidoscopy

Abstract

Many colorectal carcinomas can be diagnosed by rigid sigmoidoscopy. One important limiting factor in the usefulness of this investigation is the presence of faeces; another is inability to negotiate the recto-sigmoid bend. 101 patients (47 men) were sent a Microlax enema with instruction to use it before their first attendance in the outpatient department. The grade of preparation [on a scale of 0 (empty rectum) to 3, with grades 0 and 1 providing an adequate view], height achieved with the sigmoidoscope and whether or not the extent of the examination was limited by faeces were recorded. These data were compared with results in 78 patients (38 men) who did not receive any special preparation. There were no serious difficulties with self-administration. An adequate view was obtained in 89 (88%) of those who had received an enema and in 41 (53%) of those who were unprepared (P < 0.001, chi 2 test). The height achieved and the percentage of patients in whom the sigmoidoscopy was not limited by faeces were also significantly increased. The mailing of micro-enemas to patients who are likely to need sigmoidoscopy is a cheap measure that increases diagnostic yield and saves reattendances.

A Retrospective Study of Sigmoidoscopic Examination with Rigid Sigmoidoscope in a Medical School Sigmoidoscopy Center

“…Poor bowel preparation occurred in 16.8% of patients. While sigmoidoscopy can be done in poorly prepared patients, it is possible to get an acceptable view in 50% of these patients only, 6 thus making gut preparation preferable. The majority (94%) of our patients tolerated the procedure well, in contrast to other studies.…”

Home rectal evacuation prior to a colorectal clinic appointment: a prospective, randomized, controlled, single‐blind trial

“…Although isolated studies have shown that limitation of rigid sigmoidoscopy by the presence of faeces is uncommon [ 7], most recent studies emphasize that views are suboptimal in over 50% of patients who undergo rigid sigmoidoscopy without bowel preparation [ 3–6]. The notion that enemas or suppositories may simulate or conceal signs of disease [ 1, 2] has been refuted by a number of studies [ 3–6], including the present one.…”

“…Although isolated studies have shown that limitation of rigid sigmoidoscopy by the presence of faeces is uncommon [ 7], most recent studies emphasize that views are suboptimal in over 50% of patients who undergo rigid sigmoidoscopy without bowel preparation [ 3–6]. The notion that enemas or suppositories may simulate or conceal signs of disease [ 1, 2] has been refuted by a number of studies [ 3–6], including the present one. Evacuation of the rectum, either voluntarily [ 5] or with the aid of enemas or suppositories [ 3–6], has been shown significantly to improve quality of views on rigid sigmoidoscopy and increase distances reached from the anal verge.…”

“…The notion that enemas or suppositories may simulate or conceal signs of disease [ 1, 2] has been refuted by a number of studies [ 3–6], including the present one. Evacuation of the rectum, either voluntarily [ 5] or with the aid of enemas or suppositories [ 3–6], has been shown significantly to improve quality of views on rigid sigmoidoscopy and increase distances reached from the anal verge. Voluntary evacuation of the rectum is not always feasible and administration of an enema or suppository in the clinic is time‐consuming and sometimes inconvenient.…”

“…Evacuation of the rectum is thought to result in inability to determine whether blood is mixed with faeces or if it is trickling down from the sigmoid colon [ 1]. However, recent studies have found that some form of mechanical bowel preparation prior to rigid sigmoidoscopy is better than no preparation [ 3–6].…”