The Anatomic Range of Examination by Fibreoptic Rectosigmoidoscopy (60 Centimetres)

Abstract

The purpose of the study was to investigate the anatomic location of the flexible rectosigmoidoscope (60 cm) when introduced as far as technically possible. One hundred and forty-nine consecutive patients referred for double-contrast enema (DCE) were examined with rectosigmoidoscopy before the radiologic examination, and CO2 was used for insufflation. A plain abdominal film was taken to locate the tip of the instrument when 60 cm or as much as possible of the instrument had been introduced. The sigmoid loop was passed and the tip of the scope located in the ascending colon or at the left flexure in 99 (66%) of the patients, and in a further 27 (18%) the upper part of the sigmoid colon was reached. The sigmoid colon had been passed in 71%, 80%, and 44% when 60, 50, and 40 cm of the instrument was introduced, respectively. DCE could be performed at the same session as the rectosigmoidoscopy, as CO2 was quickly absorbed. In the vast majority of patients the sigmoid colon can be inspected with a rectosigmoidoscope.

Incomplete screening flexible sigmoidoscopy associated with female sex, age, and increased risk of colorectal cancer

“…Prior studies have estimated that about 50-75% of sigmoidoscopies view the entire sigmoid colon, while only a minority of examinations (10-40%) visualise the entire descending colon. [13][14][15] Furthermore, when the CoCaP programme began in 1994, endoscopists were instructed to measure insertion depth based on a straightened sigmoidoscope, with all loops removed. However, no specific quality control measures were instituted to ensure that endoscopists were adhering to this protocol, so it is not known to what degree endoscopists recorded depth of insertion while loops remained.…”

Depth of Insertion At Flexible Sigmoidoscopy: Implications for Colorectal Cancer Screening and Instrument Design

“…They found that the sigmoidoscope had not passed into the descending colon in 48 % of patients. Jensen et al, however, using a plain abdominal film to determine depth of insertion of the 60-cm fiberoptic sigmoidoscope, failed to enter the descending colon in just 34 % of patients [17].…”

Procrastination and prognosis - medico-legal aspects of the diagnosis and timely treatment of colorectal cancer

“…Jensen et al used plain abdominal X ray to determine depth of insertion of the 60 cm flexible sigmoidoscope and found that they failed to enter the descending colon in 34% of patients. 18 There is no evidence to suggest that sedation can increase the depth of insertion of a flexible sigmoidoscope despite the fact that the main reason for failed sigmoid intubation is usually discomfort. 8 Unusual sigmoid looping of the endoscope appears to be a more frequent occurrence in women compared with men.…”

“…Male patients, women less than 69 years old and those with no history of a hysterectomy probably have the highest chance of a successful FS. 18 Pre-operative assessment of patients with colorectal cancer usually includes a chest X ray which excludes large lung metastases, and liver imaging is recommended, using ultrasound or CT scanning. Some may argue that intra-operative surgical palpation and post-operative imaging are reasonable alternatives.…”