The extent of examination by rigid sigmoidoscopy

Abstract

It is often stated that the majority of large bowel neoplasms can be diagnosed by rigid sigmoidoscopy since they lie within range of the instrument (I). A prospective study was undertaken by one clinician to determine how often in practice it is possible to make a full sigmoidoscopic examination and to attempt to determine some factors that may be responsible for the failure to d o so.Rigid sigmoidoscopy was carried out in 238 consecutive new outpatients. The examination was performed without preparation of the bowel using Lloyd-Davies' pattern instrument (length 25cm, diameter 1.8cm) with the patient in the left lateral position. The furthest distance passed was recorded and, where the examination was considered to be limited, the reason was given to be the result of discomfort of the patient, the inability of the examiner, the presence of faeces obscuring vision or pathological narrowing of the bowel.The furthest distance the instrument could be passed was less than 14cm in 18 patients (7.5 per cent), from 14 to less than 16cm in 54 (22.7 per cent), from 16 to less than 22cm in 52 (21.9 per cent) and greater than 22cm in 114 (47.9 per cent). Examination beyond 16 cm was possible in 113 of 138 men (82 per cent) and 53 of 100 women (53 per cent), a significant difference (2' = 26.1; P<O.OOl). There was a bimodal distribution of the extent of the examination with peaks at 14-15 cm and at 22-25cm (Fig. l), the first peak being greater than the second in women and vice versa in men.The age and race distribution was similar among patients having examinations greater or less than 16cm. Examination beyond 16cm was possible in 23 (51 per cent) of 43 female patients with haemorrhoids and 7 (41 per cent) in 17 female patients with functional or diverticular disease, an insignificant difference. Failure to pass the instrument 16cm or beyond was due to intolerance of the patient in 43 cases (I8 per cent), inability of the examiner in 18 cases (7.5 per cent) and faeces in 18 (7.5 per cent). Intolerance was significantly more common in women (31 per cent) than men (12 per cent) (x2 = 19.5; P < 0.00 I). CommentDespite the increasing use of flexible sigmoidoscopy, rigid sigmoidoscopy is likely to continue as the routine method in the initial examination of patients with colorectal disease since it is simple, rapid and inexpensive. However, in this study, examinations to 16cm and beyond were possible in only twothirds of all cases and in one-half of female patients, most limited examinations terminating at about 15 cm from the anal verge.Failure to pass the rectosigmoid junction was shown radiologically to be the cause of a limited examination (2), and the first peak in Distances from anal verge passed by instrumenr on rigid in most cases. Few examinations terminated between 16 and 20 cm, indicating that once 16 cm had been passed, impediment to advancement for a further few centimetres was unlikely. The sex difference was previously observed in a retrospective study which reported examinations beyond 20cm in 82 per cent of men ...

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

“…A rigid instrument can be passed 22cm or more in about half of the patients, which means that often only the distal part of the sigmoid colon can be reached (5). However, in almost one-quarter only the rectum can be inspected, and it has been concluded that the rigid rectosigmoidoscope is unreliable for examination of the distal sigmoid colon, especially in women succeeded in 32%, and in the present study the success rate was 46%.…”

“…( 5 ) . More of the rectosigmoid colon can be reached with a flexible instrument, but how much of the distal colon is inspected varies.Lehman et al (6) could introduce the whole instrument (60cm) in about half of their patients, whereas McCallum et al (7)…”

Rigid videosigmoidoscopy vs conventional sigmoidoscopy

“…The mean pain scores showed that the VS caused significantly less discomfort than the CS (3.0 [range, 0-7] versus 5.5 [1][2][3][4][5][6][7][8][9][10]; p < 0.001) (Fig. 2).…”

“…Up to 30% of patients experience moderate to severe discomfort during rigid sigmoidoscopy [14]. Previous studies have reported success in passing the rectosigmoid junction in 70% of cases using a LloydDavies sigmoidoscope of 18 mm diameter [7]. Others, using a smaller sigmoidoscope of 13 mm diameter have succeeded in 66-92% of cases, depending on bowel preparation and patient position [5].…”

“…The examination is uncomfortable [14], and the instrument often fails to pass the rectosigmoid junction [2,4,11,13], particularly in women [7,9]. The views are limited and can only be seen by one person at a time.…”