flexible sigmoidoscopy
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Introduction
A procedure for viewing the rectum & sigmoid colon. 35 & 60 cm sigmoidoscopes are used.
Indications
- follow-up for rectal cancer
- screening for colon cancer*
- screening interval= every 5 years
- once, age 55-65 years, reduces colorectal carcinoma incidence & mortality[4]
- yield of screening depends on sigmoidoscopist[3]
- colorectal adenomas detected in 9-16% of screenings
- neglible benefit in older women[7]
- evaluation of change in bowel habits
- rectal bleeding
- abdominal pain
- decompression of sigmoid volvulus
- removal of foreign body
Contraindications
- patient refusal
- patient is dying or at the point of death (moribund)
- unstable cardiac condition
- respiratory insufficiency
- peritonitis
- known or suspected perforation
- toxic megacolon
- sigmoid stricture
- fulminant colitis
- severe acute diverticulitis
Benefit/risk
- number needed to treat (NNT)
- 1000 over 9.4 years to prevent 1 death due to colorectal cancer[6]*
- numbers needed to harm = 1000 sigmoidoscopies to result in 1 serious complications[6]#
* it is difficult to reconcile that 1/2 of colon cancers appear to be right-sided with the often reported benefits of flexible sigmoidoscopy as comparable to colonoscopy
* this is especially so in the context of financial incentives for preforming procedures in a fee for service setting
# since the recommended time interval for sigmoidoscopy is every 5 years, 2 patients would be harmed for each patient benefitted
Procedure
Patient preparation:
- informed consent
- avoid eating red or orange gelatin the day prior to the procedure
- fleet enema* every 30 min beginning 2 hours before procedure until the return is clear
- left lateral position with right knee flexed more than left
* see bowel preparation for colonoscopy or flexible sigmoidoscopy
Complications
- intestinal perforation
- bleeding
- vasovagal reaction
- transient bacteremia (< 1&)
Notes
Caution:
- 10% of patients have combustible levels of hydrogen & methane in the bowel
- do NOT use electrocautery during sigmoidoscopy because of risk of explosion
- making the patient and appointment & offering a single screening test results in best compliance[5]
More general terms
More specific terms
- flexible sigmoidoscopy with ablation of neoplasm/polyp
- flexible sigmoidoscopy with cautery
- flexible sigmoidoscopy with decompression of volvulus
- flexible sigmoidoscopy with removal of foreign body
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 334-36
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 3.0 3.1 Journal Watch 24(12):97, 2004 Atkin W, Rogers P, Cardwell C, Cook C, Cuzick J, Wardle J, Edwards R. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology. 2004 May;126(5):1247-56. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15131784
- ↑ 4.0 4.1 Segnan N et al. Once-only sigmoidoscopy in colorectal cancer screening: Follow-up findings of the Italian Randomized Controlled Trial
SCORE. J Natl Cancer Inst 2011 Sep 7; 103:1310 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21852264 - ↑ 5.0 5.1 Bevan R et al. Implementing a national flexible sigmoidoscopy screening program: Results of the English early pilot. Endoscopy 2015 Mar; 47:225 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25268309
- ↑ 6.0 6.1 6.2 Tang VA, Boscardin WJ, Stijacic-Cenzer I, Lee SJ Time to benefit for colorectal cancer screening: survival meta-analysis of flexible sigmoidoscopy trials. BMJ 2015;350:h1662 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25881903 <Internet> http://www.bmj.com/content/350/bmj.h1662
Brenner H Colorectal cancer screening for older adults. BMJ 2015;350:h2029 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25882058 <Internet> http://www.bmj.com/content/350/bmj.h2029 - ↑ 7.0 7.1 Holme O et al. Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: Pooled analysis of randomised trials. BMJ 2017;356:i6673 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28087510 Free PMC Article <Internet> http://www.bmj.com/content/356/bmj.i6673
Haug U. Flexible sigmoidoscopy screening for colorectal cancer. Different outcomes in men and women are a challenge for decision makers. BMJ 2017;356:j75 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28087640 <Internet> http://www.bmj.com/content/356/bmj.j75
Holme O, Loberg M, Kalager M et al Long-Term Effectiveness of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality in Women and Men: A Randomized Trial. Ann Intern Med. 2018. April 24. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29710125 <Internet> http://annals.org/aim/article-abstract/2679355/long-term-effectiveness-sigmoidoscopy-screening-colorectal-cancer-incidence-mortality-women - ↑ Flexible Sigmoidoscopy https://www.niddk.nih.gov/health-information/diagnostic-tests/flexible-sigmoidoscopy
- ↑ MedlinePlus Sigmoidoscopy http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm