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Journal articles on the topic 'Sigmoidoscopy'

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Published: 4 June 2021

Last updated: 1 March 2023

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1

Parmar, Hardik, Arun R., Sahdevsinh Chauhan, and Akshay Sutaria. "Efficacy of OPD based rigid sigmoidoscopy in diagnosing the patients with bleeding per rectum." International Surgery Journal 6, no. 1 (December 27, 2018): 261. http://dx.doi.org/10.18203/2349-2902.isj20185484.

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Background: The aim of study was to evaluate the patients with bleeding per rectum by rigid sigmoidoscopy and to know the various causes of bleeding per rectum in our OPD population and to select the best approach to treat the underlying pathology.Methods: A total 63 patients with bleeding per rectum in whom cause could not be ascertained by routine methods like proctoscopy were considered from outpatient department form January 2017 to June 2018 for the study. Out of 63 patients, rigid sigmoidoscopy done in 31 patients and results were documented. All 31 patients were undergone for complete clinical examination and rigid sigmoidoscopic examination in the surgical OPD and routine blood, urine and stool investigations were also done.Results: Out of 31 cases in which sigmoidoscopic examination has been done, definitive source of bleeding is identified in 22 cases (70.97%) and in 9 cases (29.03%), the source of bleeding could not be detected by rigid sigmoidoscope.Conclusions: Rigid sigmoidoscopy has a very high diagnostic yield (approximately 71% in this study) in patients with bleeding per rectum which could not be detected by routine ano proctoscopy. Hence rigid sigmoidoscopy would be recommended in the workup of patients presenting with bleeding per rectum and it also serves an equally important function in excluding serious colonic lesions like malignancy and enables us to reassure the patient.

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2

Marsh, S. K., and S. P. J. Huddy. "Self-Administered Disposable Micro-Enemas before Outpatient Sigmoidoscopy." Journal of the Royal Society of Medicine 89, no. 11 (November 1996): 616–17. http://dx.doi.org/10.1177/014107689608901106.

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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, χ2 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.

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3

Epstein, Michael, Linda Holmes, Robert G. Finkel, Stafford S. Goldstein, and Mary R. Clance. "Sigmoidoscopy." Nurse Practitioner 24, Supplement (November 1999): 16. http://dx.doi.org/10.1097/00006205-199911001-00098.

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4

WEISSMAN, E. "Sigmoidoscopy." JNCI Journal of the National Cancer Institute 85, no. 23 (December 1, 1993): 1965. http://dx.doi.org/10.1093/jnci/85.23.1965.

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5

Clawson, Robert J. "Sigmoidoscopy." Lancet 356, no. 9235 (September 2000): 1120. http://dx.doi.org/10.1016/s0140-6736(05)74572-4.

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6

Abdulazeez, Z., N. Kukreja, N. Qureshi, and S. Lascelles. "Colonoscopy and flexible sigmoidoscopy for follow-up of patients with left-sided diverticulitis." Annals of The Royal College of Surgeons of England 102, no. 9 (November 2020): 744–47. http://dx.doi.org/10.1308/rcsann.2020.0181.

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Introduction The prevalence of diverticular disease has been increasing in the western world over the last few decades, causing a growing burden on health care systems. This study compared the uses of flexible sigmoidoscopy with colonoscopy as a follow-up investigation for patients diagnosed with acute left-sided diverticulitis and to evaluate the need for using either procedure. Materials and methods A retrospective study of 327 patients diagnosed with acute diverticulitis was carried out. Of this total, 240 patients with left-sided diverticulitis diagnosed via computed tomography were included. These patients were categorised into two equal groups: the first 120 patients underwent colonoscopy and the second 120 patients underwent flexible sigmoidoscopy. Results All colonoscopes and flexible sigmoidoscopes confirmed the computed tomography diagnosis of sigmoid diverticular disease with no major new findings. All colonoscopes and flexible sigmoidoscopes were reported as having no complications, with nine colonoscopes reported as being difficult compared with only three flexible sigmoidoscopes. All biopsies were reported as no malignancy. Full bowel preparation was required in all colonoscopes, compared with no preparation required for flexible sigmoidoscopes. Conclusions There is no evidence to support the routine use of endoscopic evaluation after an episode of left-sided diverticulitis diagnosed on computed tomography if no worrying radiological findings have been reported. This study supports similar findings from other studies and therefore we disagree with The Royal College of Surgeons of England (Association of Coloproctology of Great Britain and Ireland recommendations) commissioning guide, which advocates routine surveillance of the colon.

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7

Lukovich, Péter, Noémi Csibi, Réka Brubel, Krisztina Tari, Szilvia Csuka, László Harsányi, János Rigó Jr., and Attila Bokor. "Prospektív vizsgálat a sigmoideoscopia diagnosztikai érzékenységének meghatározására vastagbelet infiltráló endometriosisban." Orvosi Hetilap 158, no. 7 (February 2017): 264–69. http://dx.doi.org/10.1556/650.2017.30663.

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Abstract: Introduction and aim: In the treatment of colorectal endometriosis a multidisciplinary laparoscopic resection is suggested, for this reason the correct selection of bowel infiltration is essential before surgery. Patients and method: Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. In endoscopically confirmed cases multidisciplinary surgery was performed, the remaining patients were operated by a gynecologic team only. Results: Endometriosis was endoscopically confirmed in 224 patients (58.49%), 108 of them underwent multidisciplinary operation, the negative 135 cases received gynaecological surgery. Bowel endometriosis was confirmed in 103 out of 108 cases intraoperatively, while in 8 cases of the sigmoidoscopically negative patients bowel infiltration was diagnosed intraoperatively by the gynaecological team. Complete sigmoidoscopy was performed in 43.47% of the cases. Intraluminal endometriosis was found in 4.91%, secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis) in 26.06% and suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. Conclusion: Sigmoidoscopy performed by an experienced gastroenterologist is a highly sensitive examination for the diagnosis of bowel endometriosis. Orv. Hetil., 2017, 158(7), 264–269.

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8

Graham, John R. "Flexible sigmoidoscopy." Medical Journal of Australia 165, no. 1 (July 1996): 55. http://dx.doi.org/10.5694/j.1326-5377.1996.tb124844.x.

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9

Ashkin, Evan. "Sigmoidoscopy Reimbursement." Annals of Internal Medicine 131, no. 10 (November 16, 1999): 792. http://dx.doi.org/10.7326/0003-4819-131-10-199911160-00024.

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10

&NA;. "Sigmoidoscopy (Continued)." Nurse Practitioner 24, Supplement (November 1999): 18. http://dx.doi.org/10.1097/00006205-199911001-00113.

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11

Williams, C. B. "Flexible sigmoidoscopy." Gut 27, no. 6 (June 1, 1986): 749. http://dx.doi.org/10.1136/gut.27.6.749.

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12

Levin, Theodore R., and Albert M. Palitz. "Flexible Sigmoidoscopy." Gastrointestinal Endoscopy Clinics of North America 12, no. 1 (January 2002): 23–40. http://dx.doi.org/10.1016/s1052-5157(03)00055-2.

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13

Harper, Michael B., and John B. Pope. "FLEXIBLE SIGMOIDOSCOPY." Primary Care: Clinics in Office Practice 24, no. 2 (June 1997): 341–57. http://dx.doi.org/10.1016/s0095-4543(05)70397-3.

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14

Lubowski, D. Z., and G. L. Newstead. "Rigid sigmoidoscopy." Surgical Endoscopy 20, no. 5 (January 17, 2006): 812–14. http://dx.doi.org/10.1007/s00464-005-0580-0.

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15

Silvis, Stephen E. "Flexible sigmoidoscopy." Gastroenterology 89, no. 4 (October 1985): 926. http://dx.doi.org/10.1016/0016-5085(85)90606-7.

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16

Brandt, C. P., J. J. Piotrowski, and J. J. Alexander. "Flexible sigmoidoscopy." Surgical Endoscopy 11, no. 2 (February 1997): 113–15. http://dx.doi.org/10.1007/s004649900309.

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17

Lewis, Stephen F., and Norman M. Jensen. "Screening sigmoidoscopy." Journal of General Internal Medicine 11, no. 9 (September 1996): 542–44. http://dx.doi.org/10.1007/bf02599602.

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18

Steele, Robert JC, Francis A. Carey, Greig Stanners, Jaroslaw Lang, Jess Brand, Linda A. Brownlee, Emilia M. Crichton, et al. "Randomized controlled trial: Flexible sigmoidoscopy as an adjunct to faecal occult blood testing in population screening." Journal of Medical Screening 27, no. 2 (November 5, 2019): 59–67. http://dx.doi.org/10.1177/0969141319879955.

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Objectives Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopy at age 60 in a population being offered biennial faecal occult blood test screening from age 50. This randomized controlled trial assessed if flexible sigmoidoscopy would be an effective adjunct to faecal occult blood test. Methods In the Scottish Bowel Screening Programme between June 2014 and December 2015, 51,769 individuals were randomized to be offered flexible sigmoidoscopy instead of faecal occult blood test at age 60 or to continue faecal occult blood test. Those not accepting flexible sigmoidoscopy and those with normal flexible sigmoidoscopy were offered faecal occult blood test. All with flexible sigmoidoscopy-detected neoplasia or a positive faecal occult blood test result were offered colonoscopy. Results Overall flexible sigmoidoscopy uptake was 17.8%, higher in men than women, and decreased with increasing deprivation (25.7% in the least to 9.2% in the most deprived quintile). In those who underwent flexible sigmoidoscopy, detection rate for colorectal cancer was 0.13%, for adenoma 7.27%, and for total neoplasia 7.40%. In those who underwent colonoscopy after a positive flexible sigmoidoscopy, detection rate for colorectal cancer was 0.28%, adenoma 8.66%, and total neoplasia 8.83%. On an intention to screen basis, there was no difference in colorectal cancer detection rate between the study and control groups. Adenoma and total neoplasia detection rate were significantly higher in the study group, with odds ratios of 5.95 (95%CI: 4.69–7.56) and 5.10 (95%CI: 4.09–6.35), respectively. Conclusions In a single screening round at age 60, there was low uptake and neoplasia detection rate. Flexible sigmoidoscopy detected significantly more neoplasia than faecal occult blood test alone.

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Cespedes, Iraima, Ursula Seidler, Ulla Walter, and Maren Dreier. "Physicians’ view on sigmoidoscopy as an additionally offered method for colorectal cancer screening." Zeitschrift für Gastroenterologie 57, no. 09 (September 2019): 1059–66. http://dx.doi.org/10.1055/a-0963-0433.

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Abstract Background In Germany, colorectal cancer (CRC) screening includes a fecal blood test or colonoscopy, but not a sigmoidoscopy, which has been shown to reduce CRC incidences and mortality. Our aim was to compile physicians’ experiences with sigmoidoscopy and their assessments of this procedure being an additional, possible screening method for early CRC detection. Methods At the end of 2015, gastroenterologists and internists in Lower Saxony and North Rhine-Westphalia who regularly perform screening colonoscopies in outpatient care were contacted per mail. Standardized telephone interviews consisting of 17 questions and lasting 10–15 minutes were conducted. Results Nearly two-thirds (56/87) of the respondents reject sigmoidoscopy as an acceptable early detection method. Compared to colonoscopy, key features of the sigmoidoscopy include more favorable patient-related aspects, while procedural aspects, except sedation, clearly rate in favor of the colonoscopy. In the instance that colonoscopy is rejected, 75 % of the physicians consider a sigmoidoscopy to be a possible alternative. Conclusions The survey provides important practical insights into outpatient sigmoidoscopy. A majority of the physicians does not support evidence-based sigmoidoscopy for CRC screening. However, individuals who reject a colonoscopy are, in line with the current guideline, identified as a target group for a screening sigmoidoscopy. The benefit from an additionally offered sigmoidoscopy in CRC screening should be further analyzed with special consideration given to the preferences of insurees within the German healthcare system.

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20

Maliampurakal, Akash J., Donald C. McMillan, John H. Anderson, Paul G. Horgan, and David Mansouri. "Factors associated with the efficacy of polyp detection during routine flexible sigmoidoscopy." Frontline Gastroenterology 9, no. 2 (August 26, 2017): 135–42. http://dx.doi.org/10.1136/flgastro-2017-100849.

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ObjectiveFlexible sigmoidoscopy reduces the incidence of colonic cancer through the detection and removal of premalignant adenomas. However, the efficacy of the procedure is variable. The aim of the present study was to examine factors associated with the efficacy of detecting polyps during flexible sigmoidoscopy.Design and patientsRetrospective observational cohort study of all individuals undergoing routine flexible sigmoidoscopy in NHS Greater Glasgow and Clyde from January 2013 to January 2016.ResultsA total of 7713 patients were included. Median age was 52 years and 50% were male. Polyps were detected in 1172 (13%) patients. On multivariate analysis, increasing age (OR 1.020 (1.016–1.023) p<0.001), male sex (OR 1.23 (1.10–1.38) p<0.001) and the use of any bowel preparation (OR 3.55 (1.47–8.57) p<0.001) were associated with increasing numbers of polyps being detected. There was no significant difference in the number of polyps found in patients who had received an oral laxative preparation compared with an enema (OR 3.81 (1.57–9.22) vs 3.45 (1.43–8.34)), or in those who received sedation versus those who had not (OR 1.00 vs 1.04 (0.91–1.17) p=0.591). Furthermore, the highest number of polyps was found when the sigmoidoscope was inserted to the descending colon (OR 1.30 (1.04–1.63)).ConclusionsIncreasing age, male sex and the utilisation of any bowel preparation were associated with an increased polyp detection rate. However, the use of sedation or oral laxative preparation appears to confer no additional benefit. In addition, the results indicate that insertion to the descending colon optimises the efficacy of flexible sigmoidoscopy polyp detection.

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Kirkøen, Benedicte, Paula Berstad, Edoardo Botteri, Eirin Dalén, Jens Nilsen, Geir Hoff, Thomas de Lange, and Tomm Bernklev. "Acceptability of two colorectal cancer screening tests: pain as a key determinant in sigmoidoscopy." Endoscopy 49, no. 11 (September 22, 2017): 1075–86. http://dx.doi.org/10.1055/s-0043-117400.

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Abstract Background Participants’ experience with a screening test can influence adherence, and therefore the efficacy of screening programs. We compared screening with unsedated flexible sigmoidoscopy and fecal immunochemical testing (FIT) for participants’ satisfaction with the decision and for willingness to repeat colorectal cancer screening. Methods In a prospective, randomized trial 3257 individuals (50 – 74 years) were invited to either flexible sigmoidoscopy or FIT (1:1), of whom 1650 took up the offer (52.6 %). In total, 1497 screening participants completed at least one questionnaire, either before screening, and/or at three time points in the following year, that measured willingness to repeat screening, willingness to recommend screening, and satisfaction with decision to attend. There were 769 and 728 responders in the flexible sigmoidoscopy and FIT group, respectively. Additionally, 581 flexible sigmoidoscopy participants also completed a pain questionnaire. Results 1 year later, 10 % of the flexible sigmoidoscopy participants were not willing to repeat screening, compared to 5 % of FIT participants. A higher percentage of women compared to men would not repeat flexible sigmoidoscopy screening (adjusted odds ratio [OR] 2.52, 95 % confidence interval [95 %CI] 1.48 to 4.28). Notably, 22 % of women reported pain during flexible sigmoidoscopy compared to 5 % of men. When we added pain to the statistical model, pain was significantly associated with unwillingness to repeat flexible sigmoidoscopy (OR 3.15, 95 %CI 1.68 to 5.87), while gender was no longer associated (OR 1.53, 95 %CI 0.82 to 2.88). Conclusion Acceptability for flexible sigmoidoscopy and for FIT was high among Norwegian screening participants, though FIT participants were more willing to repeat screening. Women were less willing to repeat screening with flexible sigmoidoscopy compared to men. This gender difference seemed partly due to pain, and therefore preventable.This study is registered at ClinicalTrials.gov: NCT01538550.

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Lin, Jiun-Nong, Chang-Bi Wang, Chih-Hui Yang, Chung-Hsu Lai, and Hsi-Hsun Lin. "Risk of infection following colonoscopy and sigmoidoscopy in symptomatic patients." Endoscopy 49, no. 08 (May 24, 2017): 754–64. http://dx.doi.org/10.1055/s-0043-107777.

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Abstract Background and study aims Previous studies describing the incidence of infection after colonoscopy and sigmoidoscopy are limited. The aim of this study was to determine the incidence of infection, and to propose a nomogram to predict the probability of infection following colonoscopy and sigmoidoscopy in symptomatic patients. Patients and methods A nationwide retrospective study was conducted by analyzing the National Health Insurance Research Database of Taiwan. The incidence of infection within 30 days after colonoscopy and sigmoidoscopy was assessed and compared with a control group matched at a ratio of 1:1 based on age, sex, and the date of examination. Results In all, 112 543 patients who underwent colonoscopy or sigmoidoscopy and 112 543 matched patients who did not undergo these procedures were included. The overall incidence of infection within 30 days after colonoscopy and sigmoidoscopy was 0.37 %, which was significantly higher than that of the control group (0.04 %; P < 0.001). Diverticulitis, peritonitis, and appendicitis were the most common infections. Patients who underwent colonoscopy or sigmoidoscopy had a 9.38-fold risk of infection (95 % confidence interval, 6.81 – 12.93; P < 0.001) compared with the control group. The predicted infection-free rates of the nomogram were closely aligned with the actual infection-free rates, with a bootstrapping concordance index of 0.763. Conclusions Colonoscopy and sigmoidoscopy are associated with an increased risk of infection, which may occur after these procedures. Our nomogram may provide clinicians with an easy tool to evaluate the risk of infection after colonoscopy and sigmoidoscopy in symptomatic patients.

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Buccolo, Larissa S., and Chris B. Hyun. "Screening Flexible Sigmoidoscopy Using a Gastroscope Versus a Sigmoidoscope in Primary Care." American Journal of Gastroenterology 100 (September 2005): S389. http://dx.doi.org/10.14309/00000434-200509001-01071.

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Kalloo, Anthony N., and Stanley B. Benjamin. "Flexible fiberoptic sigmoidoscopy." Postgraduate Medicine 85, no. 3 (February 15, 1989): 145–50. http://dx.doi.org/10.1080/00325481.1989.11700604.

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Cuzick, J. "Once-only sigmoidoscopy." Annals of Oncology 10 (1999): S65—S69. http://dx.doi.org/10.1093/annonc/10.suppl_6.s65.

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26

Variyam, Easwaran P. "Practical Flexible Sigmoidoscopy." Gastrointestinal Endoscopy 45, no. 3 (March 1997): 339–40. http://dx.doi.org/10.1016/s0016-5107(97)70293-1.

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McCarthy, Bruce D., and Mark A. Moskowitz. "Screening flexible sigmoidoscopy." Journal of General Internal Medicine 8, no. 3 (March 1993): 120–25. http://dx.doi.org/10.1007/bf02599753.

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Patel, Sameet, Shubham Jain, Sanjay Chandnani, Prasanta Debnath, Qais Contractor, Seemily Kahmei, Rima Kamat, and Pravin Rathi. "ADEQUACY OF SIGMOIDOSCOPY IN COMPARISION TO COLONOSCOPY TO ASSESS DISEASE ACTIVITY DURING FOLLOW UP IN PATIENTS WITH ULCERATIVE COLITIS." Inflammatory Bowel Diseases 28, Supplement_1 (January 22, 2022): S31—S32. http://dx.doi.org/10.1093/ibd/izac015.047.

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Abstract BACKGROUND Endoscopic remission is the current treatment target in patients with Ulcerative Colitis (UC). Literature on adequacy of sigmoidoscopy in comparison to colonoscopy to assess endoscopic and histologic activity during follow up is sparse. METHODS This is an interim analysis of a prospective study of patients diagnosed with UC with disease extent proximal to the sigmoid colon. Fifty adult patients underwent a complete colonoscopy with segmental biopsies. Endoscopic disease activity was graded using Mayo Endoscopic Subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity score (UCEIS). The histological grading was done using the Nancy score, Robarts Histopathology Index (RHI) and Simplified Geboes Score (SGS). The maximum rectosigmoid disease activity was compared with the maximum disease activity in the rest of the colon. RESULTS Endoscopic Correlation: Sigmoidoscopic evaluation using MES showed good correlation with pan colonoscopic evaluation for disease activity with a sensitivity of 92.11%, specificity of 66.67%, accuracy of 86% (95% CI – 73.26% to 94.18%), kappa value (k) of 0.58 (p value < 0.001) and Area under curve (AUC) of 0.82 (95% CI- 0.74 to 0.942). Similarly, sigmoidoscopic evaluation using UCEIS score showed good correlation with pan colonoscopic evaluation for disease activity with a sensitivity of 95.0%, specificity of 70%, accuracy of 90% (95% CI – 78.19% to 96.67%), k of 0.68 (p value < 0.001) and AUC of 0.895 (95% CI- 0.805 to 0.924). Disease activity in the colon missed by performing a sigmoidoscopy using MES and UCEIS score is only 6% and 4% respectively. Histological Correlation: Histologic findings in rectosigmoid showed good correlation with histologic findings in rest of the colon using Nancy’s score [Sensitivity of 97.96%, specificity of 100%, accuracy of 98% (95% CI – 89.35% to 99.95%), k of 0.658 (p value < 0.001) and AUC of 0.99 (95% CI- 0.959 to 1.0)], Simplified Geboes Score [Sensitivity of 97.92%, specificity of 100%, accuracy of 98% (95% CI – 89.35% to 99.95%), k of 0.79 (p value < 0.001) and AUC of 0.99 (95% CI- 0.962 to 1.0)], and Robarts Histopathology Index [Sensitivity of 95.56%, specificity of 80%, accuracy of 94% (95% CI – 83.45% to 98.75%), k of 0.694 (p value < 0.001) and AUC of 0.878 (95% CI- 0.667 to 1.0) ]. Histologic disease activity in the colon missed by performing a sigmoidoscopy using Nancy score, SGS and RHI is only 2%, 2% and 4% respectively. CONCLUSION In patients diagnosed with UC and having disease extent proximal to the sigmoid colon, sigmoidoscopic evaluation has good correlation with pan colonoscopic evaluation for grading endoscopic and histological disease activity. A sigmoidoscopic examination is adequate to assess the disease activity in patients with disease extent proximal to the sigmoid colon.

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Jodal, Henriette C., Lise M. Helsingen, Joseph C. Anderson, Lyubov Lytvyn, Per Olav Vandvik, and Louise Emilsson. "Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis." BMJ Open 9, no. 10 (October 2019): e032773. http://dx.doi.org/10.1136/bmjopen-2019-032773.

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ObjectiveEvaluate effectiveness, harms and burdens of faecal blood testing, sigmoidoscopy and colonoscopy screening for colorectal cancer over 15 years.DesignWe performed an update of a Cochrane systematic review, and performed network meta-analysis comparing randomised trials evaluating colorectal cancer screening with guaiac faecal occult blood test (gFOBT) (annual, biennial), faecal immunochemical test (FIT) (annual, biennial), sigmoidoscopy (once-only) or colonoscopy (once-only) in a healthy population, aged 50–79 years. We conducted subgroup analysis on sex. Follow-up >5 years was required for analysis of colorectal cancer incidence and mortality.Results12 randomised trials proved eligible. Compared with no-screening, we found high certainty evidence for sigmoidoscopy screening slightly reducing colorectal cancer incidence (relative risk (RR) 0.76; 95% confidence interval (CI 0.70 to 0.83) and mortality (RR 0.74; 95% CI 0.69 to 0.80), while gFOBT screening had little or no difference on colorectal cancer incidence, but slightly reduced colorectal cancer mortality (annual: RR 0.69; 95% CI 0.56 to 0.86, biennial: RR 0.88; 95% CI 0.82 to 0.93). No screening test reduced mortality nor incidence by more than six per 1000 screened over 15 years. Sigmoidoscopy had a greater effect in men, for both colorectal cancer incidence (women: RR 0.86; 95% CI 0.81 to 0.92, men: RR 0.75, 95% CI 0.71 to 0.79), and mortality (women: RR 0.85; 95% CI 0.71 to 0.96, men: RR 0.67; 95% CI 0.61 to 0.75) (moderate certainty).ConclusionsIn a 15-year perspective, sigmoidoscopy reduces colorectal cancer incidence, while sigmoidoscopy, annual and biennial gFOBT all reduce colorectal cancer mortality. Sigmoidoscopy may reduce colorectal cancer incidence and mortality more in men than in women.PROSPERO registration numberCRD42018093401.

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Ngu, Wee, Martin Walls, Pradeep Bhandari, Clive Stokes, Nikki Totton, Zoe Hoare, Lexi Bastable, and Colin Rees. "The B-ADENOMA Study: Bowelscope – Accuracy of Detection using Endocuff Optimisation of Mucosal Abnormalities: Study Protocol for randomised controlled trial." Endoscopy International Open 06, no. 07 (July 2018): E872—E877. http://dx.doi.org/10.1055/a-0591-9308.

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Abstract Background and study aims UK Bowel Cancer Screening flexible sigmoidoscopy (BowelScope) currently offers patients aged 55 a one-off flexible sigmoidoscopy for adenoma clearance to decrease colorectal cancer incidence by interrupting the adenoma-carcinoma sequence. Recent evidence has shown maximum benefit in increasing adenoma detection rate (ADR) using the Endocuff Vision device in the left side of the colon and in screening patients. Currently, ADR is low and shows unacceptable variation in BowelScope. ADR is a quality indicator in screening sigmoidoscopy and higher rates have been shown to reduce colorectal cancer incidence. Patients and methods This will be a prospective, multicenter, UK-based randomized controlled trial (RCT) comparing ADR in Endocuff-assisted versus standard bowel cancer screening flexible sigmoidoscopy (BowelScope). All patients aged 55 to 61 years invited to BowelScope screening and able to give informed consent will be eligible for recruitment. Exclusion criteria include absolute contraindications to flexible sigmoidoscopy, known or suspected large bowel obstruction or pseudo-obstruction, colonic strictures or polyposis syndromes, known severe diverticular segment, active colitis, inability to give informed consent, anticoagulation precluding polypectomy and pregnancy. Patients will be randomized on the day of procedure to Endocuff-assisted flexible sigmoidoscopy or standard flexible sigmoidoscopy, stratified by age group and sex. Baseline, endoscopy and polyp data were collected as well as nurse and patient assessment of comfort. Polyp histology was collected when available. Patients will be asked to return a comfort questionnaire the following day and were followed up for 14 days for complications.The study will take place across 12 to 20 hospital trusts across the UK and recruited 3222 patients. Results The ADENOMA trial will be designed to demonstrate a significant improvement in ADR with maximal effect in the left colon and in fecal occult blood test-positive screening patients. This trial will be the first RCT to look at Endocuff Vision in bowel cancer screening flexible sigmoidoscopy. We will aim to establish whether Endocuff vision improves ADR in this population.Clinicaltrials.gov Identifier: NCT03072472

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Borren, Nienke Z., Hamed Khalili, Jay Luther, Francis P. Colizzo, John J. Garber, and Ashwin N. Ananthakrishnan. "Second-Look Endoscopy in Hospitalized Severe Ulcerative Colitis: A Retrospective Cohort Study." Inflammatory Bowel Diseases 25, no. 4 (September 11, 2018): 750–55. http://dx.doi.org/10.1093/ibd/izy282.

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Abstract Background Acute severe ulcerative colitis (ASUC) is a serious complication of ulcerative colitis (UC). Management of partial responders to steroids or rescue therapy remains challenging. Whether there is a role for re-look sigmoidoscopic evaluation in disease management is unknown. Methods Our study cohort consisted of patients who underwent 2 sigmoidoscopic procedures during the same index hospitalization for ASUC at our center. Reasons for repeat endoscopic evaluation and endoscopic and histologic severity of inflammation during both procedures were noted. Multivariable regression models were performed to identify predictors of improvement at the second endoscopic assessment and to determine the independent effect of such an improvement on in-hospital colectomy and at 3, 6, and 12 months. Results Our study included 49 patients (mean age, 42 years; 52% women). Just under one-third of patients (30%) were noted to have improved endoscopic appearance at the second sigmoidoscopy, at a median of 9 days after initial exam. None of the patients who had improvement on the second endoscopy underwent in-hospital colectomy, compared with 46% of those with worsening or persistent disease (P = 0.002). Similar differences in the improved group persisted at 3 months (P = 0.007) and 6 months (P = 0.027). Histologic severity at the first endoscopy was associated with increased risk of colectomy in-hospital (odds ratio, 3.8; 95% confidence interval, 1.02–14.21) and at 3 and 6 months. Conclusions After a median interval of 9 days, endoscopic improvement was noted in 30% of patients with ASUC undergoing a second sigmoidoscopy, which predicted lower rates of colectomy in-hospital and at 3 and 6 months.

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Simon, Jerome B. "Costs of Finding an Advanced Adenoma in Colorectal Screening." Canadian Journal of Gastroenterology 18, no. 3 (2004): 185–86. http://dx.doi.org/10.1155/2004/180351.

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The authors used computerized decision analysis to estimate the costs of finding and removing an advanced colonic adenoma in patients referred because of a positive fecal occult blood test. An advanced adenoma was defined as a villous adenoma, a tubular adenoma 10 mm or more in size, or a lesion that harboured highgrade dysplasia or cancer. Four strategies were compared: flexible sigmoidoscopy, flexible sigmoidoscopy plus air contrast barium enema, virtual colonoscopy (CT colography) and colonoscopy. Colonoscopy with polypectomy was undertaken if any of the methods detected a polyp. Probabilities and test characteristics were determined from the literature, and costs were estimated from the provincial fee schedule (Ontario) and local hospital sources. With an assumed 17% probability of an advanced adenoma being present, sigmoidoscopy was the most cost effective strategy at $1930 to find and clear an advanced lesion, but the procredure missed between one-third and almost one-half of the lesions, depending on the depth of insertion. At $2290, colonoscopy was slightly more expensive than sigmoidoscopy and more cost effective than either sigmoidoscopy plus barium enema ($2840) or virtual colonoscopy ($3681), neither of which detected as many advanced adenomas. The authors concluded that colonoscopy is the preferred investigative strategy and that improved access to colonoscopy is an important goal for occult blood screening programs.

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Davis, Paul W. "Complications of flexible Sigmoidoscopy?" Postgraduate Medicine 110, no. 1 (July 2001): 127–28. http://dx.doi.org/10.3810/pgm.2001.07.981.

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Mulvey, J. R. "Reimbursement for Flexible Sigmoidoscopy." Journal of the American Board of Family Medicine 12, no. 2 (March 1, 1999): 182. http://dx.doi.org/10.3122/jabfm.12.2.182a.

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Rodney, W. M. "Reimbursement for Flexible Sigmoidoscopy." Journal of the American Board of Family Medicine 12, no. 3 (May 1, 1999): 262–63. http://dx.doi.org/10.3122/jabfm.12.3.262c.

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WRENN, KEITH D. "Flexible Sigmoidoscopy for Screening." Annals of Internal Medicine 108, no. 3 (March 1, 1988): 494. http://dx.doi.org/10.7326/0003-4819-108-3-494_2.

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&NA;. "Practicum in Flexible Sigmoidoscopy." Nurse Practitioner 24, Supplement (November 1999): 19. http://dx.doi.org/10.1097/00006205-199911001-00135.

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Minasian, Harvey. "Modified Sigmoidoscopy Biopsy Forceps." Journal of the Royal Society of Medicine 91, no. 3 (March 1998): 148. http://dx.doi.org/10.1177/014107689809100312.

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Robinson, Richard J., Margaret Stone, and John F. Mayberry. "Sigmoidoscopy and rectal biopsy." European Journal of Gastroenterology & Hepatology 8, no. 2 (February 1996): 149–52. http://dx.doi.org/10.1097/00042737-199602000-00011.

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Murphy, A. "Sigmoidoscopy in general practice." BMJ 305, no. 6846 (July 18, 1992): 184–85. http://dx.doi.org/10.1136/bmj.305.6846.184-c.

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Verne, J. "Sigmoidoscopy in adenoma detection." European Journal of Cancer Prevention 2, Supplement (January 1993): 7. http://dx.doi.org/10.1097/00008469-199301001-00022.

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LEVIN, T., C. CONELL, J. SHAPIRO, S. CHAZAN, M. NADEL, and J. SELBY. "Complications of screening sigmoidoscopy." Gastroenterology 120, no. 5 (April 2001): A65. http://dx.doi.org/10.1016/s0016-5085(01)80323-1.

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Bowman, Marjorie A., and David C. Wherry. "Training for flexible sigmoidoscopy." Gastrointestinal Endoscopy 31, no. 5 (October 1985): 309–12. http://dx.doi.org/10.1016/s0016-5107(85)72212-2.

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Levin, Theodore R., Carol Conell, Jean A. Shapiro, Shella G. Chazan, Marion Nadel, and Jove V. Selby. "Complications of screening sigmoidoscopy." Gastroenterology 120, no. 5 (April 2001): A65. http://dx.doi.org/10.1016/s0016-5085(08)80323-x.

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Maley, E. A. "Value of flexible sigmoidoscopy." Archives of Internal Medicine 155, no. 4 (February 27, 1995): 426a—427. http://dx.doi.org/10.1001/archinte.155.4.426a.

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Cohen, Michael E. "Sigmoidoscopy: Rigid or Flexible?" JAMA: The Journal of the American Medical Association 258, no. 23 (December 18, 1987): 3388. http://dx.doi.org/10.1001/jama.1987.03400230048024.

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Lovett, James, Daniel Kirgan, and Byron McGregor. "Inguinal herniation justifies sigmoidoscopy." American Journal of Surgery 158, no. 6 (December 1989): 615–17. http://dx.doi.org/10.1016/0002-9610(89)90206-7.

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Neugut, Alfred I., and Benjamin Lebwohl. "Colonoscopy vs Sigmoidoscopy Screening." JAMA 304, no. 4 (July 28, 2010): 461. http://dx.doi.org/10.1001/jama.2010.1001.

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Kruss, Daniel M. "Sigmoidoscopy: Blaming the Tools." JAMA: The Journal of the American Medical Association 259, no. 9 (March 4, 1988): 1326. http://dx.doi.org/10.1001/jama.1988.03720090018014.

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Singh, S., M. Bowditch, A. Dennison, and A. J. Shorthouse. "Sigmoidoscopy with a view." BJS 81, no. 12 (December 1994): 1795. http://dx.doi.org/10.1002/bjs.1800811229.

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