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Performing screening flexible sigmoidoscopy using colonoscopes: experience in 500 subjects
D K Rex1, G A Lehman, R H Hawes
1Department of Medicine, Indiana University School of Medicine, Indianapolis.
Gastrointestinal Endoscopy
|September 1, 1990
Summary
Longer flexible sigmoidoscopes offer minimal additional yield for unsedated screening colonoscopies. Most polyps are found within 60 cm, making longer instruments unnecessary for this patient group.
Area of Science:
- Gastroenterology
- Medical Devices
- Colorectal Cancer Screening
Background:
- Controversy exists regarding the optimal length of flexible sigmoidoscopes for colorectal cancer screening.
- Flexible sigmoidoscopy is a common procedure for detecting distal colon abnormalities.
Purpose of the Study:
- To evaluate the additional diagnostic yield of using longer colonoscopes (168-cm) beyond 60 cm in unsedated patients undergoing screening flexible sigmoidoscopy.
- To determine if longer instruments improve polyp detection rates in the distal colon.
Main Methods:
- A screening examination was performed on 500 asymptomatic subjects using 168-cm colonoscopes.
- Subjects were unsedated and received standard sigmoidoscopy preparation.
- Depth of penetration and polyp detection at various lengths were recorded.
Main Results:
- The mean depth of colonoscope penetration was 66 cm.
- Only 5 out of 87 detected polyps were found above 60 cm.
- Examination withdrawal due to poor preparation or discomfort did not significantly affect penetration depth.
Conclusions:
- Using flexible sigmoidoscopes longer than 60 cm provides minimal additional benefit for polyp detection in unsedated patients undergoing screening after standard preparation.
- Standard-length flexible sigmoidoscopes are likely sufficient for this indication.