Symposium on outpatient anorectal procedures. Flexible fiberoptic sigmoidoscopy: an office procedure

Patients who had benign polyps and cancers were studied retrospectively to define whether use of the 60-cm flexible sigmoidoscope would markedly improve the diagnostic yield over the 25-cm rigid sigmoidoscope. Of the polyps found, 48% could have been seen by the rigid sigmoidoscope and 85% by the flexible sigmoidoscope. Cancers were within reach of digital examination in 21%, of the rigid sigmoidoscope in 38% and of the flexible sigmoidoscope in 60%. This verifies the greater diagnostic yield by the flexible sigmoidoscope. In 211 asymptomatic patients who underwent flexible fiberoptic sigmoidoscopy, the scope reached to 25 cm in all and to 50 cm in 75%. The average time required for the examination was 4.9 minutes. Of these patients, who had also undergone rigid sigmoidoscopy previously, 76% preferred the flexible scope, 18% preferred the rigid scope and 6% could tell no difference. The yield of neoplasms was 4% in the distal 25 cm of the colon and rectum, but an additional 8% were found in the sigmoid colon. This review supports the need for flexible sigmoidoscopy in the office as a screening tool for detection of polyps and early diagnosis of cancer in the asymptomatic patient over 40 years of age. Technique, costs and complications are discussed.