Flexible sigmoidoscopy: diagnostic yield in 1015 patients.

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Diagnostic Endoscopy

Background:

• Colorectal cancer screening and diagnosis are critical for public health.
• Flexible sigmoidoscopy (FS) is a common endoscopic procedure for evaluating the lower gastrointestinal tract.
• Identifying neoplastic lesions in symptomatic patients is essential for timely intervention.

Purpose of the Study:

• To determine the number of neoplastic lesions (adenomatous polyps and cancer) detectable by FS in patients with colorectal symptoms.
• To analyze the age distribution of patients diagnosed with neoplastic lesions via FS.
• To evaluate the efficacy and safety of FS as an initial diagnostic tool.

Main Methods:

• A total of 1015 patients aged 20-89 with colorectal symptoms underwent FS.
• Indications included rectal bleeding, occult blood loss, anemia, change in bowel habit, weight loss, and abdominal pain.
• FS examined a mean distance of 49 cm, with bowel preparation using Fleet enemas; the procedure was well-tolerated without complications.

Main Results:

• Eighty-five neoplastic lesions were found in 78 patients.
• 54% of adenomatous polyps and 61% of cancers were detected beyond 20 cm from the anal verge.
• Neoplastic lesions were identified in all adult decades, with detection rates increasing with age, peaking in the 7th decade (11.2%). Cancer was diagnosed in patients over 40, with higher incidence in those over 60 (3.3%) compared to younger patients (0.8%).

Conclusions:

• Flexible sigmoidoscopy is a safe and effective initial diagnostic procedure for detecting neoplastic lesions in symptomatic patients.
• FS plays a crucial role in identifying colorectal polyps and cancers, particularly those located distally.
• The study highlights the importance of FS across all adult age groups presenting with colorectal symptoms.