Investigation of colonic symptoms: the value of flexible sigmoidoscopy

Colonic symptoms and large-bowel disease are common in elderly people, but the optimum investigative schema is not well established. Double-contrast barium enema (DCBE) and full colonoscopy share several drawbacks; both require colonic preparation which at best causes stool frequency and urgency, at worse dehydration and hypovolaemia. Many physicians feel that in the elderly this represents such a risk that inpatient preparation is preferred. Both investigations may involve much discomfort and distress. Rigid sigmoidoscopy is the traditional first colonic examination in patients with colonic symptoms, but will detect fewer than 10% of significant colonic lesions. Further investigation is almost always needed in elderly patients.