Diagnostic Yield of Flexible Sigmoidoscopy in Symptomatic Population: An Insight to Rapid Access Sigmoidoscopy Clinic

Abstract

Aim: The study aim was to investigate the correlations between suspicious lower GI symptoms and endoscopic findings in symptomatic population using flexible sigmoidoscopy.
Methods: Retrospective review of all rapid access sigmoidoscopy clinic referrals was performed. Clinical, sigmoidoscopy findings and outcome were reviewed. Patients were further monitored for over five years for new cancers.
Results: A total of 445 patients met the inclusion criteria. Most patients (87.2%) had a flexible sigmoidoscopy in their first visit; 41.2% had barium enema to investigate proximal bowel. Polyp detection rate was 12.6% with an average distance of 23.1±18.9 cm from the anal verge. Passing mucus (p=0.05) and incontinence (p=0.035) were the only predictive symptoms for polyps. Cancer detection rate was 7%. Almost 93% of cancers were detected with the flexible sigmoidoscope alone with an average distance of 23.1±16.6 cm with majority being advanced as 17.9% had Duke’s A. Weight loss (p=0.005), tenesmus (p=0.006) and passing mucus per rectum (p=0.008) were three predictive symptoms on univariate and multivariate analysis. One patient developed a primary cancer 5 years from his index sigmoidoscopy. Substantial savings were achieved using this model of investigation.
Conclusion: Flexible sigmoidoscopy is easy, safe, sensitive and cost effective investigation for patients with suspicious lower colonic symptoms.