Diagnostic Yield of Flexible Sigmoidoscopy in Symptomatic Population: An Insight to Rapid Access Sigmoidoscopy Clinic
DOI:
https://doi.org/10.17140/SROJ-1-102Keywords:
Symptomatic, Sigmoidoscopy, CancerAbstract
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.
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009; 59(4): 225-249. doi: 10.3322/caac.20006
Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007; 18(3): 581-592. doi: 10.1093/annonc/ mdl498
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statis-tics, 2002. CA Cancer J Clin. 2005; 55(2): 74-108.
National cancer screenig service. Recommendations for a colorectal cancer screening programme in Ireland. Letter of submission and executive summary. Website: http://www.can-cerscreening.ie/publications/Colorectal-Recommendations.pdf 2009; HSE press. 2-7.
Vellacott K, Roe A, Mortensen N. An evaluation of a direct access flexible fibreoptic sigmoidoscopy service. Ann R Coll Surg of Engl. 1987; 69(4): 149-152.
Lamah M, Ahmad SM, Charalampopoulos A, Ho J, Leicester RJ. Three-year evaluation of a rapid-access coloproctology clinic. Dig Surg. 2000; 17(2): 150-153. doi: 10.1159/000018819
Bruster S, Jarman B, Bosanquet N, Weston D, Erens R, Delbanco TL. National survey of hospital patients. BMJ. 1994; 309(6968): 1542-1546. doi: 10.1136/bmj.309.6968.1542
Majumdar SR, Fletcher RH, Evans AT. How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol. 1999; 94(10): 3039-3045. doi: 10.1111/j.1572-0241- .1999.01454.x
Lieberman DA, Holub JL, Moravec MD, Eisen GM, Peters D, Morris CD. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA. 2008; 300(12): 1417-1422. doi: 10.1001/jama.300.12.1417
Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case– control study of screening sigmoidoscopy and mortality from col-orectal cancer. N Engl J Med. 1992; 326: 653-657. doi: 10.1056/ NEJM199203053261001
Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a mul-ticentre randomised controlled trial. The Lancet. 2010; 375: 1624- 1633. doi: 10.1016/S0140-6736(10)60551-X
Vipond M, Moshakis V. Four-year evaluation of a direct-access fibreoptic sigmoidoscopy service. Ann R Coll Surg Engl. 1996; 78(1): 23-26.
Flashman K, O’Leary DP, Senapati A, Thompson MR. The De-partment of Health’s “two week standard” for bowel cancer: is it work-ing? Gut. 2004; 53(3): 387-391. doi: 10.1136/gut.2003.020503
Jensen J, Kewenter J, Asztély M, Lycke G, Wojciechowski J. Double contrast barium enema and flexible rectosigmoidoscopy: a reliable diagnostic combination for detection of colorectal neo-plasm. Br J Surg. 1990; 77(3): 270-272.
Duthie GS, Drew PJ, Hughes MA, et al. A UK training pro-gramme for nurse practitioner flexible sigmoidoscopy and a pro-spective evaluation of the practice of the first UK trained nurse flexible sigmoidoscopist. Gut. 1998; 43: 711-714. doi: 10.1136/ gut.43.5.711
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993; 329(27): 1977-1981. doi: 10.1056/NEJM199312303292701
Umpleby H, Williamson RC. Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum. 1984; 27: 299-304. doi: 10.1007/BF02555634
Binda V, Pereira-Lima J, Nunes CA, Falkemberg LT, Azambuja DB, Cruz JV. Is there a role for sigmoidoscopy in symptom atic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population. Arq Gastroenterol. 2007; 44(1): 2-7. doi: 10.1590/S0004-28032007000100002
Selvachandran S, Hodder RJ, Ballal MS, Jones P, Cade D. Prediction of colorectal cancer by a patient consultation ques-tionnaire and scoring system: a prospective study. Lancet. 2002; 360(9329): 278-283. doi: 10.1016/S0140-6736(02)09549-1
Knottnerus J, Knipschild P, Sturmans F. Symptoms and se-lection bias: the influence of selection towards specialist care on the relationship between symptoms and diagnoses. Theo-retical Med and Bioeth. 1989; 10(1): 67-81.
Fijten GH, Blijham GH, Knottnerus JA. Occurrence and clinical significance of overt blood loss per rectum in the gen-eral population and in medical practice. Br J Gen Pract. 1994; 44(384): 320-325.
Goulston K, Chapuis P, Bokey L. Significance of bowel symptoms. Med J Aust. 1987; 146(12): 631-633.
Thompson M. ACPGBI Referral guidelines for colorectal cancer. Colorectal Dis. 2002; 4: 287-297. doi: 10.1046/j.1463- 1318.2002.00348.x
Neugut A, Garbowski G, Waye J, et al. Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding. Am J Gastroen-terol. 1993; 88: 1179-1185.
Hamilton W, Round A, Sharp D, Peters TJ. Clinical features of colorectal cancer before diagnosis: a population-based case– control study. Br J Cancer. 2005; 93(4): 399-405. doi: 10.1038/ sj.bjc.6602714
Summerton N, Mann S, Sutton J, et al. Developing clini-cally relevant and reproducible symptom-defined populations for cancer diagnostic research in general practice using a com-munity survey. Fam Pract. 2003; 20(3): 340-346. doi: 10.1093/ fampra/cmg317
Lieberman DA, de Garmo PL, Fleischer DE, Eisen GM, Chan BK, Helfand M. Colonic neoplasia in patients with non-specific GI symptoms. Gastrointest Endosc. 2000; 51(6): 647- 651.
Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in as-ymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000; 343: 169-174.
Kronborg O, Fenger C, Olsen J, Jørgensen OD, Sønder-gaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996; 348(9040): 1467- 1471.
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Surgical Research (SR) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.