Flexible sigmoidoscopy and whole colonic imaging in the diagnosis of cancer in patients with colorectal symptoms

Thompson, Michael R.; Flashman, Karen; Wooldrage, Kate; Rogers, Pauline; Senapati, Asha; O’Leary, D; Atkin, Wendy

doi:10.1002/bjs.6234

Cited by 28 publications

(69 citation statements)

References 18 publications

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“…In a large study involving 16,433 symptomatic cases who underwent flexible sigmoidoscopy over a 16 year period in a single colorectal unit in south of England, it was shown that the chance of missing a proximal lesion with this procedure is about 2.5% (Thompson et al, 2008). In West Africa about 50% of colorectal cancers are located in the rectum of which 78% are within reach of the examining finger, with another 20% in the sigmoid, descending and splenic flexure of the colon (Dakubo et al, 2010;Irabor and Adedeji, 2009;Naaeder and Archampong, 1994).…”

Section: Discussionmentioning

confidence: 99%

Utilisation and diagnostic yield of large bowel endoscopy at Korle-Bu Teaching Hospital

Dakubo¹,

Seshie²,

Ankrah³

2014

J. Med. Biomed. Sci.

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Large bowel endoscopy, the most accurate diagnostic investigation of the colon and rectum has been available at the Korle-Bu Teaching for close to two decades and has been used mostly for diagnosis. This retrospective study assessed patients who have undergone large bowel endoscopy, with the aim of defining the utilization of the diagnostic yield and the predominance of the varied methods. From January 1998 to December 2011, a total of 2,151 patients comprising 1,302(60.5%) males and 763(35.5%) females underwent large bowel endoscopy. Patient age ranged from 8 to 100 years with a median age of 53 years and an inter-quartile range of 25 -72 years. The proportion of the varied methods was: colonoscopy (832; 39%), flexible sigmoidoscopy (704; 33%), rigid sigmoidoscopy (406; 19%) and proctoscopy (192; 9%). Bleeding per rectum (57.0%) was the commonest primary complaint with an overall diagnostic yield of 48.4%. In 888(41.6%) cases no pathology was found. Haemorrhoidal disease accounted for 690(32.3%) cases followed by tumours 191(9.0%). Sigmoidoscopy (both rigid and flexible) diagnosed 141(95.3%) of the tumours and colonoscopy diagnosed the remaining 7(4.7%) tumours Complete colonoscopy was achieved in 491(59%) cases scheduled for colonoscopy. In most symptomatic cases the diagnostic yield of endoscopy was high with tumours being the second commonest diagnosis after haemorrhoids. Many of the tumours were diagnosed with the sigmoidoscope. It is therefore recommended that flexible sigmoidoscopy be made available in all hospital in Ghana.

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Section: Discussionmentioning

confidence: 99%

Utilisation and diagnostic yield of large bowel endoscopy at Korle-Bu Teaching Hospital

Dakubo¹,

Seshie²,

Ankrah³

2014

J. Med. Biomed. Sci.

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“…Colorectal endoscopic screening has greatly improved the detection rates of early disease (Stages I and II disease) in the West, more so in whites than in blacks. 5 The stage of colorectal cancer at time of diagnosis reported in the US 34 Of the 321 patients with adenocarcinoma all except four had invasive tumour. The patients with carcinoma-insitu presented with rectal bleeding and had endoscopy which identified their tumours that were subsequently resected after histological confirmation of the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Colorectal Carcinoma: An Update of Current Trends in Accra

Dakubo¹,

Naaeder²,

Tettey³

et al. 2011

West African Journal of Medicine

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“…Data for these investigations were then collected by removing the 'primary care' filter from the search. The following papers were considered to inform the accuracy of the remaining investigations: Oono et al 101 for faecal immunochemical testing, Thompson et al 102 for flexible sigmoidoscopy, Pickhardt et al 103 (only sensitivity) and Halligan et al 104 for CTC, and Pickhardt et al 103 for colonoscopy.…”

Section: Diagnostic Accuracymentioning

confidence: 99%

Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis

Westwood

Ramos

Lang

et al. 2017

Health Technol Assess

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BackgroundColorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation.ObjectivesTo assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms.MethodsTwenty-four resources were searched to March 2016. Review methods followed published guidelines. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. The cost-effectiveness analysis considered long-term costs and quality-adjusted life-years (QALYs) that were associated with different faecal occult blood tests and direct colonoscopy referral. Modelling comprised a diagnostic decision model, a Markov model for long-term costs and QALYs that were associated with CRC treatment and progression, and a Markov model for QALYs that were associated with no CRC.ResultsWe included 10 studies. Using a single sample and 10 µg Hb/g faeces threshold, sensitivity estimates for OC-Sensor [92.1%, 95% confidence interval (CI) 86.9% to 95.3%] and HM-JACKarc (100%, 95% CI 71.5% to 100%) indicated that both may be useful to rule out CRC. Specificity estimates were 85.8% (95% CI 78.3% to 91.0%) and 76.6% (95% CI 72.6% to 80.3%). Triage using FITs could rule out CRC and avoid colonoscopy in approximately 75% of symptomatic patients. Data from our systematic review suggest that 22.5–93% of patients with a positive FIT and no CRC have other significant bowel pathologies. The results of the base-case analysis suggested minimal difference in QALYs between all of the strategies; no triage (referral straight to colonoscopy) is the most expensive. Faecal immunochemical testing was cost-effective (cheaper and more, or only slightly less, effective) compared with no triage. Faecal immunochemical testing was more effective and costly than guaiac faecal occult blood testing, but remained cost-effective at a threshold incremental cost-effectiveness ratio of £30,000. The results of scenario analyses did not differ substantively from the base-case. Results were better for faecal immunochemical testing when accuracy of the guaiac faecal occult blood test (gFOBT) was based on studies that were more representative of the correct population.LimitationsOnly one included study evaluated faecal immunochemical testing in primary care; however, all of the other studies evaluated faecal immunochemical testing at the point of referral. Further, validation data for the Faecal haemoglobin, Age and Sex Test (FAST) score, which includes faecal immunochemical testing, showed no significant difference in performance between primary and secondary care. There were insufficient data to adequately assess FOB Gold, RIDASCREEN Hb or RIDASCREEN Hb/Hp complex. No study compared FIT assays, or FIT assays versus gFOBT; all of the data included in this assessment refer to the clinical effectiveness of individual FIT methods andnottheir comparative effectiveness.ConclusionsFaecal immunochemical testing is likely to be a clinically effective and cost-effective strategy for triaging people who are presenting, in primary care settings, with lower abdominal symptoms and who are at low risk for CRC. Further research is required to confirm the effectiveness of faecal immunochemical testing in primary care practice and to compare the performance of different FIT assays.Study registrationThis study is registered as PROSPERO CRD42016037723.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Flexible sigmoidoscopy and whole colonic imaging in the diagnosis of cancer in patients with colorectal symptoms

Cited by 28 publications

References 18 publications

Utilisation and diagnostic yield of large bowel endoscopy at Korle-Bu Teaching Hospital

Utilisation and diagnostic yield of large bowel endoscopy at Korle-Bu Teaching Hospital

Colorectal Carcinoma: An Update of Current Trends in Accra

Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis

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