Rigid sigmoidoscopy: An evaluation of three parameters regarding diagnostic accuracy

Abstract

Rigid sigmoidoscopy is the method employed for examining the rectum and sigmoid colon in most general surgical clinics. Commonly, this is performed without any prior preparation of the bowel and with the patient in the left lateral (Sims') position. This study was designed to assess three factors relating to this method: preparation of the bowel; position of the patient; and the experience of the operator. The study shows that diagnostic accuracy without preparation is adequate in only 50 per cent of cases but, by employing a preliminary disposable (Fletcher's) enema, this can be improved to 80 per cent. Employing the knee-elbow position gave only slight advantage over the usual Sims' position and operator experience did not improve diagnostic accuracy once familiarity with the use of the sigmoidoscope had been achieved. The study underlines the importance of preparation as an essential prelude to sigmoidoscopy.

Rigid videosigmoidoscopy vs conventional sigmoidoscopy

“…Previous studies have reported success in passing the rectosigmoid junction in 70% of cases using a LloydDavies sigmoidoscope of 18 mm diameter [7]. Others, using a smaller sigmoidoscope of 13 mm diameter have succeeded in 66-92% of cases, depending on bowel preparation and patient position [5]. Our study showed that the VS passed the rectosigmoid in 82% of cases.…”

“…The mean pain scores showed that the VS caused significantly less discomfort than the CS (3.0 [range, 0-7] versus 5.5 [1][2][3][4][5][6][7][8][9][10]; p < 0.001) (Fig. 2).…”

“…Previous studies have reported the discovery of a neoplasm in the colorectum in 1-14% of cases, depending on case mix of new and follow-up patients [3,5,13]. A large case-controlled study showed lower mortality from cancer of the rectum and distal colon in a group screened by rigid sigmoidoscopy [10]; however, no randomized studies have been done to prove conclusively that sigmoidoscopy has a role in screening.…”

“…Rigid sigmoidoscopy is an easy technique to learn [5], and it is relatively safe [8]. Nevertheless, it has not been adopted by many primary-care practitioners [3], possibly because interpretation of the findings occasionally requires an experienced eye, and there is no satisfactory method of recording the examination for a second opinion.…”

Iatrogenic perforation at colonic imaging

“…Rigid sigmoidoscopy is an outpatient procedure, usually performed without bowel preparation, and has limited accuracy (approximately 50%) in detecting rectal pathology [11]. Rigid scopes are 25–30 cm in length and thus capable of assessing the complete rectum (15 cm) and the distal sigmoid in some cases.…”