Availability of Flexible Sigmoidoscopy for Outpatients, Inpatients,and Mass Screening at a Proctologic Clinic

ABSTRACT

PURPOSE: The clinical guidelines and rationale published by the American Gastroenterological Association in 1997 recommended that it is not necessary to screen patients in the average risk group who are below the age of 50. The purpose of this study was to evaluate both the effectiveness of flexible sigmoidoscopy (FS) as a diagnostic and screening tool and the utility of screening at an age earlier than 50 years. METHODS: From Jan. to Dec. 1997, FS was used in 8964 cases. These cases were divided into three groups Group A, 1336 outpatients; Group B, 5308 cases involving a hemorrhoidal operation; and Group C, 2320 cases of mass screening. RESULTS: The mean age was lower in Group B (42.4 11.5) than in Group A (47.0 14.5) and Group C (46.1 10.7). The incidences of cancer, inflammatory bowel disease (IBD), and nonspecific proctocolitis in Group A were significantly higher than they were in Groups B and C, and the FS findings in Groups B and C were similiar. The locations of the polyps, cancer, IBD, and nonspecific proctocolitis were below the left colon in 91.9% cases involving an abnormal finding. Also, the locations of polyps and IBD determined by using FS and by using colonoscopy (CS) were not very different. About two-thirds of the carcinomas found by using FS in all three groups were located in the upper rectum and the sigmoid. In Group B, the FS findings did not depend on whether or not an enema had been administered. Also, the total incidence of cancer in patients less than forty years of age was nearly the same as the incidence of cancer in Group B and the incidence of cancer in Group C. CONCLUSIONS:The risk of cancer for patients in the average risk group who are under 50 years of age should not be underestimated. FS is effective not only for the diagnosis of colorectal disease but also as an initial screening technique for patients below forty years of age.