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John F. Mayberry - One of the best experts on this subject based on the ideXlab platform.
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Sigmoidoscopy and rectal biopsy: a survey of current UK practice.
European journal of gastroenterology & hepatology, 1996Co-Authors: R. J. Robinson, M. A. Stone, John F. MayberryAbstract:Objective : To establish the pattern of practice of Sigmoidoscopy and rectal biopsy in the UK, and to estimate the rate of occurrence of important complications. Design : Postal questionnaire enquiring about practice in the previous 2 years. Subjects : Consultant members of the British Society of Gastroenterology. Main outcome measures : Bleeding or perforation following Sigmoidoscopy and rectal biopsy. Results : Completed replies were received from 277 consultants, giving a response rate of 84%. Of the sigmoidoscopies performed, 71% were rigid and the remainder fibreoptic flexible Sigmoidoscopy (FOS). The complication rate after Sigmoidoscopy and rectal biopsy was 0.01%. Perforation was significantly more common in FOS than in rigid Sigmoidoscopy (eight in 134482 sigmoidoscopies versus five in 328 815, χ 2 =5.18, P< 0.05). The distance from anal margin and wall of biopsy did not influence perforation rates. Significant bleeding was similar with both techniques (eight in 134482 versus 35 in 328 815, χ 2 =2.27, NS). Conclusion : Rigid Sigmoidoscopy is still more widely used than FOS in the UK, and is probably safer. Complications resulting from rectal biopsy are uncommon but perforation occurs more frequently with FOS than with rigid Sigmoidoscopy. The site of biopsy appears to be unimportant.
Hermann Brenner - One of the best experts on this subject based on the ideXlab platform.
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colonoscopy and Sigmoidoscopy use among the average risk population for colorectal cancer a systematic review and trend analysis
Cancer Prevention Research, 2019Co-Authors: Rafael Cardoso, Michael Hoffmeister, Tobias Niedermaier, Chen Chen, Hermann BrennerAbstract:Monitoring population-level colonoscopy and Sigmoidoscopy use is crucial to estimate the future burden of colorectal cancer and guide screening efforts. We conducted a systematic literature search on colonoscopy and Sigmoidoscopy use, published between November 2016 and December 2018 in the databases PubMed and Web of Science to update previous reviews and analyze time trends for various countries. In addition, we used data from the German and European Health Interview Surveys and the National Health Interview Survey to explore recent time trends for Germany and the US, respectively. The literature search yielded 23 new articles: fourteen from the US and nine from Australia, Canada, England, Germany, Saudi Arabia, and South Korea. Colonoscopy use within 10 years was highest and, apart from the youngest age groups eligible for colorectal cancer screening, kept increasing to levels close to 60% in the US and Germany. A recent steep increase was also observed for South Korea. Limited data were available on Sigmoidoscopy use; regional studies from the US suggest that Sigmoidoscopy has become rarely used. Despite high uptake and ongoing increase in the US, Germany, and South Korea, use of colonoscopy and Sigmoidoscopy has either remained low or essentially unknown for the majority of countries.
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diagnostic performance of one off flexible Sigmoidoscopy with fecal immunochemical testing in a large screening population
Epidemiology, 2017Co-Authors: Tobias Niedermaier, Michael Hoffmeister, Korbinian Weigl, Hermann BrennerAbstract:BACKGROUND Flexible Sigmoidoscopy and fecal immunochemical tests are established diagnostic tests for colorectal cancer (CRC) screening and less invasive, less expensive, and easier to conduct than colonoscopy. However, little is known about their joint diagnostic performance compared with colonoscopy. We aimed to assess the expected diagnostic performance of joint use of flexible Sigmoidoscopy and fecal immunochemical test. METHODS We assessed the overall and site-specific prevalences of colorectal neoplasms and the overall sensitivity, specificity, area under the receiver operating characteristics curve of a quantitative fecal immunochemical test (FOB Gold, Sentinel Diagnostics, Milano, Italy) among 3,466 participants in screening colonoscopy in Germany. Results were used to model the expected diagnostic performance of joint use of flexible Sigmoidoscopy and fecal immunochemical testing. RESULTS CRC and advanced adenomas were found in 29 (1%) and 354 (10%) participants, respectively. The area under the curve of fecal immunochemical testing for these outcomes could be raised from 96% to 100% and from 70% to 89%, respectively, by combining it with flexible Sigmoidoscopy. At 90% specificity, sensitivity of fecal immunochemical testing would increase from 97% to 100% for CRC and from 40% to 79% for advanced adenomas. CONCLUSIONS Combining flexible Sigmoidoscopy and fecal immunochemical testing might strongly enhance diagnostic performance of each single test to a level close to the diagnostic performance of screening colonoscopy while avoiding many unnecessary colonoscopies.
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potential for colorectal cancer prevention of Sigmoidoscopy versus colonoscopy population based case control study
Cancer Epidemiology Biomarkers & Prevention, 2007Co-Authors: Hermann Brenner, Jenny Changclaude, Christoph M Seiler, T Sturmer, Michael HoffmeisterAbstract:We aimed to estimate the proportions of colorectal cancer cases that might be prevented by Sigmoidoscopy compared with colonoscopy among women and men. In a population-based case control study conducted in Germany, 540 cases with a first diagnosis of primary colorectal cancer and 614 controls matched for age, sex, and county of residence were recruited. A detailed lifetime history of endoscopic examinations of the large bowel was obtained by standardized personal interviews, validated by medical records, and compared between cases and controls, paying particular attention to location of colorectal cancer and sex differences. Overall, 39%, 77%, and 64% of proximal, distal, and total colorectal cancer cases were estimated to be preventable by colonoscopy. The estimated proportion of total colorectal cancer cases preventable by Sigmoidoscopy was 45% among both women and men, assuming that Sigmoidoscopy reaches the junction of the descending and sigmoid colon only and findings of distal polyps are not followed by colonoscopy. Assuming that Sigmoidoscopy reaches the splenic flexure and colonoscopy is done after detection of distal polyps, estimated proportions of total colorectal cancer preventable by Sigmoidoscopy increase to 50% and 55% (73% and 91% of total colorectal cancer preventable by primary colonoscopy) among women and men, respectively. We conclude that colonoscopy provides strong protection against colorectal cancer among both women and men. The proportion of this protection achieved by Sigmoidoscopy with follow-up colonoscopy in case of distal polyps may be larger than anticipated. Among men, this regimen may be almost as effective as colonoscopy, at least at previous performance levels of colonoscopy.
Michael Hoffmeister - One of the best experts on this subject based on the ideXlab platform.
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colonoscopy and Sigmoidoscopy use among the average risk population for colorectal cancer a systematic review and trend analysis
Cancer Prevention Research, 2019Co-Authors: Rafael Cardoso, Michael Hoffmeister, Tobias Niedermaier, Chen Chen, Hermann BrennerAbstract:Monitoring population-level colonoscopy and Sigmoidoscopy use is crucial to estimate the future burden of colorectal cancer and guide screening efforts. We conducted a systematic literature search on colonoscopy and Sigmoidoscopy use, published between November 2016 and December 2018 in the databases PubMed and Web of Science to update previous reviews and analyze time trends for various countries. In addition, we used data from the German and European Health Interview Surveys and the National Health Interview Survey to explore recent time trends for Germany and the US, respectively. The literature search yielded 23 new articles: fourteen from the US and nine from Australia, Canada, England, Germany, Saudi Arabia, and South Korea. Colonoscopy use within 10 years was highest and, apart from the youngest age groups eligible for colorectal cancer screening, kept increasing to levels close to 60% in the US and Germany. A recent steep increase was also observed for South Korea. Limited data were available on Sigmoidoscopy use; regional studies from the US suggest that Sigmoidoscopy has become rarely used. Despite high uptake and ongoing increase in the US, Germany, and South Korea, use of colonoscopy and Sigmoidoscopy has either remained low or essentially unknown for the majority of countries.
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diagnostic performance of one off flexible Sigmoidoscopy with fecal immunochemical testing in a large screening population
Epidemiology, 2017Co-Authors: Tobias Niedermaier, Michael Hoffmeister, Korbinian Weigl, Hermann BrennerAbstract:BACKGROUND Flexible Sigmoidoscopy and fecal immunochemical tests are established diagnostic tests for colorectal cancer (CRC) screening and less invasive, less expensive, and easier to conduct than colonoscopy. However, little is known about their joint diagnostic performance compared with colonoscopy. We aimed to assess the expected diagnostic performance of joint use of flexible Sigmoidoscopy and fecal immunochemical test. METHODS We assessed the overall and site-specific prevalences of colorectal neoplasms and the overall sensitivity, specificity, area under the receiver operating characteristics curve of a quantitative fecal immunochemical test (FOB Gold, Sentinel Diagnostics, Milano, Italy) among 3,466 participants in screening colonoscopy in Germany. Results were used to model the expected diagnostic performance of joint use of flexible Sigmoidoscopy and fecal immunochemical testing. RESULTS CRC and advanced adenomas were found in 29 (1%) and 354 (10%) participants, respectively. The area under the curve of fecal immunochemical testing for these outcomes could be raised from 96% to 100% and from 70% to 89%, respectively, by combining it with flexible Sigmoidoscopy. At 90% specificity, sensitivity of fecal immunochemical testing would increase from 97% to 100% for CRC and from 40% to 79% for advanced adenomas. CONCLUSIONS Combining flexible Sigmoidoscopy and fecal immunochemical testing might strongly enhance diagnostic performance of each single test to a level close to the diagnostic performance of screening colonoscopy while avoiding many unnecessary colonoscopies.
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potential for colorectal cancer prevention of Sigmoidoscopy versus colonoscopy population based case control study
Cancer Epidemiology Biomarkers & Prevention, 2007Co-Authors: Hermann Brenner, Jenny Changclaude, Christoph M Seiler, T Sturmer, Michael HoffmeisterAbstract:We aimed to estimate the proportions of colorectal cancer cases that might be prevented by Sigmoidoscopy compared with colonoscopy among women and men. In a population-based case control study conducted in Germany, 540 cases with a first diagnosis of primary colorectal cancer and 614 controls matched for age, sex, and county of residence were recruited. A detailed lifetime history of endoscopic examinations of the large bowel was obtained by standardized personal interviews, validated by medical records, and compared between cases and controls, paying particular attention to location of colorectal cancer and sex differences. Overall, 39%, 77%, and 64% of proximal, distal, and total colorectal cancer cases were estimated to be preventable by colonoscopy. The estimated proportion of total colorectal cancer cases preventable by Sigmoidoscopy was 45% among both women and men, assuming that Sigmoidoscopy reaches the junction of the descending and sigmoid colon only and findings of distal polyps are not followed by colonoscopy. Assuming that Sigmoidoscopy reaches the splenic flexure and colonoscopy is done after detection of distal polyps, estimated proportions of total colorectal cancer preventable by Sigmoidoscopy increase to 50% and 55% (73% and 91% of total colorectal cancer preventable by primary colonoscopy) among women and men, respectively. We conclude that colonoscopy provides strong protection against colorectal cancer among both women and men. The proportion of this protection achieved by Sigmoidoscopy with follow-up colonoscopy in case of distal polyps may be larger than anticipated. Among men, this regimen may be almost as effective as colonoscopy, at least at previous performance levels of colonoscopy.
Rao K Manne - One of the best experts on this subject based on the ideXlab platform.
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the sentinel hyperplastic polyp a marker for synchronous neoplasia in the proximal colon
The American Journal of Gastroenterology, 1991Co-Authors: P G Foutch, K Pardy, James A. Disario, Rao K ManneAbstract:We prospectively screened 129 asymptomatic subjects (mean age 64 yr) with flexible Sigmoidoscopy. Colonoscopy was performed at a later date, regardless of the sigmoidoscopic result. Our intent was 1) to establish the prevalence of proximal neoplasms in patients with and without hyperplastic polyps within reach of the 60-cm sigmoidoscope and 2) to determine whether a distal (sentinel) hyperplastic polyp predicts the presence of synchronous neoplastic polyps higher up in the colon. Our results show that 15% of asymptomatic adult subjects without polyps on Sigmoidoscopy have adenomas in proximal colonic segments that can be diagnosed only by colonoscopy. By comparison, proximal neoplasms were detected in 32% (p less than 0.05) and 37% (p less than 0.05) of patients when hyperplastic or adenomatous polyps, respectively, were present on the sigmoidoscopic examination. This finding suggests that a distal (sentinel) hyperplastic polyp by itself may be a marker for neoplastic polyps in proximal colonic segments. Also, the "index" adenoma and "sentinel" hyperplastic polyp may be equivalent for predicting the presence of proximal neoplasms. The observed detection rates for these polyps were both significantly higher than expected when compared to patients who did not have polyps in the distal colon or rectum. If these results can be confirmed by a larger prospective trial, then full colonoscopy for detection of proximal neoplasms may be indicated when either an index adenoma or sentinel hyperplastic polyp is detected by Sigmoidoscopy.
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flexible Sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic average risk men
Digestive Diseases and Sciences, 1991Co-Authors: P G Foutch, K Pardy, Rao K Manne, James A. Disario, Hugh Mai, D KerrAbstract:Asymptomatic men (N=114) 50 years of age or older had screening for colorectal neoplasia with flexible Sigmoidoscopy followed by colonoscopy regardless of the sigmoidoscopic result. Our study objective was to determine the prevalence of patients having isolated adenomatous polyps in a proximal colonic segment in the absence of a distal index neoplasm within reach of the sigmoidoscope. Through the combined use of Sigmoidoscopy and colonoscopy, adenomatous polyps were detected in 47 of 114 individuals (41%). A total of 88 adenomas was found. Seventeen patients had isolated neoplasms in proximal colonic segments in the absence of distal adenomas. These patients represented 15% of screened subjects (17 of 114) and 20% of individuals who lacked adenomas on Sigmoidoscopy (17 of 84). The majority of proximal neoplasms were small (<1.0 cm), tubular adenomas. Flexible Sigmoidoscopy may be ineffective for screening asymptomatic men for neoplasia. However, it remains to be determined if a 20% miss rate (for those with a normal sigmoidoscopic examination) is significant and whether small proximal adenomas are worth finding.
Robert E. Schoen - One of the best experts on this subject based on the ideXlab platform.
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Re: Risk of perforation after colonoscopy and Sigmoidoscopy: a population-based study.
Journal of the National Cancer Institute, 2003Co-Authors: Robert E. Schoen, Theodore R. LevinAbstract:Gatto et al. (1) report on perforation rates after Sigmoidoscopy and colonoscopy to better inform clinicians making screening decisions. However, the perforation rates for Sigmoidoscopy far exceed those reported in the screening setting, including 1/50 000 in the Kaiser Permanente Colorectal Cancer Prevention (CoCaP) Sigmoidoscopy screening program (2); 1/40 332 in the U.K. screening trial (3); and 1/25 000 in a series from the Mayo Clinic, Scottsdale, AZ (4). The elevated Sigmoidoscopy perforation rate reported by Gatto et al. is due to inclusion of failed colonoscopy and special, high-risk Sigmoidoscopy. Their broad inclusion criteria are demonstrated by the codes used for Sigmoidoscopy, which include Sigmoidoscopy with polypectomy, control of bleeding, decompression of volvulus, and removal of a foreign body. The inclusion of high-risk procedures and failed colonoscopy explains their observed 30to 50-fold increase in Sigmoidoscopy perforations compared with the perforation rate in screening populations. As such, their results do not inform clinicians about Sigmoidoscopy screening decisions. Their anomalous results demonstrate the pitfall of using procedure codes in an ad-
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predictors of advanced proximal neoplasia in persons with abnormal screening flexible Sigmoidoscopy
Clinical Gastroenterology and Hepatology, 2003Co-Authors: Paul F Pinsky, Robert E. Schoen, Robert S Bresalier, Joel L. Weissfeld, Richard B Hayes, John K GohaganAbstract:Abstract Background & Aims: The relationship between distal and proximal colonic findings is uncertain. Thus, there is no consensus on which findings on screening flexible Sigmoidoscopy should trigger colonoscopy. Methods: We analyzed data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between distal and proximal colonic findings. Results: A total of 8802 subjects had an abnormal baseline Sigmoidoscopy and colonoscopy follow-up. Subjects with Conclusions: Among subjects with a polypoid lesion on screening flexible Sigmoidoscopy, those with small tubular distal adenomas are at similar risk for advanced proximal neoplasia as those without distal adenomas. Subjects with a large, villous, or dysplastic distal adenoma are at increased risk. A strategy that encourages individuals with small tubular adenomas on Sigmoidoscopy to undergo follow-up colonoscopy and excludes those with nonadenomatous lesions is of questionable validity, because both groups are at similar risk for advanced proximal neoplasia.
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Patient satisfaction with screening flexible Sigmoidoscopy.
Archives of internal medicine, 2000Co-Authors: Robert E. Schoen, Joel L. Weissfeld, Nancy J. Bowen, Galen Switzer, Andrew BaumAbstract:Background Screening flexible Sigmoidoscopy is an underused cancer prevention procedure. Physicians often cite patient discomfort as a reason for not requesting Sigmoidoscopy, but patient experiences and attitudes toward Sigmoidoscopy have not been well studied. Objective To measure patient satisfaction and the determinants of satisfaction with screening Sigmoidoscopy. Methods An instrument to assess satisfaction with screening Sigmoidoscopy was developed. Responses were evaluated with a factor analysis, tested for reproducibility and internal consistency, and validated against an external standard. Results A total of 1221 patients (666 men and 555 women; mean age, 61.8 years) were surveyed after Sigmoidoscopy. Examinations were performed by a nurse practitioner (n=668), internist (n=344), or gastrointestinal specialist (n=184). More than 93% of the participants strongly agreed or agreed they would be willing to undergo another examination, and 74.9% would strongly recommend the procedure to their friends. Regarding pain and discomfort, 76.2% strongly agreed or agreed that the examination did not cause a lot of pain, 78.1% stated that it did not cause a lot of discomfort, and 68.5% thought that it was more comfortable than they expected. Fifteen percent to 25% of the patients indicated they had a lot of pain, great discomfort, or more discomfort than expected. Women were more likely to have significant pain or discomfort than men (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.3; P Conclusions Approximately 70% of individuals who undergo screening Sigmoidoscopy are satisfied and find the procedure more comfortable than expected, whereas only 15% to 25% find the procedure unpleasant. Physicians should not project discomfort onto patients as a reason for not requesting screening Sigmoidoscopy.
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Sigmoidoscopy use among primary care physicians.
Preventive medicine, 1995Co-Authors: Robert E. Schoen, Joel L. Weissfeld, L. H. KullerAbstract:Background. Despite endorsement by a variety of professional societies, screening Sigmoidoscopy is performed on a small minority of patients. We performed a survey of primary care physicians in Allegheny County to examine in detail their current practice and attitude toward screening Sigmoidoscopy. Methods. Physicians were surveyed by mail or telephone. Eligible respondents were required to practice in the county and perform direct patient care. Results. Of 732 adult primary care physicians in Allegheny County, 400 were randomly selected for sampling and 279, or 70%, responded. Over 88% of physicians agreed completely or partly with current American Cancer Society recommendations for screening Sigmoidoscopy, but only 34% (95% CI 29-39%) reported they regularly refer or schedule patients for screening. Physicians who screen were more likely to be from internal medicine or family practice (P < 0.001) and to be trained in (P < 0.001) or to personally perform (P < 0.001) Sigmoidoscopy. The greater the number of barriers to screening cited by physicians, including cost, patient discomfort, equipment availability, low probability of finding a lesion, time it takes to do Sigmoidoscopy, and the risk of the procedure, the lower the screening rate (P = 0.002). Conclusion. (a) Although primary care physicians in Allegheny County report that they support screening Sigmoidoscopy, only one-third regularly refer or schedule patients, (b) physicians who are trained in or who perform Sigmoidoscopy are more likely to screen patients, and (c) further education and training of primary care physicians in Sigmoidoscopy will be required to increase screening rates.
