Flexible sigmoidoscopy

Flexible sigmoidoscopy is the visual examination of the rectum and sigmoid colon (and sometimes a bit higher) with flexible steerable 60 cm (24 inch) instrument that can bend around the corners of the bowel.  Approximately 55% of polyps and cancers develop within the reach of a 60 cm flexible sigmoidoscope.  An expert examiner can sometimes assess more than 60 cm of bowel with this instrument since the bowel can often be made to accordion down over the scope, like a sock.  Flexible sigmoidoscopy requires a full bowel prep.  Sedation is rarely used.  The test is reasonably safe; the rate of perforation of the bowel by the scope is 1 in 6,000.  In a number of studies, flexible sigmoidoscopy has been shown to reduce the colorectal cancer death rate by up to 85% within the range of examination.  In a recent review of 187 colorectal cancer patients diagnosed at the Pezim Clinic, flexible sigmoidoscopy would have identified 79% of them.

Flexible sigmoidoscopy is, in theory, a simple office procedure that can be done without any patient sedation, and it is frequently recommended as a screening method (combined with fecal occult blood testing).  Initially, it was thought to be so simple that Family Physicians could offer it in their offices.  However, for a number of reasons, that has not worked out.  For the average physician, the scopes are too expensive to purchase and operate, too complicated to disinfect without specialized equipment and staff, and it is not an easy procedure to do accurately and safely with minimal pain to the patient.  So most patients who could benefit from a flexible sigmoidoscopy are referred to a specialist and then encounter as they would for a colonoscopy.  Moreover, the specialist will often just do a colonoscopy anyway since it is often simpler to schedule.  At the Pezim Clinic, we have the equipment and staff to offer flexible sigmoidoscopy and we do about 500 each year.  Patients will typically not wait any longer than three weeks for the procedure.

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