Flexible fiberoptic sigmoidoscopy in the practice of a surgeon

Abstract

The extent to which surgeons participate in surveillance programs depends on their clinical interests, referral patterns, and the needs of the community. The design of surveillance programs, including designation of normal and high risk individuals, and the type and frequency of screening examinations has been studied. The patient's history guides the surgeon in deciding whether and how to implement a surveillance program for a given patient. Sixty-centimeter FFS is clearly superior to 25-cm rigid sigmoidoscopy in screening for rectosigmoid and sigmoid neoplasia. 1-4. 6 The average viewing distance of the rigid sigmoidoscope is less than 20 cm/ whereas in FFS it consistently reaches 40 to 50 cm. The reported diagnostic yield of asymptomatic polyps and cancers is 1.7 to 3 times as great. 4 FFS in sigmoid diverticular disease is very accurate in confirming or ruling out questionable sigmoid lesions noted on barium enema. Some of the logistic and practical deficiencies of FFS include the increased initial expense and maintenance costs, the longer examination and cleaning time, the greater degree of endoscopic skill necessary to use it effectively, and the inadequate cost-effectiveness in small practice settings. Two compelling arguments for FFS screening not often acknowledged are the more dignified examination position, left lateral decubitus rather than knee-chest or jack-knife, and the greater degree of comfort. The value of FFS for neoplasia surveillance is limited. FFS is not a substitute for complete visualization of the colon by colonoscopy or barium contrast enema. The depth of insertion of the FFS is a function of several variables, including endoscopic skill, instrument design, bowel preparation, and the patient's anatomy and cooperation. At what depth another 5cm tube insertion will yield an important increase in percent of lesions detected, or obviate the need for total colonoscopy or barium enema has not been determined. The point of diminishing returns in cancer screening with FFS has yet to be determined. At that point, patient enthusiam or compliance with follow-up examinations may fall off, and the long term effectiveness of a surveillance program is threatened.