Sigmoid-descending Colon Junction Research Articles

Investigation of the relationship between colonoscopy insertion difficulty factors and endoscope shape using an endoscopic position detection unit.

In this study, we investigated the relationship between the cecal intubation time (CIT) and the form and method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure using an endoscopic position detection unit (UPD), with reference to various factors [age, sex, body mass index (BMI), history of abdominal and pelvic surgery, and diverticulum]. A total of 152 patients underwent colonoscopy with UPD. The mean age was 66.9 ± 12.4 years, and the male to female ratio was 3.6:1. The average CIT time was 14.3 ± 8.2 min. Age, number of experienced endoscopies, history of abdominal and pelvic surgery, BMI, and diverticulum were associated with prolonged CIT; SDJ passage pattern was straight: 8.6 ± 5.0, alpha loop: 11.8 ± 5.6, puzzle ring-like loop: 20.2 ± 5.0, reverse alpha loop: 22.4 ± 9.7, and other loop: 24.7 ± 10.5. The hepatic flexure passing method was in the following order: right rotation maneuver: 12.6 ± 6.6, push maneuver: 15.1 ± 5.9, and right rotation with positional change maneuver: 20.5 ± 7.2. In conclusion, colonoscopy with UPD revealed an association between CIT and SDJ passage pattern and hepatic flexure passing method.

Primary Epiploic Appendagitis: Not Rare But Rarely Diagnosed Pathology.

The aim of this study is to determine the clinical and laboratory parameters which may be suggestive of or even pathognomonic for primary epiploic appendagitis (PEA) and to discuss the diagnostic efficacy of ultrasound (US) compared to computed tomography (CT) in patients with PEA. For this retrospective study, 92 patients diagnosed with PEA using US, CT or both modalities were included. All patient symptoms, clinical findings and laboratory parameters were reviewed. The CT and US images of the PEA were evaluated for lesion size and location, the relationship of the lesion to the colon and the distance of the lesion to the skin. There were 16 female and 76 male patients in the study group. The mean age was 35 years (range: 38-79 years). Well-localized abdominal pain was the primary symptom in all patients. The mean leukocyte count was 7857±1326 mm-3. The most frequent localization of PEA was sigmoiddescending colon junction (79/92). In patients who were examined by both US and CT, the size of the fatty central core was between 15-48 mm (mean:28.10 mm) and 9-22 mm (mean:15.07 mm) in its long-axis and short-axis diameter, respectively on US, whilst that by CT was between 15-46 mm (mean:26.88 mm) and 9-21 mm (mean:14.40 mm) in its long-axis and short-axis diameter, respectively. In patients who were examined by both US and CT, the mean distance of the lesions to the skin was 20.80 mm and 33.97 mm, respectively. All patients were treated conservatively with complete resolution of symptoms within a week of presentation. PEA is an unrare self-limiting condition that should be considered in the differential diagnosis of acute abdomen. To support clinicians and radiologists regarding PEA and its clinical, laboratory and radiological findings, targeted sonographic examination - which is radiation and contrast agent-free - could be highly sufficient for the diagnosis of PEA and may prevent unnecessary further imaging and mistreatment.

Investigation of the New Advantages of Colonoscope Insertion with an Endoscopic Position Detection Unit.

The use of an endoscopic position detection unit (UPD) enables better and more objective understanding of the shape and position of the colonoscope. Here, we investigated the reproducibility of the insertion of a colonoscope with UPD. Study participants were 122 patients who received a colonoscopy with UPD twice for the purpose of large bowel screening and surveillance. The mean age of participants was 69.7 ± 10.4 years, and the male-to-female ratio was 9.2:1. The colonoscope insertion technique was primarily based on the shaft-holding, shortening insertion method. The cecal intubation time was recorded; the method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure. The mean cecal intubation time was 990 ± 511 s. The cecal intubation time and the patterns for passing through the SDJ and hepatic flexure were significantly correlated between the first and second colonoscopies. Use of a UPD revealed good reproducibility of colonoscope insertion. This is the first time we have proved that both time and pattern are inserted in much the same way for the first and second times. In patients' conducted UPD combination TCS after the second time, it was suggested that individual tailor-made insertions are possible based on the information from the first time.

A case of arteriovenous malformation in the inferior mesenteric artery region resected surgically under intraoperative indocyanine green fluorescence imaging.

Introduction and importanceAn arteriovenous malformation (AVM) is defined as a vascular malformation with a short, non-capillary communication between the arteries and veins. Most gastrointestinal AVMs are solitary, occurring predominantly in the stomach, small intestine and right colon, and rarely in the inferior mesenteric artery (IMA) region.Case presentationA 70-year-old man was first diagnosed with ischemic enteritis two years earlier, and was hospitalized several times with the same diagnosis. He visited our hospital because of left lower abdominal pain and melena. Colonoscopy showed findings suggestive of ischemic enteritis, and contrast-enhanced computed tomography (CT) and IMA angiography showed hyperplasia and dilation of blood vessels from the sigmoid-descending colon junction to the upper rectum. We performed conventional laparoscopic low anterior resection using intraoperative intravenous injection of indocyanine green (ICG). The final diagnosis was arteriovenous malformation in the IMA region. The patient had an uneventful postoperative course and was discharged on the 13th day after the operation.Clinical discussionCases of AVM in the IMA region are relatively rare. This is the first reported case of AVM in the IMA region that was resected under intraoperative ICG fluorescence imaging (FI), which provided useful information on the extent of intestinal resection and mesenteric dissection required, and confirmed the adequacy of intestinal blood flow during and after mesenteric dissection and anastomosis.ConclusionIt is advisable to use ICG FI intraoperatively during resection of AVMs in the IMA region, as with colorectal cancer surgery.

Influencia del sexo, la edad y el índice de masa corporal en la anatomía del colon sano. Variaciones anatómicas del colon sano.

Objective: This study analyzes the influence of sex, age and body mass index on the anatomy of the colon as determined by three-dimensional reconstructions from computed tomography scans. Methods: 130 patients were included, each of whom underwent a three-dimensional reconstruction of the colon from abdominal CT scans without obvious signs of pathology. Information corresponding to sex, age and body mass index was obtained from each patient, and morphometric data obtained from measurements taken at the pubic symphysis, superior and inferior mesenteric artery, hepatic angle, splenic angle, ileocecal junction and sigmoid-descending colon junction were considered. Results: Morphological analysis showed an important anatomical variability of the reconstructed colon. Statistical analysis showed significant differences in the measurements obtained when grouping subjects by sex, age (under 65 years vs over 65 years) and body mass index (normopese, overweight and obese). Conclusions: Colon anatomical variations can be studied with three-dimensional reconstructions from CT scans, indicating that sex, age and body mass index have a significant influence on such variability.

Persistent Descending Mesocolon as An Intraoperative Risk Factor in Laparoscopic Surgery for Left-Sided Colon and Rectal Cancer.

Persistent descending mesocolon (PDM) represents a failure of fusion of the descending mesentery, leading to anatomical abnormalities. This study aimed to examine the effects of anatomical features of PDM on laparoscopic surgical outcomes. Patient backgrounds, surgical outcomes, anatomical characteristics, and operative findings were retrospectively compared between 186 patients classified into PDM and non-PDM groups who underwent primary resection for left-sided colon and rectal cancer at our hospital from January 2019 to December 2020. PDM was diagnosed in nine patients (4.8%). The operative time (337 ± 165 vs 239 ± 107 min, p=0.010) was significantly different between PDM and non-PDM groups, but bleeding loss was not different (108 ± 97 ml vs 53 ± 142 ml, p=0.259). In PDM patients, in addition to abnormal fixation of the sigmoid-descending colon junction, adhesion of the mesentery of the colon and small intestine in 100%, and adhesion between the mesocolon in 33% patients was confirmed intraoperatively. Ileus was more common in the PDM group (two cases, 22%) and in the non-PDM group (10 cases, 5.6%), but there was no significant difference in overall postoperative complications between the two groups (p=0.215). The duration of postoperative hospital stay (28 ± 20 vs 16 ± 11 days, p=0.002) was significant between the two groups. The left colonic artery (LCA) could not be preserved in six patients in the PDM group, one of whom had anastomotic leakage and two of whom required additional resections due to intraoperative intestinal blood flow failure. PDM prolonged operative times and duration of postoperative stay in laparoscopic surgery for left-sided colon and rectal cancer. Division of the LCA in PDM patients should be considered an intraoperative risk factor for injury to the marginal artery.

Dynamic patient position changes during colonoscope withdrawal increase adenoma detection: a randomized, crossover trial

Colonoscopy has a miss rate for adenomas that may partly relate to poor visualization of the colonic surface. Dynamic position changes during colonoscope withdrawal can improve luminal distension. To assess whether position changes also improve adenoma and polyp detection. Randomized crossover clinical trial. Academic endoscopy unit. This study involved 130 patients who presented for routine colonoscopy. Examination either entirely in the left lateral position followed by position changes (cecum to hepatic flexure, left lateral; transverse colon, supine; splenic flexure and descending colon, right lateral) or vice versa. After both examinations, polyps were removed for histopathology. Proportion of patients with ≥1 polyp or adenoma detected between the hepatic flexure and the sigmoid-descending colon junction. Luminal distension was measured on a scale of 1 to 5: 1, total collapse; 5, fully distended. At least 1 adenoma was detected in 34% of patients in colon areas in which the patient position differed from left lateral (transverse colon, splenic flexure, descending colon) compared with 23% examined with the patient in the left lateral position alone (P = .01). At least 1 polyp was detected in 52% of patients with position changes versus 34% of patients examined in the left lateral position alone (P < .001). Adenoma and polyp detection were positively correlated with an improved distension score (correlation coefficient, 0.12; P < .001). Adenomas were detected in 16% of colon areas with adequate distension scores (4 and 5) compared with 7% of those with borderline or nondiagnostic scores (1-3; P < .001). Single-operator study. Dynamic position changes during colonoscope withdrawal significantly improved polyp and adenoma detection. ( NCT00234650).

Management of Sigmoid Volvulus Based on Ladd's Procedure: A Case Report

Sigmoid volvulus is a rare but potentially life-threatening condition in childhood. Colectomy is usually required to prevent recurrent volvulus, which carries a high risk of morbidity and mortality. Here, we report a non-resection method based on the concept of Ladd's procedure to treat a sigmoid volvulus in a 15-year-old boy. After reduction of the volvulus, the distance between the sigmoid-rectal junction and the sigmoid-descending colon junction was widened by dissecting the meso-sigmoid colon along the course of the long axis. No colon resection was performed. The total operation time was less than an hour. The post-operative recovery was uneventful. There was no recurrent volvulus during a follow-up of 1 year. Widening the base of the mesosigmoid according to the concept of Ladd's procedure may be considered as a more simple and safe alternative treatment to prevent recurrent sigmoid volvulus in children.

Comparing Attendance and Detection Rate of Colonoscopy With Sigmoidoscopy and FIT for Colorectal Cancer Screening

We conducted a study to estimate population coverage and detection rate (DR) achievable through different strategies of colorectal cancer (CRC) screening. A population-based multicenter randomized trial comparing 3 strategies was used: (1) biennial immunologic fecal occult blood test (FIT), (2) "once only" sigmoidoscopy (FS), and (3) "once only" colonoscopy (TC). A random sample of men and women, aged 55 to 64 years, was drawn from general practitioners' (GP) rosters. Eligible subjects, randomized within GP, were mailed a personal invitation. Nonresponders in groups 2 and 3 were invited again at 12 and 24 months. Screenees with "high-risk" distal polyps (villous component >20%, high-grade dysplasia, CRC, size >or=10 mm, >2 adenomas) at FS, or with positive FIT, were referred for TC. The attendance rate was 32.3% (1965/6075) for FIT, 32.3% (1944/6018) for FS, 26.5% (1597/6021) for TC. FIT detected 2 patients with CRC (0.1%) and 21 with an advanced adenoma (1.1%). The corresponding figures were as follows: 12 (0.6%) and 86 (4.5%) patients, respectively, for FS; 13 (0.8%) and 100 (6.3%) patients, respectively, for TC. To detect 1 advanced neoplasm, it would be necessary to invite 264 people with FIT, 60 with FS, 53 with TC. FS would have detected 27.3% of the proximal advanced neoplasms detected at TC. Assuming the same participation rate at TC as at FS, 48 TCs would be necessary to detect 1 additional advanced neoplasm missed by FS. When participants are offered 1 screening test, participation is lower in a TC than in an FS program. However, DR of advanced neoplasia is higher with TC.

The Utility of Flexible Sigmoidoscopy after CT Colonography Revealing Only Rectosigmoid Findings

Purpose: The VA Cooperative 380 and the CONCeRN Trial both demonstrated the superior yield of colonoscopy to sigmoidoscopy in average risk individuals undergoing colorectal cancer (CRC) screening. Current consortium guidelines indicate that colonoscopy is the preferred CRC screening test. However, resources are inadequate to provide population colonoscopy screening and alternative methods are needed. Computed tomographic colonography (CTC) is another total colonic examination that has been shown to be as accurate as colonoscopy for the detection of colonic neoplasia 6 mm or larger at our institution. The aim of this study was to determine the prevalence of advanced colonic neoplasia in patients in whom CTC revealed only recto-sigmoid (RS) polyps and to determine the diagnostic yield of only polypectomy via flexible sigmoidoscopy (FS) examination in such patients. Methods: All subjects were participants in a trial in which they underwent both CTC and colonoscopy with segmental unblinding. Patients with only RS findings by CTC were retrospectively identified. Findings at FS were estimated by including only lesions that were identified and removed distal to the descending sigmoid junction during colonoscopy. This anatomic delineation was chosen because several studies have shown that the average endoscopist in a primary care setting is able to reliably examine the colon to the sigmoid-descending colon junction with FS. Pathologic evaluations of any lesions proximal to this point were reviewed. Polyps were classified according to the following criteria: Adenocarcinoma, tubulovillous adenoma, tubular adenoma > 1 cm, and > = 3 tubular adenomas were considered advanced findings. All other lesions were deemed non-advanced. Results: 203 patients had only RS polyps identified on CTC. 64 (32%) of these patients were found to have right sided lesions during colonoscopy. Three (1.5%) of these lesions were advanced neoplastic lesions. Conclusions: Miss rates for advanced lesions with FS after CTC showing only RS lesions are comparable to miss rates for colonoscopy. FS may be used to follow-up CTC which only reveal RS findings with little risk of missing proximal advanced colonic neoplasia. Employing this strategy would decrease the cost and risk of follow-up examinations after CTC. Further study to determine the cost effectiveness of this approach is warranted.

A Novel Device: The Colon-Air-Discharge-Tube, Is Easier, Safer and Lesser Discomfort to the Patients During Total Colonoscopy

Background & Aims: Colonoscopy is a widely utilized diagnostic procedure for colon diseases. However, it is frequently a painful for the patients. One of the reasons is excessive air in the colon, which causes elongation of it. We examined whether a novel air-discharge-tube decreased the colonoscopy time and the pain. Methods: This consists of a 30-cm vinyl tube (4 mm diameter) and have four segments (A: a 5-cm intake segment into the rectum with holes, B: a 1.5-cm plastic ball that gets hooked by the anal sphincter, C: a 6-cm built in spring to avoid collapse of the tube because of the pressure between the sphincter and the fiber scope in the anal canal, D: a discharge segment about 20 cm in length extending out of the anal, with holes; excessive air and fluid are continuously discharged via this tube. Between August 2004 and November 2004, 33 male (age, 54.1 ± 13.5 y) and 14 female (age, 55.5 ± 12.1 y) underwent colonoscopy at our hospital with informed consents. None of the patients had any history of abdominal surgery. The patients were randomly divided into two groups, one in which the tube was used (Group A), and the other in which it was not (Group B). And the time to the Sigmoid-Descending Colon Junction (SDJ) and the time to the cecum were measured with the insert length of fiber. The pain was scored on a visual analog scale (VAS) for the patients who had history of colonoscopy before this study. Results: The overall success rate of scope insertion up to the cecum was 100% (47/47 cases). The Group A consisted 23 patients (17M/6F, age 51.5 ± 14.8 y) and the Group B consisted 24 patients (16M/8F, age 57.4 ± 10.5 y, P = 0.12). The time to the SDJ was significantly decreased in Group A (142.0 ± 44.0″) as compared to that in Group B (199.6 ± 77.1″, P = 0.0031), and the length to the SDJ was shorter in Group A (52.6 ± 17.1 cm) than in Group B (66.3 ± 15.0 cm, P = 0.0056). The time to the cecum was also significantly decreased in Group A (323.0 ± 109.8″) as compared to that in Group B (522.3 ± 166.1″, P = 0.000016). However, the length to the cecum was not significantly different between the two groups (Group A: 79.1 ± 7.3 cm vs. Group B: 80.4 ± 7.5 cm, P = 0.56). The VAS of the pain was significantly lower in Group A (6.8 ± 3.0; 13M/3F) than in Group B (9.2 ± 1.7; 11M/2F, P = 0.015). Conclusion: The colon-air-discharge tube decreased the time to the cecum and the pain associated with colonoscopy.

What does sigmoidoscopy really miss?: Lewis JD, Kimmie NG, Hung KE, et al., Detection of proximal adenomatous polyps with screening sigmoidoscopy—a systematic review and meta-analysis of screening colonoscopy, Arch Intern Med 2003;163:413–20

The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. Lewis et al. performed a systematic review and meta-analysis of screening colonoscopy studies. Published studies through July 31, 2000 of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. The authors generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. With the sigmoid–descending colon junction used to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [Cl] = 1.42–4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio = 2.36; 95% CI = 1.30–4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio = 1.44; 95% CI = 0.79–6.62). The prevalence of isolated advanced proximal neoplasia in the three studies was 2%, 3%, and 5%, respectively. When the sigmoid–descending colon junction is used to identify the beginning of the distal colon, this yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI = 13.6%–19.1%). Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increasing prevalence of synchronous proximal neoplasia. From 2% to 5% of patients undergoing screening colonoscopy might have isolated advanced proximal neoplasia.

Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy.

The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies. Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%). Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.

6971 Association of duration of the test with yield and miss rate of polyps at screening sigmoidoscopy.

AIMS To study the association of the duration of the test with the polyps yield and the miss rate for polyps of sigmoidoscopy (FS) among patients undergoing FS screening for coloretal cancer (CRC). METHODS We compared the polyps yield of FS and colonoscopy (TC) among subjects referred for TC in Turin in the context of the SCORE trial of FS screening for CRC, conducted as parallel study to the UK trial (coordinator:W Atkin). Endoscopists were instructed to excise all small (=5 mm) polyps detected at FS and to record the duration of the test, as well as shape, size and location of all polyps detected. Patients detected with polyps >5 mm, CRC, high-risk polyps=5 mm (villous component, severe dysplasia), >2 adenomas were referred for TC.TCs were performed within 1 month from FS in the same Endoscopy Unit. Only subjects with complete FS (instrument passed beyond the sigmoid-descending colon junction, under adequate bowel preparation) were included in this analysis.Patients with distal CRC were excluded. RESULTS Out of 3540 FSs performed in Turin, 2888 (81.6%) were completed. Complete information for the analysis is available for 2225 tests (duration of the procedure was not recorded in 557 and polyp size in 6 cases). FS was completed within 5 minutes in 64.6% of the cases, between 6 and 10 minutes in 29.6% and it required >10 minutes in 5.7% of the patients. Polyps yield was 11%, 27.3%, and 45.9% (p-trend-: 10 minutes respectively. The observed increase in the detection rate was associated with an increase in the proportion of polyps=5 mm: 56.7%, 68.1% and 88.5% for tests completed within 5, 10 and >10 minutes respectively (p-trend- : 10 minutes respectively. CONCLUSIONS Only a small proportion of the screening FS lasted more than 10 minutes.A positive association was observed between polyps yield and duration of the test, mainly attributable to a trend toward a higher detection rate for small polyps. The time devoted to the excision of small polyps might explain the longer duration of the tests in these cases. Accuracy of the screening FS was apparently not reduced if the test was completed within 5 minutes.

Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects

The significance of distal colonic hyperplastic polyps was investigated in 482 asymptomatic average-risk subjects, aged 50–75 years, in whom fecal occult blood test results were negative and who underwent screening colonoscopy. The incidence of adenomas in the colon proximal to the sigmoid-descending colon junction in subjects with hyperplastic polyps distal to that point was 18% and was similar to the incidence of proximal colonic adenomas in subjects with no distal colonic polyps (15%). The incidence of proximal colonic adenomas in subjects with distal colonic adenomas was 38% and was significantly greater than the incidence found in individuals with no distal colonic polyps or only hyperplastic polyps. Our data do not support distal colonic hyperplastic polyps as markers for proximal colonic adenomas in asymptomatic average-risk subjects.

Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests

Colonoscopy was performed on 210 asymptomatic average-risk persons, aged 50–75 years, who had negative fecal occult blood test results. Colonoscopy was complete to the cecum in 209 subjects. Fifty-three subjects (25%) had adenomas and two had cancer. All of the adenomas ≥1 cm in size and both cancers occurred in subjects aged ≥60 years. Fifty-one percent of subjects with adenomas and one with cancer had no neoplasms distal to the sigmoid-descending colon junction. One subject had a major postpolypectomy hemorrhage that stopped spontaneously. Screening colonoscopy, therefore, has a high yield for detection of neoplasms in asymptomatic average-risk persons aged ≥60 years with negative fecal occult blood test results. The yield is low in persons aged 50–54 years and intermediate in persons aged 55–59 years.

Diagnostic Value of Fiberoptic Sigmoidoscopy: Evaluation of the Anatomical Extent

The anatomical level reached by the fully inserted flexible sigmoidoscope (60 cm) determines the effective potential of the instrument in the detection of left colon diseases. We performed flexible fiberoptic sigmoidoscopy (FFS) in 50 patients, without the help of fluoroscopy and without trying to reduce the bendings of the sigmoid colon. After having inserted the instrument, the endoscopist would define the section reached: sigma, sigmoid-descending colon junction, descending colon, splenic flexure. Barium sulphate was then injected through the fiberoptic sigmoidoscope in order to verify the level: the exact anatomical localization of the tip of the instrument was therefore determined by means of fluoroscopy. 90% of the investigations visualized the whole sigmoid colon, and in 52% more than 50% of the descending colon was studied; the splenic flexure was reached in only 22% of cases. Worse results, i.e. the visualization of only the sigmoid colon, were achieved in old and overweight patients, who had previously undergone abdominal or pelvic surgery. The paper concludes underlining the great diagnostic potential of FFS in the screening and early diagnosis of left colon diseases. FFS should become the surgeon’s first instrumental investigation even in his own surgery, as the technique is easy to perform, fairly inexpensive and requires simple preparation.

Who Should Do Gastrointestinal Endoscopy?-Reply

In Reply.— The COMMENTARY Who Should Be Doing Gastrointestinal Endoscopy? was intended to address the problem of untrained persons attempting fiberoptic endoscopy on patients when expertise is available. The value of flexible sigmoidoscopy as a screening tool for colon cancer is not disputed. However, this half-a-loaf procedure (flexible fiberoptic sigmoidoscopy) 1,2 may lead to inadequate examinations when the need for total colonoscopy exists. Drs Felmar and Rodney agree that teaching the procedure is appropriate. The basic question concerns who should do flexible sigmoidoscopy. It should not be assumed that proficiency at rigid sigmoidoscopy implies competency to perform flexible sigmoidoscopy. It is not appropriate, therefore, to attempt flexible sigmoidoscopy without first obtaining training and demonstrating competency in the performance of the procedure. The training required to perform short colonoscopy with the 60-cm instrument may be less than that required for total colonoscopy, though the negotiation of the sigmoid-descending colon junction is

Limitations and complications of colonoscopy

Limitations and complications of colonoscopy