A Comparison of Unsedated Colonoscopy and Flexible Sigmoidoscopy in the Family Medicine Setting: An LA Net Study

Article Figures & Data

Table 1.

Guidelines for Modified Colon Endoscopy

Primary indications:

Screening for colorectal cancer in asymptomatic patients according to ACS guidelines
Rescreening of patients with history of treated colon cancer
- –Known familial colon cancer history
Diagnostic examinations:
- –Evaluation of positive FOBT
- –Evaluation of rectal bleeding
- –Evaluation of change in bowel habits
- –Follow-up of selected patients previously found to have benign lesions

Contraindications:

Reasons to terminate procedure and refer to consultant endoscopist:

Inability to advance endoscope with reasonable effort and within reasonable time
Excessive patient discomfort
Extensive diverticulosis with inability to identify lumen
Discovery of active inflammatory bowel disease or diverticulitis
Discovery of multiple lesions that will require extensive polypectomy
Discovery of obstructing lesion
Discovery of obvious cancer
Visual recognition of incompletely removed dysplastic lesion

Lesions to biopsy using biopsy forceps:

Lesions to NOT biopsy using biopsy forceps:

Lesions to remove with snare:

Lesions to NOT remove with snare:

Table 2.

Sample Characteristics for Modified Colon Endoscopy and Flexible Sigmoidoscopy Groups

* P < .05.
† Mean, 59.6, SD, 12.5; range, 31.2–86.2.
‡ Mean, 51.3, SD, 13.4; range, 25.7–80.0.
All data shown as N (%). MCE, modified colon endoscopy; FS, flexible sigmoidoscopy.

Table 3.

Completion Rate, Site Visualized, Depth Reached, Complications

	MCE (n = 48)	FS (n = 35)
Procedure completed	40 (83.3)	24 (75.0)
Reasons for noncompletion
Bleeding	0 (0.0)	0 (0.0)
Discomfort	4 (8.3)	4 (11.4)
Excessive looping	0 (0.0)	0 (0.0)
Poor preparation	3 (6.3)	0 (0.0)
Obstructing mass	2 (4.2)	0 (0.0)
Not specified	0 (0.0)	7 (63.6)
Reached maximum depth^* (160 cm for ME/60 cm for FS)	9 (18.8)	14 (40.0)
Anatomical site visualized^*
Sigmoid colon	0 (0.0)	1 (2.9)
Descending colon	0 (0.0)	11 (31.4)
Splenic flexure	2 (4.2)	12 (34.3)
Transverse colon	6 (12.5)	9 (25.7)
Hepatic flexure	1 (2.1)	0 (0.0)
Ascending colon	35 (72.9)	0 (0.0)
Cecum	3 (6.3)	0 (0.0)
Maximum depth (cm) for procedure^*^†
0–20	0 (0.0)	1 (2.9)
21–40	0 (0.0)	6 (17.1)
41–60	3 (6.3)	28 (80.0)
61–80	1 (2.1)	0 (0.0)
81–100	3 (6.3)	0 (0.0)
101–120	7 (14.6)	0 (0.0)
121–140	15 (31.3)	0 (0.0)
141–160	19 (39.6)	0 (0.0)
Complications reported (bleeding, infection, perforation, and other)	0 (0.0)	0 (0.0)

* P < .05
† For MCE: mean, 130.1; SE, 30.1. For FS: mean, 50.6; SD, 10.0.
All data presented as N (%). MCE, modified colon endoscopy; FS, flexible sigmoidoscopy.

Table 4.

Descriptive Data About Clinical Findings for Modified Colon Endoscopy and Flexible Sigmoidoscopy

Table 5.

Variations in Outcomes by Clinician