Sigmoidoscopy aids bowel cancer triage
MedWire News: GPs should use flexible sigmoidoscopy (FS) to assess patients with symptoms suggestive of bowel cancer, UK researchers believe.
Noting that change in bowel habit and rectal bleeding are not symptomatic of right-sided colon cancer, and that left colon screening is adequate, Sarit Badiani (Good Hope Hospital, Sutton Coldfield) and co-workers investigated the value of FS as a triage tool.
They examined data for 206 patients who underwent right-sided hemicolectomy for colorectal cancer between January 2004 and January 2008. Overall, 78.5% of patients presented with iron-deficiency anemia (IDA), 9.1% presented with a palpable abdominal mass and 12.4% of patients presented with both IDA and an abdominal mass.
Just 9.7% of patients reported rectal bleeding and/or a change in bowel habit without experiencing IDA or abdominal mass. Of these individuals, endoscopy revealed left-sided pathology in 12, while one patient had a family history of bowel cancer.
The researchers say that, following current guidelines, these 13 patients would have been referred for whole-colonic imaging. Thus, proximal cancer would have gone undetected in seven (3.4%) of the patients if sigmoid endoscopy had been the only investigation performed.
"Whether a 'miss rate' of 3% is acceptable is a matter for discussion between the clinician, patient and the provider of healthcare resources," Badiani et al comment. Recommending that patients with a normal FS be followed-up by watchful waiting, they conclude: "If this policy was accepted there would be considerable savings to the NHS and patient morbidity."
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By Lynda Williams