Feasibility of high-volume screening sigmoidoscopy using a flexible fiberoptic endoscope and a disposable sheath system

Am J Gastroenterol. 1996 Jul;91(7):1331-7.


Objectives: Sigmoidoscopy is an effective screening test for colorectal cancer but has yet to have a major impact on mortality because, in part, of inadequate utilization by physicians. To address concerns of inefficient use of time and resources, we examined the feasibility of high volume, single-day flexible sigmoidoscopy (FS) screening sessions using an innovative fiberoptic sigmoidoscope with a disposable sheath system.

Methods: All City of Boston employees over the age of 50 yr (n = 6137) were invited by mail to undergo a screening FS at Boston City Hospital (BCH). Respondents (n = 564) were contacted by phone by the program coordinator on receipt of a prepaid postcard and were scheduled (n = 227) consecutively into 15-min slots on 1 of 6 1/2-day (3-h) weekend sessions. Preregistration was completed at BCH during the week before each session and included enrollment, completion of a brief risk questionnaire, documentation of informed consent, and bowel prep instructions. Procedures were performed by three physician endoscopists rotating among four endoscopy rooms per session. Each room was staffed with a nurse to aid in patient care and a technician to set up equipment.

Results: A total of 198 of the 227 (87%) scheduled patients underwent screening FS during the three sessions. Physicians performed a mean of 3.5 procedures per room per hour, or 4.7 procedures per hour overall, with a mean depth of scope insertion of 51 +/- 10 cm and a mean procedure time of 4.7 +/- 3.3 min. Equipment set-up time and patient turnaround time averaged 4.6 +/- 1.7 min and 11.0 +/- 6.0 min, respectively. Polyps were detected in 29 (14.6%) patients, and a Dukes' A cancer was detected in one (0.5%). The only complication was a cardiac arrhythmia. A crude estimate of direct costs approximated $ 75 per examination.

Conclusion: High volume, single-day FS using the fiberoptic sigmoidoscope with a disposable sheath system offers an effective strategy for enhancing physicians compliance, and possibly patient compliance, with screening sigmoidoscopy through more efficient use of time and resources.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Boston
  • Colonic Polyps / diagnosis
  • Colonic Polyps / economics
  • Colonic Polyps / prevention & control
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / economics
  • Colorectal Neoplasms / prevention & control
  • Costs and Cost Analysis
  • Feasibility Studies
  • Female
  • Fiber Optic Technology / economics
  • Fiber Optic Technology / instrumentation
  • Fiber Optic Technology / methods
  • Fiber Optic Technology / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / economics
  • Mass Screening / instrumentation
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Sigmoidoscopes
  • Sigmoidoscopy / economics
  • Sigmoidoscopy / methods
  • Sigmoidoscopy / statistics & numerical data*