Rigid Sigmoidoscopic Examination, an Investigation Down but Not Out: A 5-Year Single-Center Experience on 9418 Patients

Abstract

ABSTRACT Background: Rigid sigmoidoscopy (RS) in the present era of flexible sigmoidoscopies is falling out of favor although it continues to be used in some centers as an outpatient (OP) department procedure. Aims: This study aims to determine the utility of RS for diagnosis of rectosigmoidal pathologies in the OP setting with emphasis on neoplastic lesions. Methods: We retrospectively studied the RS records and histopathology reports (HPRs) of 5 years (July 2013–June 2018) done in the Department of Gastroenterology at Medical College Calicut. Results: During the study period, 9418 RS examinations were done, and a total of 6921 abnormalities were picked up, giving a diagnostic yield of 73.5%. Most common indication was bleeding per rectum (PR) (51%), followed by constipation (29%). The most common lesion found was hemorrhoids 39.8% followed by proctitis 13.7%, neoplasms 9.7%, and others 10.3% while 26.5% studies were normal. HPRs showed 7.7% to be malignant, 5.8% were adenoma, 12.2% were inflammatory bowel disease ulcerative colitis (IBD UC), 2.2% were solitary rectal ulcer syndrome, 1.2% nonspecific colitis, 1.7% nonneoplastic polyps, 2.7% were normal, and 1.4% were inconclusive. Of the 4812 patients with complaints of bleeding PR, 4739 (98.5%) had a diagnosis after RS, of which hemorrhoids (72.7%) was the most common cause followed by proctitis (14.2%), neoplasm (9%), and others (4.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of RS in detecting neoplasia was 98.2%, 96.8%, 66.1%, and 99.9%, respectively, when HPR was gold standard. RS was found to be effective for assessing activity in IBD UC. Conclusion: RS is a simple, cheap, and effective tool for diagnosing various rectosigmoid pathologies. RS can be used as an effective screening test for rectosigmoid pathologies, especially neoplasia and IBD UC.