Sigmoidoskopi
Özet
Sigmoidoskopi, kalın bağırsağın son 60 santimetrelik bölümünü inceleyen, genellikle sedasyon gerektirmeyen ve kolonoskopiye göre daha kolay hazırlık süreci sunan etkili bir tanı yöntemidir. En yaygın kullanım alanı kolorektal kanser taraması olan bu prosedür, esnek bir cihaz yardımıyla rektum ve sigmoid kolonun görselleştirilmesini, biyopsi alınmasını ve bazı tedavi edici işlemlerin uygulanmasını sağlar. Tarihsel süreçte rijit cihazlardan teknolojik videoendoskoplara evrilen bu yöntem, 40 yaş altı rektal kanama, akut kolit şüphesi ve sol kolon hastalıklarının takibi gibi durumlarda kritik bir rol oynar. İşlem öncesi genellikle lavman ile yapılan sınırlı bir temizlik yeterli olurken, işlem sırasında perforasyon ve kanama gibi riskler oldukça düşüktür. Kolon perforasyonu, akut divertikülit ve toksik megakolon gibi durumlar işlemin mutlak kontrendikasyonları arasında yer alır. Her ne kadar sağ kolon lezyonlarını saptayamama gibi bir dezavantajı olsa da, sigmoidoskopi uygun aralıklarla uygulandığında kalın bağırsak kanserine bağlı ölümleri %60-80 oranında azaltan, düşük maliyetli ve güvenli bir stratejik araçtır.
Sigmoidoscopy is an effective diagnostic method that examines the last 60 centimeters of the large intestine, typically requiring no sedation and offering an easier preparation process than colonoscopy. Its most common indication is colorectal cancer screening, utilizing a flexible device to visualize the rectum and sigmoid colon, perform biopsies, and apply certain therapeutic procedures. Having evolved from rigid tools to technological video endoscopes, this method plays a critical role in cases such as rectal bleeding in patients under 40, suspected acute colitis, and follow-up of left-sided colon diseases. Pre-procedure preparation usually involves simple enemas, and the risks of complications like perforation or bleeding remain very low. Absolute contraindications include colonic perforation, acute diverticulitis, and toxic megacolon. Although it cannot detect proximal colon lesions, sigmoidoscopy is a cost-effective and safe strategic tool that, when performed at regular intervals, has been shown to reduce mortality from colorectal cancer by 60-80%.
Referanslar
Rao VS, Ahmad N, Al-Mukhtar A, et al. Comparison of rigid vs flexible sigmoidoscopy in detection of significant anorectal lesions. Colorectal Dis. 2005:7 (1):61-4.
Haycock A, Cohen C, Saunders B, et al. (2014) Cotton and Williams' Practical Gastrointestinal Endoscopy: The Fundamentals. 7th ed. Chichester, UK: John Wiley & Sons.
Hopkins HH, Kapany NS. A flexible fibrescope, using static scanning. Nature. 1954;173(4392):39–41.
Schroy PC, 3rd, Wilson S, Afdhal N. Feasibility of high-volume screening sigmoidoscopy using a flexible fiberoptic endoscope and a disposable sheath system. Am J Gastroenterol. 1996;91(7):1331–1337.)
Brown AR, DiPalma JA. Bowel preparation for gastrointestinal procedures. Curr Gastroenterol Rep 2004; 6:395.
Ori Y, Rozen-Zvi B, Chagnac A, et al. Fatalities and severe metabolic disorders associated with the use of sodium phosphate enemas: a single center's experience. Arch Intern Med 2012; 172:263.
Lawrance IC, Willert RP, Murray K. Bowel cleansing for colonoscopy: prospective randomized assessment of efficacy and of induced mucosal abnormality with three preparation agents. Endoscopy 2011; 43:412.
A consensus document on bowel preparation before colonoscopy: Prepared by a Task Force From The American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc 2006;63:894–909.
Shaukat A, Kahi CJ, Burke CA, et al. ACG Klinik Kılavuzları: Kolorektal Kanser Taraması 2021. Am J Gastroenterol 2021; 116:458.
US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 315:2564.
Wilt TJ, Harris RP, Qaseem A, High Value Care Task Force of the American College of Physicians. Screening for cancer: advice for high-value care from the American College of Physicians. Ann Intern Med 2015; 162:718.
US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325:1965.
Aasma S, Kahi, CJ, Burke CA. Et al. Clinical Guidelines: Colorectal Cancer Screening 2021, The American Journal of Gastroenterology: March 2021;116:458-479 doi: 10.14309/ajg.0000000000001122
SEER*Stat Database: Incidence - SEER 21 Regs Limited-Field Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2018 Sub (2000-2016) - Linked To County Attributes - Total U.S., 1969-2017 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2019, based on the November 2018 submission. https://seer.cancer.gov/data/ (Accessed on June 05, 2019).
Schoenfeld P, Cash B, Flood A, et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005; 352:2061–2068
Lopes G, Stern MC, Temin S, et al. Early Detection for Colorectal Cancer: ASCO Resource-Stratified Guideline Journal of Global Oncology 2019:5, 1-22
Nikpour S, Ali Asgari A. Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol. 2008 Nov 14;14(42):6536-40. doi: 10.3748/wjg.14.6536. PMID: 19030208; PMCID: PMC2773342
Pasha SF, Shergill A, et al. ASGE Standards of Practice Committee, The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 2014; 79:875.
Gonvers JJ, De Bosset V, Froehlich F, et al. Appropriateness of colonoscopy: hematochezia. Endoscopy 1999; 31:631.
Tehseen I, DuPont H. Approach to the patient with infectious colitis: clinical features, study and treatment, Current Opinion in Gastroenterology: January 2021;37:66-75 doi: 10.1097 / MOG.0000000000000693
B. Shen, Khan K, Ikenberry SO, et al. “The role of endoscopy in the management of patients with diarrhea, Gastrointest. Endosc., 2009;71: 887–892 doi: https://doi.org/10.1016/j.gie..11.025.
Farraye FA, Odze RD, Eaden J, et al; AGA Institute Medical Position Panel on Diagnosis and Management of Colorectal Neoplasia in Inflammatory Bowel Disease. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology 2010;138:738-45.
Greenstein AJ, Sachar DB, Smith H, et al. Cancer in universal and left-sided ulcerative colitis: factors determining risk. Gastroenterology 1979; 77:290.
Priyanka K, Grimmett J, Champine M et al. Hereditary colorectal polyposis and cancer syndromes: a primer on diagnosis and management. American College of Gastroenterology| ACG 112.10 2017: 1509-1525.
Rodriguez-Bigas MA, Vasen HF, O'Malley L, et al. Health, life, and disability insurance and hereditary nonpolyposis colorectal cancer. Am J Hum Genet. 1998 Mar. 62(3):736-7.
Hanson B, MacDonald R, Shaukat A. Endoscopic and medical therapy for chronic radiation proctopathy: a systematic review. Dis Colon Rectum 2012; 55:1081.
Vasant DH, Paine PA, Black CJ, et al British Society of Gastroenterology guidelines on the management of irritable bowel syndrome Gut 2021;70:1214-1240.
Peery AF, Shaukat A, Strate LL. AGA Clinical Practice Update on Medical Management of Colonic Diverticulitis: Expert Review. Gastroenterology. 2021 Feb;160(3):906-911.e1. doi: 10.1053/j.gastro.2020.09.059. Epub 2020 Dec 3. PMID: 33279517; PMCID: PMC7878331.
Bhagatwala J, Singhal A, Aldrugh S, et al (December 2nd 2015). Colonoscopy — Indications and Contraindications, Screening for Colorectal Cancer with Colonoscopy, Rajunor Ettarh, IntechOpen, DOI: 10.5772/61097.
Qureshi WA, Rajan E, Adler DG, et al. American Society for Gastrointestinal Endoscopy. ASGE Guideline: Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc 2005;6:357–62
Frühmorgen P, Demling L. Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry. Endoscopy 1979; 11:146.
Complications of screening flexible sigmoidoscopy. Levin TR, Conell C, Shapiro JA, Chazan SG, Nadel MR, Selby JV Gastroenterology. 2002 Dec; 123(6):1786-92.
Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020
Ladas SD, Karamanolis G, Ben-Soussan E. Colonic gas explosion during therapeutic colonoscopy with electrocautery. World J Gastroenterol 2007;13(40):5295-8.
