Schroy P C, Wilson S, Afdhal N
Department of Medicine, Boston City Hospital, Massachusetts, USA.
Am J Gastroenterol. 1996 Jul;91(7):1331-7.
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.
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.
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.
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.
乙状结肠镜检查是结直肠癌的一种有效筛查方法，但尚未对死亡率产生重大影响，部分原因是医生的利用率不足。为了解决时间和资源利用效率低下的问题，我们使用带有一次性鞘系统的创新型纤维乙状结肠镜，研究了大容量单日柔性乙状结肠镜（FS）筛查的可行性。
通过邮件邀请所有50岁以上的波士顿市雇员（n = 6137）在波士顿市医院（BCH）接受FS筛查。收到预付费明信片后，项目协调员通过电话联系了受访者（n = 564），并将其中227人连续安排到6个半天（3小时）周末时段中的1个时段的15分钟时间段内。在每个时段前一周内在BCH完成预登记，包括登记、填写简短的风险问卷、记录知情同意书以及肠道准备说明。检查由三名内科内镜医师进行，他们在每个时段的四个内镜检查室之间轮流操作。每个检查室配备一名护士协助患者护理，一名技术人员负责设备设置。
在三个时段中，227名预约患者中有198名（87%）接受了FS筛查。医生每个检查室每小时平均进行3.5次检查，总体每小时平均进行4.7次检查，平均插入深度为51±10厘米，平均检查时间为4.7±3.3分钟。设备设置时间和患者周转时间平均分别为4.6±1.7分钟和11.0±6.0分钟。在29名（14.6%）患者中检测到息肉，在一名（0.5%）患者中检测到Dukes'A期癌症。唯一的并发症是心律失常。粗略估计每次检查的直接成本约为75美元。
使用带有一次性鞘系统的纤维乙状结肠镜进行大容量单日FS检查，通过更有效地利用时间和资源，为提高医生对筛查乙状结肠镜检查的依从性以及可能提高患者的依从性提供了一种有效策略。
