Eighty percent of the lesions found by the 60-cm flexible sigmoidoscope were beyond the reach of the rigid sigmoidoscope.
None of these lesions would have been found if, because of a negative fecal occult blood test, the patient had not been examined using a 60-cm flexible sigmoidoscope. All of these findings were beyond the reach of the 30-cm flexible sigmoidoscope.
Rodney, Hocutt, and Johnson and their co-workers[8,30-33] have provided convincing evidence to document the value of aggressive colorectal screening by properly trained family physicians using the 60-cm and 65-cm flexible sigmoidoscopes. Their earlier research supports the findings of this study; namely, that the 60-cm flexible sigmoidoscope is more effective in detecting lesions than either the shorter rigid or the shorter flexible sigmoidoscope.
It cost the Kaiser HMO an estimated $70 per patient to perform each examination using a 60-cm flexible sigmoidoscope, or $70,000 for the 1000 patients involved in this study.
Five adenomas found by the 60-cm flexible sigmoidoscope in this study were between 2.0 cm and 5.3 cm in size, and four of these had villous morphology.
The investigators believe that there is a role for screening with the 60-cm flexible sigmoidoscope even in clinically asymptomatic individuals who are over 45 years of age and have negative fecal occult blood tests.