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DISEASE PATTERN IN INDIA
INVESTIGATION OF SIGMOIDOSCOPY AGAINST COLONOSCOPY IN PRIVATE PRACTICE
OP Kapoor
Sigmoidoscopy is a very simple procedure, where the full length of the rectum and distal end of the sigmoid colon are visualised with a modern fibreoptic sigmoidoscope. Often if a patient is not constipated, no preparation is required for the investigation. Most of the pathological lesions including amoebic colitis, ulcerative colitis and malignancy of the colon are within the reach of a sigmoidoscope.
Colonoscopy is a similar procedure, where the whole colon can be visualised. Even an occasional bleeding-polyp, or angiodysplastic lesion or an unusual cancer or tuberculosis, can all be visualised. In fact, most of the colonoscopists can enter the terminal ileum. Thus, with the aid of a biopsy, a diagnosis of ileal Koch's can be made with confidence and Crohn's disease can be excluded. In the past, in such patients a diagnosis based on even the best radiological pictures was often wrong. Though the modern 3D computed tomography is as accurate as a colonoscopy, it does not facilitate a biopsy. In case a patient cannot afford, a double air contrast barium enema pictures can be taken and most of the lesions of the colon will not be missed.
Compared to sigmoidoscopy, a colonoscopy is definitely more uncomfortable and takes longer time. But most of the patients do not complain about the colonoscopy procedure. What they do complain about and what the family physician should know are the side effects of ‘Exelyte’ solution! This solution is administered to cleanse the colon before inserting the colonoscope. Loss of huge amount of water in stools along with electrolytes and other side effects of the solution often leave the patient exhausted and very uncomfortable. In an editorial on colonoscopy, the editor of the New England Journal of Medicine praised the value of the procedure in prevention of colon cancer, after the age of 50 years, if it is carried out every few years. He further mentioned, that he had turned fifty and had a colonoscopy done. He wrote that he had enjoyed the procedure, which was not very uncomfortable. But, what he did not enjoy were the side effects of ‘Exelyte’ solution. In fact, lately, three deaths have been reported in British Medical Journal caused by the water and
electrolyte imbalance.
It should be noted that a colonoscopy procedure is more than three times costlier than sigmoidoscopy. Besides this, there is an added cost of Rs. 150/- to Rs. 200/- for the Exelyte solution, not forgetting the side effects of the procedure as mentioned above!
Thus, the family physician should always ask for a sigmoidoscopy. However, if that does not give a clear answer, a colonoscopy should be asked for, especially if a double air contrast barium enema study, or 3D computed tomography of the colon have been already carried out.
Finally, just because the patient can afford the cost, or the gastroenterologist can do the procedure quickly with ease, a colonoscopy should not be asked for, instead of sigmoidoscopy. However, in case of hospitalised patients, the indications and medical supervision, along with the availability of intensive care units makes a difference in the choice of procedure. The three fatal cases reported in the British Medical Journal, were investigated in a big hospital and concluded that the patients died inspite of intensive therapy!
