{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T05:10:25Z","timestamp":1696309825755},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,11,5]],"date-time":"2013-11-05T00:00:00Z","timestamp":1383609600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Colorectal cancer screening using the faecal occult blood test (<jats:styled-content style=\"fixed-case\">FOB<\/jats:styled-content>t) detects a disproportionate number of left\u2010sided tumours. This study aims to examine the theoretical impact on neoplasia detection rates of a sigmoidoscopy\u2010first protocol in <jats:styled-content style=\"fixed-case\">FOB<\/jats:styled-content>t\u2010positive patients undergoing colonoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>From retrieved endoscopy\/pathology reports, pathology up to and including the splenic flexure was assumed detectable by sigmoidoscopy. High\u2010risk polyps prompting subsequent colonoscopy were classed as three or more polyps, one polyp of \u2265\u00a01\u00a0cm, villous or tubulovillous components or the presence of high\u2010grade dysplasia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril 2009 and <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril 2011, 4631 patients underwent colonoscopy as a result of a positive <jats:styled-content style=\"fixed-case\">FOB<\/jats:styled-content>t in <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>reater <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>lasgow and <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>lyde. Cancer was detected in 398 (9%) and adenomas were detected in 1985 (47%) of which 1323 (67%) were deemed significant according to <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>ritish <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ociety of <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>astroenterology guidelines. Applying the flexible sigmoidoscopy\u2010first model, cancer would have been detected in 329 (8%) patients and adenomas in 1640 (39%), of which 1140 (70%) would have been significant. In total, 1546 (37%) patients would have required subsequent colonoscopy, following which 21 patients would have a new diagnosis of cancer. The positive predictive values (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>s) for neoplasia (47 <jats:italic>vs<\/jats:italic> 57%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), significant neoplasia (35 <jats:italic>vs<\/jats:italic> 41%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and cancer (8 <jats:italic>vs<\/jats:italic> 9%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007) were all lower in the sigmoidoscopy\u2010first model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A significant reduction in the detection of both adenomas and cancers would be seen if the sigmoidoscopy\u2010first protocol were to be used following a positive <jats:styled-content style=\"fixed-case\">FOB<\/jats:styled-content>t. Furthermore, a significant proportion of patients would be subjected to two procedures, with considerable implications for both the patient and cost.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.12377","type":"journal-article","created":{"date-parts":[[2013,8,8]],"date-time":"2013-08-08T13:11:05Z","timestamp":1375967465000},"page":"1375-1381","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Flexible sigmoidoscopy following a positive faecal occult blood test within a bowel screening programme may reduce the detection of neoplasia"],"prefix":"10.1111","volume":"15","author":[{"given":"D.","family":"Mansouri","sequence":"first","affiliation":[{"name":"Academic Department of Surgery School of Medicine Royal Infirmary University of Glasgow Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. 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