The use of a dedicated rectosigmoidoscope for ultrasound staging of tumours of the upper and middle third of the rectum

OBJECTIVE: Tumours of the upper rectum, and many in the middle third, are not accessible to endorectal ultrasound staging because of the difficulty in reaching all sites of the rectum with a rigid probe. The aim of this prospective study was to assess whether using a dedicated rectosigmoidoscope, endorectal ultrasonography (ERUS) can accurately stage any rectal lesion irrespective of its distance from the anal verge. METHOD: A total of 173 consecutive patients with a primary rectal tumour were included. A rotating, high multifrequency (5.0-10 MHz) endoprobe was introduced through a dedicated rectosigmoidoscope and advanced above the lesion. A computer allowed for three-dimensional (3D) reconstruction of 2D images. Treatment was selected on the basis of 3D-ERUS findings. ERUS staging was correlated with pathological staging. RESULTS: The depth of invasion was correctly determined by 3D-ERUS in 78.2% of tumours of the lower rectum, 76.4% of tumours extending between the lower and middle third of the rectum, 80.9% of tumours of the middle third of the rectum, 78.5% of tumours extending between the middle and upper third of the rectum and 78.9% of tumours of the upper rectum. The accuracy for the absence of lymph node metastases was 81.2% for tumours of the lower rectum, 78.5% for tumours extending between the lower and middle third of the rectum, 85.7% for tumours of the middle third of the rectum, 83.3% for tumours extending between the middle and upper third of the rectum and 78.5% for tumours of the upper rectum. Analysis showed that there was no difference between the various tumour sites. CONCLUSION: Our findings indicate that using a dedicated proctosigmoidoscope, tumours of the upper and middle third of the rectum are equally accessible to ultrasonographic evaluation. The distance of the tumour from the anal verge does not influence the accuracy of examinations considered adequate by the operator.     

电子直乙肠镜检查在师职干部体检中的应用价值简

目的 研究电子直乙肠镜检查在军队师职干部体检中的应用价值.方法 选取来我院参加健康体检的1141名师职干部,采用电子直乙肠镜筛查直乙结肠疾病,回顾性分析痔病、肛乳头肥大、直乙结肠息肉和肿瘤的发病率.结果 1141例受检者中,痔病、肛乳头肥大、直肠息肉、乙状结肠息肉、肛管息肉、直肠癌检出率分别为56.36%（643/1141）、17.97%（205/1141）、13.50%（154/1141）、4.91%（56/1141）、0.18%（2/1141）、0.09%（1/1141）.直乙结肠息肉的检出率逐渐上升,息肉检出率与年龄成正相关,年龄越大,检出率越高.结论 随着年龄的增长,直乙结肠息肉检出率逐渐上升;电子直乙肠镜检查应作为军队师职干部外科常规的体检项目.     

The Anatomic Range of Examination by Fibreoptic Rectosigmoidoscopy (60 Centimetres)

Jensen J, Kewenter J, Swedenborg J. The anatomic range of examination by fibreoptic rectosigmoidoscopy (60 centimetres). Scand J Gastroenterol 1992;27:842-844

The purpose of the study was to investigate the anatomic location of the flexible rectosigmoidoscope (60 cm) when introduced as far as technically possible. One hundred and forty-nine consecutive patients referred for double-contrast enema (DCE) were examined with rectosigmoidoscopy before the radiologic examination, and C0₂ was used for insufflation. A plain abdominal film was taken to locate the tip of the instrument when 60 cm or as much as possible of the instrument had been introduced. The sigmoid loop was passed and the tip of the scope located in the ascending colon or at the left flexure in 99 (66%) of the patients, and in a further 27 (18%) the upper part of the sigmoid colon was reached. The sigmoid colon had been passed in 71%, 80%, and 44% when 60, 50, and 40 cm of the instrument was introduced, respectively. DCE could be performed at the same session as the rectosigmoidoscopy, as C0₂ was quickly absorbed. In the vast majority of patients the sigmoid colon can be inspected with a rectosigmoidoscope.