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Z Gastroenterol 2019; 57(09): 1059-1066
DOI: 10.1055/a-0963-0433
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Physicians’ view on sigmoidoscopy as an additionally offered method for colorectal cancer screening

Die Sigmoidoskopie zur Darmkrebsfrüherkennung aus Sicht der Ärzte
Iraima Cespedes
1   Hannover Medical School, Institute for Epidemiology, Social Medicine and Healthcare Systems Research, Hannover
,
Ursula Seidler
2   Hannover Medical School, Clinic for Gastroenterology, Hepatology and Endocrinology, Hannover
,
Ulla Walter
1   Hannover Medical School, Institute for Epidemiology, Social Medicine and Healthcare Systems Research, Hannover
,
Maren Dreier
1   Hannover Medical School, Institute for Epidemiology, Social Medicine and Healthcare Systems Research, Hannover
› Author Affiliations
Further Information

Publication History

18 April 2019

20 June 2019

Publication Date:
16 September 2019 (online)

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Abstract

Background In Germany, colorectal cancer (CRC) screening includes a fecal blood test or colonoscopy, but not a sigmoidoscopy, which has been shown to reduce CRC incidences and mortality. Our aim was to compile physicians’ experiences with sigmoidoscopy and their assessments of this procedure being an additional, possible screening method for early CRC detection.

Methods At the end of 2015, gastroenterologists and internists in Lower Saxony and North Rhine-Westphalia who regularly perform screening colonoscopies in outpatient care were contacted per mail. Standardized telephone interviews consisting of 17 questions and lasting 10–15 minutes were conducted.

Results Nearly two-thirds (56/87) of the respondents reject sigmoidoscopy as an acceptable early detection method. Compared to colonoscopy, key features of the sigmoidoscopy include more favorable patient-related aspects, while procedural aspects, except sedation, clearly rate in favor of the colonoscopy. In the instance that colonoscopy is rejected, 75 % of the physicians consider a sigmoidoscopy to be a possible alternative.

Conclusions The survey provides important practical insights into outpatient sigmoidoscopy. A majority of the physicians does not support evidence-based sigmoidoscopy for CRC screening. However, individuals who reject a colonoscopy are, in line with the current guideline, identified as a target group for a screening sigmoidoscopy. The benefit from an additionally offered sigmoidoscopy in CRC screening should be further analyzed with special consideration given to the preferences of insurees within the German healthcare system.

Zusammenfassung

Hintergrund Im neuen organisierten Darmkrebsfrüherkennungsprogramm steht den Versicherten in Deutschland der Stuhltest oder die Koloskopie zur Verfügung, jedoch nicht die Sigmoidoskopie, für die mittlerweile belegt ist, dass sie die Darmkrebsinzidenz und -mortalität senkt. Ziel war es, die Erfahrungen der Ärzte mit der Sigmoidoskopie und ihre Bewertung als mögliches zusätzliches Untersuchungsangebot in der Darmkrebsfrüherkennung zu erheben.

Methoden Ende 2015 wurden niedergelassene Gastroenterologen und Internisten in Niedersachsen und Nordrhein-Westfalen angeschrieben, die Screening-Koloskopien durchführen. Es wurden standardisierte Telefoninterviews bestehend aus 17 Fragen mit einer Dauer von 10–15 Minuten durchgeführt.

Ergebnisse Fast zwei Drittel (56/87) der Befragten lehnen die Sigmoidoskopie zur Früherkennung eindeutig ab. Während patientenseitige Aspekte eher für die Sigmoidoskopie sprechen, werden verfahrensspezifische Unterschiede bis auf die Sedierung klar für die Koloskopie gewertet. Wird die Koloskopie abgelehnt, sehen 75 % der Befragten die Sigmoidoskopie als mögliche Alternative.

Schlussfolgerung Die Befragung liefert wichtige praxisnahe Einblicke zur ambulanten Sigmoidoskopie. Die Mehrheit der teilnehmenden Ärzte befürwortet die evidenzbasierte Sigmoidoskopie zur Darmkrebsfrüherkennung nicht. Als mögliche Zielgruppe für ein zusätzliches Angebot der Sigmoidoskopie werden jedoch leitlinienkonform Personen identifiziert, die eine Koloskopie ablehnen. Das sich hieraus womöglich ergebende zusätzliche Präventionspotenzial ist im Versorgungskontext unter Berücksichtigung der Versichertenpräferenzen abzuschätzen.

Key words

evidence-based medicine - early diagnosis - colorectal neoplasms - evidence-based practice - screening - bowel cancer - cancer screening - sigmoidoscopy - endoscopy - survey

Schlüsselwörter

Evidenz-basierte Medizin - Krebsfrüherkennung - Darmkrebs - Screening - Sigmoidoskopie - Koloskopie - Endoskopie - Survey
 

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