대한대장항문학회

Purpose : The clinical guidelines and rationale published by the American Gastro<br>enterological Association in 1997 recommended that it is not necessary to screen patients in<br>the average risk group who are below the age of 50. The purpose of this study was to<br>evaluate both the effectiveness of flexible sigmoidoscopy (FS) as a diagnostic and screening<br>tool and the utility of screening at an age earlier than 50 years. Methods : From Jan. to Dec.<br>1997, FS was used in 8964 cases. These cases were divided into three groups: Group A, 1336<br>outpatients; Group B, 5308 cases involving a hemorrhoidal operation; and Group C, 2320 cases<br>of mass screening. Results : The mean age was lower in Group B (42.4 11.5) than in Group<br>A (47.0 14.5) and Group C (46.1 10.7). The incidences of cancer, inflammatory bowel<br>disease (IBD), and nonspecific proctocolitis in Group A were significantly higher than they<br>were in Groups B and C, and the FS findings in Groups B and C were similiar. The locations<br>of the polyps, cancer, IBD, and nonspecific proctocolitis were below the left colon in 91.9%<br>cases involving an abnormal finding. Also, the locations of polyps and IBD determined by<br>using FS and by using colonoscopy (CS) were not very different. About two-thirds of the<br>carcinomas found by using FS in all three groups were located in the upper rectum and the<br>sigmoid. In Group B, the FS findings did not depend on whether or not an enema had been<br>administered. Also, the total incidence of cancer in patients less than forty years of age was<br>nearly the same as the incidence of cancer in Group B and the incidence of cancer in Group<br>C. Conclusions : The risk of cancer for patients in the average risk group who are under 50<br>years of age should not be underestimated. FS is effective not only for the diagnosis of<br>colorectal disease but also as an initial screening technique for patients below forty years of<br>age.<br>