title: Open-access flexible sigmoidoscopy frequently leads to additional colonoscopy in symptomatic patients over 50 years.
abstract: OBJECTIVE
  General practitioners (GPs) in the Netherlands have open access to flexible sigmoidoscopy (FS) for patients with lower gastrointestinal symptoms, but not to colonoscopy. This study was performed to investigate the yield of FS in GP-referred patients, to evaluate the proportion of patients in whom additional colonoscopy was performed and to investigate whether there was a subgroup of patients referred for symptoms with a low risk of detecting significant findings.
  
  
  METHODS
  All patients undergoing FS in 2008 and 2009 who were referred by GPs were analyzed. Indications for additional colonoscopy were the presence of polyps and/or colorectal cancer (CRC), polyp screening or surveillance, incomplete FS or other reasons.
  
  
  RESULTS
  In total, 916 patients underwent FS. A cause for the symptoms was found in 44.2% of patients. In patients aged 50 years or older, additional colonoscopy was more frequently performed than in younger patients (27.5% vs. 9.6%, OR=3.6 [95% CI 2.4-5.4]), mainly due to a higher prevalence of adenomatous polyps (29.9% vs. 10.5%, OR=3.6 [95% CI 2.4-5.4]) and CRC (7.5% vs. 1.3%, OR=6.2 [95% CI 2.2-17.5]) during FS. In 7.8% patients undergoing FS for abdominal pain as the presenting symptom, a probable cause for the symptoms was found, mainly diverticular disease.
  
  
  CONCLUSIONS
  Due to the high prevalence of polyps and CRC in symptomatic patients aged 50 years or older undergoing FS, an additional colonoscopy is performed frequently. In patients referred with abdominal pain, FS is unlikely to reveal a relevant cause for the symptoms.
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort;Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands. hjm.pullens@meandermc.nl.
authors.forename: Hendrikus J M
authors.initials: HJ
authors.lastname: Pullens
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort,The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Joosten
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Menno A
authors.initials: MA
authors.lastname: Brink
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D004241:Diverticulum, Colon / Q000175:diagnosis / Q000453:epidemiology; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006484:Hemorrhoids / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000453:epidemiology; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D055815:Young Adult