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Quality in the technical performance of screening flexible sigmoidoscopy: recommendations of an international multi-society task group
  1. T R Levin1,
  2. F A Farraye2,
  3. R E Schoen3,
  4. G Hoff4,
  5. W Atkin5,
  6. J H Bond6,
  7. S Winawer7,
  8. R W Burt8,
  9. D A Johnson9,
  10. L M Kirk10,
  11. S C Litin11,
  12. D K Rex12
  1. 1Department of Gastroenterology, Kaiser Permanente Medical Center, CA, USA, and Kaiser Permanente Division of Research, Oakland, CA, USA
  2. 2Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
  3. 3Department of Medicine/Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  4. 4Institute of Population-based Cancer Research, Oslo, Norway
  5. 5Cancer Research UK Colorectal Cancer Unit, St Mark’s Hospital, Harrow, UK
  6. 6Department of Medicine/Gastroenterology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA
  7. 7Department of Medicine/Gastroenterology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  8. 8Department of Medicine/Gastroenterology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
  9. 9Department of Medicine/Gastroenterology, Eastern Virginia School of Medicine, Norfolk, VA, USA
  10. 10Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
  11. 11Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
  12. 12Department of Medicine/Gastroenterology, Indiana University Medical Center, Indianapolis, IN, USA
  1. Correspondence to:
    Dr T R Levin
    Kaiser Permanente Division of Research, 2000 Broadway, 2nd Floor, Oakland, CA 94612, USA; Theodore.Levin{at}


Background: Flexible sigmoidoscopy (FS) is a complex technical procedure performed in a variety of settings, by examiners with diverse professional backgrounds, training, and experience. Potential variation in technical quality may have a profound impact on the effectiveness of FS on the early detection and prevention of colorectal cancer.

Aim: We propose a set of consensus and evidence based recommendations to assist the development of continuous quality improvement programmes around the delivery of FS for colorectal cancer screening.

Recommendations: These recommendations address the intervals between FS examinations, documentation of results, training of endoscopists, decision making around referral for colonoscopy, policies for antibiotic prophylaxis and management of anticoagulation, insertion of the FS endoscope, bowel preparation, complications, the use of non-physicians as FS endoscopists, and FS endoscope reprocessing. For each of these areas, continuous quality improvement targets are recommended, and research questions are proposed.

  • FS, flexible sigmoidoscopy
  • FOBT, faecal occult blood test
  • TA, tubular adenoma
  • AA, advanced adenoma
  • SGNA, Society of Gastroenterology Nurses and Associates
  • ASGE, American Society of Gastrointestinal Endoscopists
  • flexible sigmoidoscopy
  • colorectal cancer screening
  • endoscopic screening
  • technical performance quality

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  • Conflict of interest: None declared.