Abstract
One of the most important roles of a private clinic is to find critical diseases as soon as possible. A total of 1,600 patients who underwent their first colonoscopy in the Saigusa Clinic from 1994 to 2010 were randomly extracted. We defined "advanced neoplasia (AVN)" as benign polyps with a diameter of 10mm or more and carcinoma. Amongst 115 (7%) patients who had at least one lesion of AVN, 53 (3.3%) patients developed 58 lesions of carcinoma, 36 of which were advanced. One-hundred and thirty lesions of AVN were found in 115 patients. Thirty-five (27%) of AVN arose in the proximal to sigmoid-descending junction. The median length of the interval between the first visit to the clinic and the detection of advanced cancer was 22 days. There were 11 (32%) patients diagnosed as having advanced colorectal carcinomas at their first visit by means of digital examination or on-site sigmoidoscopy. Total colonoscopy is feasible as a routine examination before anorectal surgery because about one quarter of AVN arise in the proximal colon, particularly when the patients are aged 50 years or older. However, sigmoidoscopy without preparation is an examination of choice for early discovery of cancer, especially when the patients show anal bleeding.
