Improving the view in the rectal clinic: a randomised control trial

Background: Rigid sigmoidoscopy forms an integral part of the out-patient a ssessment of patients with colorectal symptoms. However, the value of this of this examination is often diminished by faecal loading of the rectum. Th is trial aimed to determine the ability of a single self-administered glyce rine suppository to clear the rectum in preparation for rigid sigmoidoscopy , and considered patient acceptability of this practice. Methods: Consecutive patients were randomly allocated to receive suppositor y or no suppository prior to out-patient rigid sigmoidoscopy. Assessment wa s made of patient compliance, the effectiveness of rectal examination, and the depth to which the sigmoidoscope was inserted. Results: 131 patients were randomised into suppository (n = 66) or control groups (n = 65), The number of patients deemed to have good views of the re ctum (> 75% of rectal mucosa seen) was significantly greater in suppository than control groups (79% versus 26.2%, P < 0.05 Chi square test), whilst t hat of poor examinations (< 50% of rectal mucosa seen) was significantly gr eater in control than suppository groups (44.6% versus 4%, P < 0.05). The d epth of insertion of the sigmoidoscope was significantly greater in those r eceiving suppositories (54.5% versus 21.5% undergoing evaluation to 18 cm o r more, P < 0.05). Compliance amongst those who received suppositories was high with only 3 of 53 (4.5%) patients in the suppository group evaluated b y questionnaire reporting difficulty or concerns over their use. Conclusion: Self-administered suppositories are acceptable to patients and significantly improve the efficiency of outpatient rigid sigmoidoscopy. The ir usage should become routine.