From the Guidelines
The findings of a digital rectal examination (DRE) and rigid sigmoidoscopy are crucial for the diagnosis and classification of rectal cancer, with tumours within 15 cm from the anal margin being classified as rectal cancer 1. When performing a DRE and rigid sigmoidoscopy, it is essential to follow a structured approach to ensure comprehensive evaluation and accurate documentation.
Key Components of DRE and Rigid Sigmoidoscopy
- Patient identification and consent: State the patient's name, age, and that informed consent was obtained.
- Indication: Briefly mention the reason for the procedure (e.g., screening, follow-up, or specific symptoms).
- Patient preparation: Note any bowel preparation or positioning (e.g., left lateral decubitus position).
- Digital rectal exam:
- External inspection findings
- Anal tone
- Prostate characteristics (for male patients)
- Any masses, tenderness, or abnormalities
- Rigid sigmoidoscopy:
- Insertion depth
- Mucosal appearance
- Any lesions, polyps, or abnormalities observed
- Biopsies taken, if any
Classification of Rectal Cancer
According to the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of rectal cancer, tumours are classified based on their distance from the anal margin, with those within 15 cm being considered rectal cancer 1.
Importance of Accurate Documentation
Accurate documentation of DRE and rigid sigmoidoscopy findings is vital for proper diagnosis, treatment, and follow-up of rectal cancer. The use of a standardized structure for dictating DRE and rigid sigmoidoscopy findings ensures clear communication and facilitates proper documentation in the patient's medical record 1.
From the Research
Findings of Digital Rectal Examination (DRE) and Rigid Sigmoidoscopy
- The findings of DRE and rigid sigmoidoscopy can facilitate the diagnosis in patients with symptoms referable to the lower gastrointestinal tract 2.
- The overall sensitivity for DRE and rigid sigmoidoscopy was 51% and 78%, respectively, in the evaluation of penetrating rectal injuries 3.
- Rigid sigmoidoscopy proved better than DRE for diagnosis, with the greatest benefit observed with extraperitoneal injuries 3.
- A novel digital rigid sigmoidoscope provided satisfactory diagnoses in 96% of uses, with no adverse events reported 4.
- Digital rectal examination is a useful clinical procedure in the work-up of patients with colorectal or urogenital symptoms, with improved training and experience leading to better diagnostic accuracy 5.
- The expertise of the physician performing DRE is valuable in detecting anal tone, with more experienced examiners having a higher agreement with anorectal manometry 6.
Diagnostic Accuracy
- The diagnostic accuracy of DRE and rigid sigmoidoscopy can vary depending on the examiner's experience and the location of the injury 3, 6.
- Rigid sigmoidoscopy has been shown to have a higher sensitivity than DRE in the evaluation of penetrating rectal injuries 3.
- The use of a novel digital rigid sigmoidoscope can provide high-quality images and facilitate a satisfactory clinical diagnosis in 96% of uses 4.
Clinical Utility
- DRE and rigid sigmoidoscopy are important tools in the clinical examination of patients with symptoms referable to the lower gastrointestinal tract 2, 3.
- The use of DRE and rigid sigmoidoscopy can help identify patients with penetrating rectal injuries and guide further management 3.
- The expertise of the physician performing DRE is important in detecting anal tone and guiding therapeutic management 6.