Table 2.

 Areas for future research related to performance of flexible sigmoidoscopy

(1) What is the degree of adherence to recommended intervals between FS examinations among both gastroenterologists and non-gastroenterologists?

(2) Is there a clinically meaningful difference between a 5 year interval between FS examinations and a 10 year interval?

(3) What portion of the adenoma bearing cohort can safely have a follow up colonoscopy delayed until after the age of 60 years?

(4) Would a single FS between age 50–59 years successfully stratify the population according to subsequent risk of colorectal cancer, guiding the need for subsequent screening or surveillance?

(5) What will be missed by delaying this initial examination until after the age of 60 years?

(6) How many examinations are necessary to achieve and maintain technical procedural competence?

(7) What defines a complete FS insertion, based on clinically important outcomes?

(8) What should be done when a screening FS is incomplete or suboptimal?

(9) What technical improvements could improve the ease, speed, and safety of FS?

(10) Do smaller diameter endoscopes improve FS performance or patient satisfaction?

(11) What is the preferred bowel preparation for flexible sigmoidoscopy, balancing preparation quality, patient satisfaction, and safety?

(12) Are there differences in rates of missed cancer or advanced lesions by non-physicians compared with generalist and specialist physicians?

(13) Do patient preferences vary for physician v non-physician providers of FS?

(14) To what degree do office based primary care providers performing FS adhere to endoscope reprocessing guidelines?

(15) What is the incidence of preventable transmissible infection related to FS procedures and are these events related to inadequate compliance with reprocessing guidelines?

(16) Can disposable sheath endoscopes be a feasible means of delivering flexible sigmoidoscopy in high volume with reduced risk of transmitting infection?