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July 8, 1968

Routine Examination With Proctosigmoidoscope

JAMA. 1968;205(2):115-116. doi:10.1001/jama.1968.03140280069026

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To the Editor:—  As far back as 1950 (New York J Med50:89, 1950) the late Garson and I advocated the routine addition of "sigmoidoscopy as part of a physical examination, performed by the general practitioner, internist, and general surgeons, of individuals past 40 years of age." I've also stated that in a large number of patients proctosigmoidoscopic examination may be performed successfully without preliminary cleansing enemas. We also stated that the knee-chest or the knee-elbow positions are employed except in the case of debilatated or aged patients when the left lateral Sim's position is used.I wish to stress that the value of the knee-elbow position has been greatly underestimated and in my experience is superior to Sim's position. The virtue of performing endoscopy without preparation has been recognized but not universally accepted. Preliminary preparation is avoided in order to observe the unaltered mucosa and not to wash