Representative outcome studies describing the procedures of rigid sigmoidoscopy and use of the 60-cm flexible sigmoidoscope are summarized. Subspecialist outcomes are compared with those obtained by family physicians. Family physicians consistently obtain similar insertion depths and diagnostic yields, although comparison is difficult because of referral bias and inconsistency regarding the reporting of hyperplastic polyps. No complications have been reported to date. Low physician and patient compliance with suggested guidelines for sigmoidoscopic examination may be partially responsible for unchanged five-year survival rates for colorectal cancer over the last 30 years. Preliminary studies indicate that the 60-cm flexible sigmoidoscope has improved compliance in at least one setting. Longitudinal cost-benefit studies should be performed in primary care settings.