45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)

Name of the Procedure:

Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique (e.g., laser).

Summary

Proctosigmoidoscopy is a procedure that uses a rigid scope to visualize and treat abnormalities in the rectum and lower part of the colon. This particular type involves the ablation (destruction) of tumors, polyps, or other lesions using methods like laser, when easier removal techniques are not suitable.

Purpose

This procedure addresses the presence of abnormal growths or lesions in the rectum or sigmoid colon that cannot be removed by simpler methods. The goal is to remove these growths, which may be benign or malignant, and alleviate symptoms or prevent cancer progression.

Indications

• Presence of tumors or polyps not removable by simpler methods.
• Diagnostic findings of abnormal lesions during colonoscopy or sigmoidoscopy.
• Symptoms such as rectal bleeding, pain, or obstruction.
• Follow-up treatment for previously detected colorectal abnormalities.

Preparation

• Patients may need to undergo a bowel prep involving laxatives to clear the colon.
• Fasting may be required for several hours before the procedure.
• Adjustments to certain medications, especially blood thinners, may be necessary.
• Pre-procedure diagnostic tests could include blood work and imaging studies.

Procedure Description

1. The patient is positioned and a rigid proctosigmoidoscope is inserted into the rectum.
2. The scope provides a visual of the rectum and sigmoid colon.
3. Ablative tools such as a laser are used to destroy tumors, polyps, or lesions.
4. The procedure may involve the use of gas to inflate the colon for better visualization.
5. If necessary, additional treatments like tissue biopsies can be performed.
6. The scope is carefully withdrawn and the area is monitored for bleeding or other issues.

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Anesthesiologist or nurse anesthetist, if sedation is used
• Nurses and medical assistants

Risks and Complications

• Bleeding
• Perforation of the colon
• Infection
• Adverse reaction to anesthesia or sedation
• Incomplete removal of the lesion

Benefits

• Effective removal of abnormal growths.
• Alleviation of symptoms like pain and bleeding.
• Reduced risk of cancer progression or recurrence.
• Relatively quick recovery with most patients resuming normal activities shortly after.

Recovery

• Patients may experience mild discomfort or bloating.
• Instructions typically include rest, dietary adjustments, and avoiding strenuous activity for a short period.
• Follow-up appointments to monitor recovery and ensure complete lesion removal.

Alternatives

• Hot biopsy forceps, bipolar cautery, or snare technique for suitable lesions.
• Endoscopic mucosal resection (EMR) for larger or flatter lesions.
• Watchful waiting with regular monitoring in certain low-risk situations.

Patient Experience

• Patients may feel pressure or discomfort during the procedure.
• Sedation or local anesthesia is often used to enhance comfort.
• Post-procedure, there may be mild cramping or bloating, usually resolved within a few hours. Pain management medications can be offered if needed.