45347 Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

Name of the Procedure:

Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed)

Summary

A flexible sigmoidoscopy with stent placement is a minimally invasive procedure where a doctor uses a flexible tube with a camera to examine the lower part of the colon (sigmoid colon) and places a stent to open up narrowing sections. Pre- and post-dilation as well as guide wire passage are performed if necessary to ensure the stent is properly positioned.

Purpose

This procedure addresses conditions causing narrowing or blockage in the lower part of the colon, such as strictures, cancer, or benign growths. The stent helps to relieve symptoms like bowel obstruction, allowing for normal bowel movements, and improves the overall function of the colon.

Indications

• Chronic constipation or obstruction
• Symptoms of bowel blockage (pain, bloating, inability to pass gas)
• Diagnosis or suspicion of colorectal cancer
• Benign strictures causing narrowing of the colon

Preparation

• Fasting for several hours before the procedure
• Bowel cleansing regimen, which could include laxatives or enemas
• Adjustments to medications, especially blood thinners
• Potential pre-procedure diagnostic tests like blood work or imaging studies

Procedure Description

1. Pre-procedure Preparation: Patient sedates (usually mild sedation) and receives IV access.
2. Sigmoidoscopy: A doctor inserts a flexible tube (sigmoidoscope) through the rectum to visualize the sigmoid colon.
3. Guide Wire Passage: A guide wire is threaded through the scope to precisely guide the stent.
4. Dilation: The narrowed area may be dilated (stretched) before and after placing the stent to ensure proper fit.
5. Stent Placement: The endoscopic stent is positioned in the narrowed section to keep it open.
6. Post-procedure Visualization: The area is checked again for proper stent placement.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital endoscopy unit or an outpatient surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurse or endoscopy technician
• Anesthesiologist or sedation nurse (if sedation is used)

Risks and Complications

• Common: Mild bleeding, abdominal discomfort, minor infections.
• Rare: Perforation of the colon, severe bleeding, stent migration, deep infections.

Benefits

• Rapid relief from symptoms of bowel obstruction
• Improved bowel function
• Minimal recovery time compared to open surgery
• Immediate improvement may be noticed within a day or two

Recovery

• Post-procedure observation for a few hours, especially if sedation was used
• Instructions for dietary changes, typically starting with liquids
• Temporary restrictions in physical activity
• Follow-up appointments for monitoring the stent

Alternatives

• Other endoscopic procedures (balloon dilation without stent)
• Surgical resection of the affected colon segment
• Conservative management with medications and diet adjustments
• Pros: Some alternatives may avoid stent-related risks; cons: Often more invasive or less effective

Patient Experience

• During: Possible mild discomfort, but generally not painful due to sedation
• After: Mild bloating or cramping, manageable with prescribed pain relief measures
• Reassurance: Most patients tolerate the procedure well and benefit significantly from symptom relief.