Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
CPT4 code
Name of the Procedure:
Proctosigmoidoscopy, Rigid
Common name(s): Rigid sigmoidoscopy, Proctoscopy
Technical/Medical terms: Rigid proctosigmoidoscopy
Summary
A proctosigmoidoscopy is a diagnostic procedure that uses a rigid tube to examine the rectum and the sigmoid colon. It may involve collecting specimens by brushing or washing for further analysis.
Purpose
The procedure is used to diagnose issues in the rectum and sigmoid colon, such as inflammation, polyps, infections, or cancer.
Goals/Expected Outcomes:
- Identify abnormalities or lesions.
- Collect tissue or cell samples for testing.
- Provide clear images to aid diagnosis.
Indications
Symptoms/Conditions:
- Rectal bleeding.
- Persistent diarrhea or constipation.
- Unexplained abdominal pain.
- Detection of colorectal cancer.
- Monitoring of known conditions, like inflammatory bowel disease.
Patient Criteria: Patients presenting with gastrointestinal symptoms that require direct visualization and possible tissue sampling for accurate diagnosis.
Preparation
Pre-procedure Instructions:
- Clear liquid diet 1-2 days before the procedure.
- Laxatives or enemas may be required for bowel clearance.
- Medication adjustments may be necessary; consult your doctor.
Diagnostic Tests:
- Blood tests to assess general health.
- Possibly prior imaging studies like a CT scan or colonoscopy.
Procedure Description
- Patient Positioning: The patient will lie on their side with knees drawn to the chest.
- Anesthesia/Sedation: Usually, local anesthesia is applied, but sedation may be used in some cases.
- Insertion: A lubricated, rigid scope (sigmoidoscope) is gently inserted into the rectum.
- Examination: The scope is advanced to view the rectum and sigmoid colon. Air may be insufflated to expand the colon for a better view.
- Specimen Collection: Brushes or saline washes may be used to collect tissue samples.
- Completion: After examination and specimen collection, the scope is carefully withdrawn.
Tools/Equipment:
- Rigid sigmoidoscope
- Brushes for specimen collection
- Saline solutions for washes
Duration
Typically 15-30 minutes.
Setting
Performed in hospitals, outpatient clinics, or specialized surgical centers.
Personnel
- Gastroenterologist or colorectal surgeon.
- Assisting nurse.
- Anesthetist (if sedation is used).
Risks and Complications
Common Risks:
- Discomfort or pain during the procedure.
- Minor bleeding.
Rare Risks:
- Perforation of the colon.
- Infection.
- Adverse reaction to anesthesia or sedation.
Management of Complications:
- Immediate medical intervention for any severe complications like perforation.
- Antibiotics for infection.
Benefits
- Accurate diagnosis of colorectal issues.
- Early detection of serious conditions like cancer.
- Relief from symptoms with targeted treatment.
Expected Benefits Realization: Usually within days once test results are analyzed.
Recovery
Post-Procedure Care:
- Rest for a few hours post-procedure.
- Drink plenty of fluids to replace any lost during bowel preparation.
Recovery Time: Usually, patients can resume normal activities the next day.
Restrictions/Follow-Up: You may need a follow-up appointment to discuss biopsy results if samples were taken.
Alternatives
Other Treatment Options:
- Flexible sigmoidoscopy: Uses a flexible tube, offering more comfort and a broader range.
- Colonoscopy: Examines the entire colon.
- Imaging studies: CT or MRI scans can provide additional information.
Pros and Cons of Alternatives:
- Flexible sigmoidoscopy and colonoscopy are more comprehensive but may require more extensive preparation.
- Imaging studies are non-invasive but may not provide as detailed views as direct visual examination.
Patient Experience
During the Procedure:
- Sensation of pressure or cramping as the scope is inserted.
- Brief discomfort if local anesthesia is used.
Post-Procedure:
- Mild cramping or gas from air insufflation.
- Minor bleeding if biopsies were taken.
Pain Management and Comfort:
- Pain is usually minimal; over-the-counter pain relievers can be used if needed.
- Relax and follow post-procedure instructions to ensure comfort.