Name of the Procedure:

Proctosigmoidoscopy, rigid; with dilation (e.g., balloon, guide wire, bougie)

Summary

Proctosigmoidoscopy with dilation is a diagnostic and therapeutic procedure where a rigid scope is used to examine the rectum and sigmoid colon. If necessary, dilation is performed to widen narrowed areas using instruments such as a balloon, guide wire, or bougie.

Purpose

This procedure is used to address conditions causing narrowing or blockage in the rectum or sigmoid colon, such as strictures or obstructions. The goal is to diagnose the underlying condition and alleviate symptoms by widening the narrowed areas to improve bowel function and relieve discomfort.

Indications

• Chronic constipation or difficulty passing stool due to suspected narrowing
• Rectal bleeding or unexplained changes in bowel habits
• Pain during bowel movements
• Follow-up to monitor an identified stricture or obstruction

Preparation

• Patient may be required to fast for several hours before the procedure.
• Bowel-cleansing preparations may be necessary to ensure the colon is clear for visual examination.
• Adjustments to medications, particularly blood thinners, may be advised.
• Pre-procedure assessments might include blood tests or imaging studies.

Procedure Description

1. The patient is placed in a specific position, usually lying on their side.
2. Sedation or a mild form of anesthesia may be administered for comfort.
3. A rigid proctosigmoidoscope is gently inserted into the rectum and slowly advanced into the sigmoid colon.
4. The healthcare provider examines the bowel lining and identifies any narrow areas.
5. If a narrowing is found, dilation is performed using appropriate tools such as a balloon, guide wire, or bougie.
6. The scope is then withdrawn, and the patient is monitored until the effects of sedation have worn off.

Duration

The procedure typically takes about 15 to 30 minutes, depending on the complexity and the need for dilation.

Setting

Proctosigmoidoscopy with dilation is usually performed in an outpatient clinic, an endoscopy suite, or a hospital setting.

Personnel

• Gastroenterologist or colorectal surgeon
• Registered nurse or endoscopy nurse
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common risks include mild discomfort, bloating, and cramping. Rare but serious complications may involve:

• Perforation of the bowel
• Infection
• Bleeding
• Adverse reactions to sedation

Management of these complications typically involves immediate medical attention and, in severe cases, surgical intervention.

Benefits

The procedure is highly effective in diagnosing conditions causing bowel obstruction and providing relief from symptoms. Patients can usually expect improvement in bowel function and a reduction in pain and discomfort shortly after the procedure.

Recovery

• Patients are observed until the sedation wears off, usually 1-2 hours.
• Mild discomfort or bloating may occur but should resolve quickly.
• Instructions include dietary advice, activity restrictions, and signs of complications to watch for.
• Follow-up appointments may be scheduled to assess the outcome and manage any ongoing issues.

Alternatives

• Flexible sigmoidoscopy or colonoscopy, which use a flexible scope and may be less uncomfortable
• Imaging studies (e.g., CT scan) for non-invasive evaluation
• Medical management with medication for less severe conditions
• Surgery for severe or non-responsive strictures

Each alternative has its pros and cons, often related to the invasiveness, accuracy of diagnosis, and immediacy of treatment.

Patient Experience

Patients may feel discomfort during scope insertion and dilation, but sedation helps minimize pain. Post-procedure, most patients experience minimal discomfort with quick recovery. Pain management includes over-the-counter pain relief if required and clear instructions to ensure comfort and safety throughout the recovery period.