Name of the Procedure:

Proctosigmoidoscopy, rigid; with removal of a single tumor, polyp, or other lesion by snare technique.

Summary

A proctosigmoidoscopy is a medical procedure where a doctor uses a rigid tube to examine the rectum and lower part of the colon. During this procedure, if any abnormal growths like a tumor, polyp, or lesion are found, they can be removed using a snare technique, which involves looping a wire around the growth and cutting it off.

Purpose

This procedure is used to diagnose and treat abnormalities in the rectum and lower colon. The primary goals are to identify and remove any suspicious or harmful growths, such as polyps or small tumors, which can prevent the progression to more serious conditions like cancer.

Indications

• Symptoms such as rectal bleeding, abnormal stools, or unexplained weight loss.
• Presence of polyps seen on imaging studies.
• Follow-up on previously identified lesions.
• Patients over a certain age or with a family history of colorectal cancer may be candidates for screening.

Preparation

• The patient may be required to fast for several hours before the procedure.
• A bowel preparation, involving laxatives or enemas, is typically needed to clear the colon.
• The doctor may advise stopping certain medications that could affect bleeding or interact with sedative/anesthetic agents.

Procedure Description

1. The patient is positioned comfortably, usually lying on their side.
2. Sedation or local anesthetic may be administered to minimize discomfort.
3. The rigid proctoscope, a tube-like instrument with a light and camera, is gently inserted into the rectum.
4. The doctor examines the rectum and lower colon for abnormalities through the proctoscope.
5. If a tumor, polyp, or lesion is detected, a snare—a wire loop—is used to capture and remove it.
6. The removed tissue is sent to a lab for further analysis.

Duration

The procedure typically takes about 20 to 30 minutes.

Setting

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

Personnel

• A gastroenterologist or colorectal surgeon performs the procedure.
• A nurse or medical assistant is present to aid with the procedure.
• An anesthesiologist may be involved if sedation is used.

Risks and Complications

• Common risks include minor bleeding and discomfort at the site.
• Rare risks include perforation of the colon, significant bleeding, infection, or adverse reactions to sedation.
• Any complications are managed promptly with follow-up care or additional procedures if necessary.

Benefits

• Early detection and removal of potentially pre-cancerous polyps or tumors.
• Alleviation of symptoms such as bleeding or obstruction.
• Provides a definitive diagnosis through tissue biopsy, leading to appropriate treatment plans.

Recovery

• Patients are typically observed for a short period post-procedure to ensure there are no immediate complications.
• They may experience mild cramping or bloating, which usually resolves within a few hours.
• Normal activities can usually be resumed the next day.
• Follow-up appointments may be scheduled to discuss biopsy results or further treatment.

Alternatives

• Flexible sigmoidoscopy or colonoscopy, which use flexible scopes and can visualize a larger portion of the colon.
• Non-invasive tests like fecal occult blood testing (FOBT) or stool DNA tests for screening purposes.
• Each alternative has its pros and cons in terms of invasiveness, comprehensiveness, and diagnostic accuracy.

Patient Experience

• During the procedure, the patient might feel pressure, mild cramping, or discomfort.
• Sedation or anesthesia significantly reduces discomfort and anxiety.
• Post-procedure, patients might feel slightly bloated or have some mild bleeding if polyps were removed.
• Pain is usually minimal and managed with over-the-counter pain relievers.
• Ensuring clear communication with the healthcare team helps address any concerns or discomfort promptly.