45334 Sigmoidoscopy, flexible; with control of bleeding, any method

Name of the Procedure:

Sigmoidoscopy, Flexible; with Control of Bleeding, Any Method

• Commonly referred to as "Flexible Sigmoidoscopy with Hemostasis."

Summary

A flexible sigmoidoscopy with control of bleeding is a medical procedure that involves using a thin, flexible tube equipped with a camera and special instruments to examine the lower part of the colon and rectum. This procedure can not only diagnose conditions but also treat active bleeding by various methods.

Purpose

• Medical Condition: This procedure addresses gastrointestinal bleeding originating from the lower part of the colon and rectum.
• Goals: To visualize the lower colon, identify the source of bleeding, and control or stop the bleeding to prevent further complications.

Indications

• Symptoms that may prompt this procedure include rectal bleeding, anemia, or unexplained changes in bowel habits.
• Patients with known conditions such as diverticulosis, colorectal polyps, or ulcers may particularly benefit from this intervention.

Preparation

• Patients are generally instructed to follow a clear liquid diet 24 hours before the procedure and to undergo bowel preparation using laxatives.
• Discontinuation of certain medications, such as blood thinners, may be necessary. Diagnostic blood tests may also be conducted beforehand.

Procedure Description

1. Introduction of the Sigmoidoscope: A lubricated, flexible tube (sigmoidoscope) is gently inserted into the rectum.
2. Examination: The integrated camera transmits images of the colon's interior to a monitor, allowing for real-time examination.
3. Identification of Bleeding: The healthcare provider identifies the source of bleeding.
4. Control of Bleeding: Various techniques such as clipping, cauterization, or injection of hemostatic agents are employed to stop the bleeding.
   • Tools include the flexible sigmoidoscope, biopsy forceps, electrocautery devices, and hemostatic clips.
   • Sedation or local anesthesia may be used to ensure patient comfort.

Duration

The procedure typically lasts between 15 to 30 minutes.

Setting

This procedure is usually performed in an outpatient clinic or a specialized endoscopy unit within a hospital setting.

Personnel

• An endoscopist (a gastroenterologist or specially trained surgeon) performs the procedure.
• Supporting staff may include nurses, endoscopy technicians, and, if sedation is used, an anesthesiologist or a certified nurse anesthetist.

Risks and Complications

• Common Risks: Mild abdominal discomfort, bloating, and minor bleeding from biopsy sites.
• Rare Complications: Perforation of the colon, significant bleeding, or adverse reactions to sedatives. Management may involve medication, further endoscopic intervention, or even surgery.

Benefits

• Immediate relief from active gastrointestinal bleeding.
• Accurate diagnosis and the potential for early intervention in conditions such as polyps or malignancies.
• Patients often notice symptom improvement shortly after the procedure.

Recovery

• Post-procedure, patients are usually monitored for a short period to ensure there are no immediate complications.
• Instructions may include avoiding heavy lifting and adhering to a specific diet for a day or two.
• Mild cramping or bloating may be felt, but these typically resolve quickly.
• Follow-up appointments may be scheduled to review findings and discuss further treatment.

Alternatives

• Colonoscopy: A comprehensive examination of the entire colon may be recommended if upper colon issues are suspected.
• CT Colonography: A non-invasive imaging technique, though it does not offer the ability to control bleeding.
• Medical Management: Using medication to control symptoms until a more suitable intervention can be determined.
• Pros and Cons: Alternatives like colonoscopy offer broader visual diagnostics but may involve longer prep and recovery times. Less invasive options like CT colonography do not provide therapeutic capabilities but pose fewer immediate risks.

Patient Experience

• During the procedure, patients may feel mild pressure or cramping but are usually kept comfortable through sedation.
• After the procedure, feeling gassy and experiencing minor cramping is common, but these symptoms typically subside quickly.
• Pain management includes over-the-counter pain relievers and adherence to post-procedure instructions for a smooth recovery.