Name of the Procedure:

Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance

Summary

A flexible sigmoidoscopy with directed submucosal injection involves using a thin, flexible tube with a camera to examine the lower part of the colon. During this procedure, the doctor may inject a substance directly into the submucosal layer of the colon.

Purpose

This procedure is used to diagnose and treat various colon conditions. Goals include identifying abnormalities, taking biopsies, and treating issues such as inflammation or bleeding through targeted injections.

Indications

• Persistent diarrhea or constipation
• Abdominal pain
• Rectal bleeding or blood in the stool
• Screening for colorectal cancer or polyps
• Inflammatory bowel disease (IBD) management
• Abnormal findings on imaging studies

Preparation

• Fast for at least 12 hours before the procedure.
• Follow a bowel preparation regimen, usually involving a laxative.
• Adjust medications as advised, particularly anticoagulants or antiplatelet drugs.
• Undergo any recommended pre-procedure diagnostic tests, such as blood work.

Procedure Description

1. Preparation: Patient positioned on the side; sedation may be administered.
2. Insertion: Flexible sigmoidoscope is inserted through the rectum into the sigmoid colon.
3. Inspection: Camera on the sigmoidoscope transmits images allowing the doctor to inspect the colon.
4. Injection: If necessary, a substance (e.g., saline, dye, medication) is injected into the submucosal layer for treatment or diagnostic purposes.
5. Completion: The scope is slowly withdrawn, and the procedure is concluded.

Tools used include the flexible sigmoidoscope and injection device. Sedation is usually mild or moderate, but varies based on patient comfort and medical needs.

Duration

The procedure typically takes around 15-30 minutes.

Setting

Usually performed in an outpatient clinic or ambulatory surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurse or medical assistant
• Anesthesiologist or sedation nurse (if sedation is used)

Risks and Complications

Common risks include abdominal discomfort, bloating, and minor rectal bleeding. Rare complications may involve perforation of the colon, severe bleeding, and reactions to sedation or injected substances. Proper management protocols are in place for these complications.

Benefits

Benefits include accurate diagnosis and targeted treatment, potentially providing immediate relief from certain symptoms. Improved outcomes for managing chronic conditions and preventing colorectal cancer.

Recovery

Post-procedure care involves observation until sedation wears off, if used. Patients can usually resume normal activities within 24 hours but should avoid strenuous activities for a short period. Mild bloating or cramping may be experienced. Follow-up appointments to discuss results or further treatment may be necessary.

Alternatives

• Colonoscopy, providing a full-length examination of the colon.
• Imaging tests like CT colonography or barium enema.
• Symptomatic treatment with medications alone. Each alternative has its pros and cons regarding invasiveness, accuracy, and treatment capabilities.

Patient Experience

During the procedure, patients might feel pressure or mild cramping but sedation can help minimize discomfort. Post-procedure, some bloating or cramping may occur, but pain is generally mild and manageable with over-the-counter medications.