Name of the Procedure:

Sigmoidoscopy, flexible with transendoscopic balloon dilation

Summary

A flexible sigmoidoscopy is a procedure in which a doctor uses a flexible tube with a camera (a sigmoidoscope) to examine the lower part of the colon (sigmoid colon and rectum). If a narrowed section of the colon (stricture) is found, a balloon attached to the end of the sigmoidoscope can be inflated to dilate, or widen, the narrowed area.

Purpose

This procedure is commonly used to diagnose and treat conditions affecting the lower colon, such as strictures caused by inflammation, scarring, or tumors. The main goal is to alleviate symptoms like abdominal pain, constipation, and bowel obstruction by widening the narrowed areas to improve bowel function and comfort.

Indications

• Persistent abdominal pain or discomfort
• Chronic constipation or difficulty passing stools
• Evidence of strictures observed in imaging tests
• Follow-up for inflammatory bowel diseases like Crohn's disease or ulcerative colitis

Patient candidates are typically those who show signs of lower gastrointestinal tract issues and those who haven't responded well to other treatments.

Preparation

• Fasting for 8-12 hours before the procedure
• Bowel cleansing with a laxative solution as instructed by your doctor
• Medication adjustments, particularly if you are on blood thinners
• A pre-procedure consultation may include a physical exam and review of medical history

Procedure Description

1. The patient will be asked to lie on their side.
2. Sedation or anesthesia may be administered to ensure comfort.
3. A lubricated, flexible sigmoidoscope with a camera is gently inserted into the rectum and slowly advanced into the sigmoid colon.
4. The doctor examines the colon's lining on a monitor.
5. If a stricture is found, a balloon dilation device is passed through the sigmoidoscope to the site.
6. The balloon is inflated to widen the narrowed area.

7. The balloon is then deflated and removed along with the sigmoidoscope.

   Specialized devices involved include the flexible sigmoidoscope and the balloon dilation catheter.

Duration

The procedure typically takes about 20-45 minutes.

Setting

Flexible sigmoidoscopies are usually performed in an outpatient clinic, endoscopy center, or hospital setting.

Personnel

• Gastroenterologist or trained endoscopist
• Registered nurse or medical assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Bleeding, especially if biopsies are taken or if there is significant inflammation
• Perforation of the colon, although rare
• Infection
• Pain or discomfort post-procedure

Benefits

• Relief from symptoms like pain, constipation, and bowel obstruction
• Improved bowel function
• Can aid in diagnosing serious conditions like cancer

Benefits are often realized soon after the procedure, though it may take a few days to feel the full effects.

Recovery

• Most patients can return home the same day.
• Mild cramping or bloating is common post-procedure.
• Follow post-procedure dietary instructions, often starting with clear liquids and gradually resuming a regular diet.
• Keep an eye on any severe symptoms, such as heavy bleeding or severe pain, and report them to your doctor immediately.
• A follow-up appointment is typically arranged to discuss findings and next steps.

Alternatives

• Colonoscopy: Provides a more comprehensive view but is more invasive.
• Non-invasive imaging like CT colonography.
• Medications to manage symptoms, though they don’t address strictures directly.
• Surgery for severe cases that cannot be managed with dilation.

Each alternative has its own benefits and drawbacks, such as invasiveness, accuracy, risk, and recovery time.

Patient Experience

During the procedure, with sedation, most patients feel minimal discomfort. After the procedure, mild cramping or bloating is normal. Manageable with over-the-counter pain relievers and typically resolves within a few days. Comfort measures include lying still as instructed and following dietary guidelines to ease recovery.