Name of the Procedure:

Sigmoidoscopy, flexible; with transendoscopic ultrasound-guided intramural or transmural fine-needle aspiration/biopsy(s)

Summary

A flexible sigmoidoscopy with transendoscopic ultrasound-guided fine needle aspiration (FNA) or biopsy is a minimally invasive procedure that uses a flexible tube with a camera and ultrasound device to examine the lower part of the large intestine (sigmoid colon) and allows for precise tissue sampling.

Purpose

This procedure is designed to diagnose and evaluate gastrointestinal conditions, such as tumors or lesions in the sigmoidal region. The goals are to obtain tissue samples for biopsy to help determine the nature of a mass or abnormality and guide further treatment.

Indications

This procedure is typically indicated for patients experiencing symptoms such as unexplained abdominal pain, rectal bleeding, changes in bowel habits, or when an abnormality has been detected in previous diagnostic tests such as a colonoscopy or imaging studies.

Preparation

Patients are usually required to follow a clear liquid diet for 24 hours before the procedure and undergo bowel preparation with laxatives to clear the colon. They may need to adjust or stop certain medications, such as blood thinners, under medical guidance. A pre-procedure checkup, including relevant diagnostic tests, may be necessary to ensure the patient is fit for the procedure.

Procedure Description

1. The patient will lie on their side, typically under mild sedation or anesthesia.
2. A flexible sigmoidoscope, equipped with a camera and an ultrasound probe, is carefully inserted through the rectum.
3. The ultrasound component allows for detailed imaging of the intestinal walls and surrounding tissues.
4. Using ultrasound guidance, the healthcare provider will use a fine needle to aspirate or biopsy tissues from areas of interest.
5. The sigmoidoscope is then slowly withdrawn, and the procedure is completed.

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

The procedure is typically performed in a hospital endoscopy unit, outpatient clinic, or specialized gastroenterology center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurses
• Anesthesiologist (if sedation or anesthesia is used)
• Technicians to assist with the ultrasound equipment

Risks and Complications

Common risks include discomfort, mild bleeding, or cramping. Rare but serious complications may involve perforation of the colon, significant bleeding, infection, or adverse reactions to anesthesia. Immediate medical attention can manage most complications.

Benefits

The procedure allows for precise sampling and diagnosis of gastrointestinal conditions, which can lead to early intervention and treatment. Recovery is quick, with minimal downtime expected.

Recovery

Post-procedure, patients are usually monitored briefly and can typically go home the same day. Instructions may include avoiding heavy lifting or strenuous activity for a short period, staying hydrated, and gradually resuming a normal diet. Follow-up appointments may be scheduled to discuss biopsy results and further treatment plans.

Alternatives

Alternatives include a complete colonoscopy, CT colonography, or non-invasive imaging studies. Each alternative has its pros and cons; for example, a complete colonoscopy provides a full view of the colon but is more invasive, while imaging studies may be less precise in tissue sampling.

Patient Experience

Patients may experience mild discomfort, bloating, or cramping during and shortly after the procedure. Sedation helps minimize pain, and pain management strategies include over-the-counter medications and warm compresses if needed. Comfort measures, such as a calming environment and clear communication from healthcare professionals, will help ease the patient’s experience.