Name of the Procedure:

Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Summary

A flexible sigmoidoscopy is a minimally invasive medical procedure in which a doctor uses a flexible tube with a camera to examine the lower part of the colon (sigmoid colon) and rectum. In addition to visual inspection, the procedure allows for the ablation (removal or destruction) of tumors, polyps, or other lesions. Pre- and post-dilation of the colon and the use of a guide wire may be included to assist with the navigation and treatment process.

Purpose

The procedure addresses abnormalities or growths, such as tumors or polyps, in the sigmoid colon and rectum. The primary goals are to diagnose issues, remove potential precancerous or cancerous growths, and alleviate symptoms associated with these lesions.

Indications

• Presence of blood in the stool
• Unexplained changes in bowel habits
• Chronic abdominal pain
• Family history of colorectal cancer
• Previous diagnoses of polyps or tumors in the colon

Preparation

• Fasting and a clear liquid diet 24 hours before the procedure.
• Bowel preparation with prescribed laxatives to clear the colon.
• Discontinuation of certain medications (e.g., blood thinners) as instructed by the doctor.
• Possible pre-procedure assessments, such as blood tests or imaging studies.

Procedure Description

1. The patient may receive mild sedation or anesthesia.
2. The patient lies on their side on an examination table.
3. A flexible sigmoidoscope is gently inserted into the rectum and gradually advanced through the sigmoid colon.
4. The scope transmits video images to a monitor, allowing the doctor to inspect the colon lining.
5. If polyps, tumors, or lesions are identified, specialized instruments are passed through the scope to ablate (remove or destroy) these abnormalities.
6. Pre-dilation may be performed if any narrowing is encountered, followed by ablation.
7. Post-dilation may be completed to ensure the colon is properly expanded.
8. Upon completion, the sigmoidoscope is carefully withdrawn.

Duration

The procedure typically takes about 20 to 30 minutes.

Setting

Typically performed in an outpatient clinic, hospital endoscopy suite, or ambulatory surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Endoscopy nurse
• Anesthesiologist or sedation nurse (if sedation is used)
• Medical assistant

Risks and Complications

• Bleeding from biopsy or ablation sites
• Perforation (tear) of the colon
• Infection
• Adverse reaction to sedation or anesthesia
• Abdominal pain or discomfort
• Incomplete procedure requiring further testing

Benefits

• Early detection and removal of potential precancerous polyps and tumors
• Relief from symptoms caused by lesions (e.g., bleeding, obstruction)
• Improved bowel health
• Potential reduction in the risk of colorectal cancer

Recovery

• Observation in a recovery area until sedation wears off.
• Mild discomfort and bloating may occur but typically resolves quickly.
• Restrictions on certain activities and diet immediately post-procedure.
• Follow-up appointment to discuss results and any further treatment, if necessary.
• Patients can usually resume normal activities within a day or two.

Alternatives

• Colonoscopy (more comprehensive but more invasive)
• CT colonography (non-invasive imaging alternative)
• Watchful waiting with regular monitoring
• Surgical removal of larger or inaccessible polyps or tumors

Patient Experience

During the procedure:

• Sedation usually ensures minimal discomfort.
• Some pressure or cramping may be felt if the colon is expanded.

After the procedure:

• Mild bloating or gas pain, but this typically resolves within hours.
• Instructions on diet and activity restrictions to aid recovery.
• Most patients can return to normal activities shortly after, with any discomfort typically being manageable with over-the-counter pain relief.