Name of the Procedure:

Sigmoidoscopy, flexible; with endoscopic mucosal resection (EMR)

Summary

A flexible sigmoidoscopy with endoscopic mucosal resection (EMR) is a minimally invasive procedure where a flexible tube equipped with a camera (sigmoidoscope) is used to examine the lower part of the colon (sigmoid colon) and rectum. If abnormal tissue or polyps are found, they can be removed using specialized tools during the procedure.

Purpose

The procedure is primarily used to diagnose and treat conditions such as colorectal polyps, early-stage cancer, and other abnormal tissues in the lower colon and rectum. The main goal is to identify and remove these abnormalities to prevent them from developing into more serious conditions.

Indications

• Rectal bleeding
• Chronic diarrhea or constipation
• Abdominal pain
• Positive fecal occult blood test (FOBT)
• Family history of colorectal cancer
• Follow-up assessment for previously found polyps

Preparation

• Fast for at least 8 hours before the procedure.
• Patients may be prescribed a bowel-cleansing solution to clear the colon.
• Adjustments may need to be made to current medications (e.g., blood thinners).
• Some patients may require pre-procedure diagnostic tests such as blood tests or imaging studies.

Procedure Description

1. Sedation: Mild sedation or local anesthesia may be provided for comfort.
2. Insertion: The sigmoidoscope is gently inserted through the anus and slowly advanced into the rectum and lower colon.
3. Inspection: The camera transmits video images to a monitor, allowing the doctor to examine the colon lining.
4. Resection: If abnormal tissue or polyps are identified, specialized tools are used to excise (cut out) and remove them. The removed tissue is often sent for pathological analysis.
5. Completion: The sigmoidoscope is carefully withdrawn, and the procedure is completed.

Duration

Typically, the procedure takes about 20 to 30 minutes, but this may vary depending on the complexity of the mucosal resection.

Setting

The procedure is usually performed in an outpatient clinic, hospital outpatient department, or a specialized endoscopy center.

Personnel

The procedure is conducted by a gastroenterologist or a specially trained endoscopist, with the assistance of nurses and, if necessary, an anesthesiologist.

Risks and Complications

• Mild discomfort or cramping
• Bleeding, particularly from the resection site
• Perforation of the colon wall (rare)
• Infection
• Adverse reaction to sedation

Benefits

• Minimally invasive with a shorter recovery time compared to surgery.
• Direct visualization and treatment of abnormalities.
• Early detection and removal of precancerous polyps can prevent colorectal cancer.

Recovery

• Patients may need to rest for a short period after the procedure and arrange for a ride home due to the effects of sedation.
• Mild cramping or bloating may be experienced post-procedure.
• Normal activities can typically be resumed within a day.
• Follow-up instructions may include dietary restrictions and avoiding heavy lifting.
• A post-procedure follow-up may be scheduled to discuss pathology results and further management.

Alternatives

• Colonoscopy: A similar but more extensive examination of the entire colon.
• CT Colonography: A non-invasive imaging test.

• Traditional Surgery: For larger or more complex lesions.

  Each alternative has its own risk-benefit profile, with flexible sigmoidoscopy being less invasive than surgery but providing less extensive visualization compared to a full colonoscopy.

Patient Experience

Patients may feel mild discomfort or cramping during the procedure, which is generally well-tolerated with sedation. Post-procedure, some bloating or mild pain may occur, but these symptoms typically resolve quickly. Pain management includes mild analgesics if necessary, and patients should follow care instructions provided by their healthcare team for optimal recovery.