Name of the Procedure:

Anoscopy with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

Summary

An anoscopy is a medical procedure used to examine the anus, anal canal, and lower rectum. When bleeding is detected, various techniques such as injections, cautery, laser, heater probes, staplers, or plasma coagulators may be employed to control it.

Purpose

The procedure addresses bleeding in the anal and rectal areas, typically caused by hemorrhoids, fissures, tumors, or other lesions. The primary goal is to identify the source of the bleeding and apply necessary interventions to stop it.

Indications

• Presence of blood in stools
• Chronic anal or rectal pain
• Known anal lesions, hemorrhoids, or anal fissures
• Anemia due to suspected gastrointestinal bleeding
• Rectal bleeding not explained by a colonoscopy

Preparation

• Fast for 6-8 hours before the procedure.
• Obtain clearance from a physician if taking blood-thinning medications.
• A pre-procedure enema or laxative may be recommended.
• Undergo routine diagnostic tests such as blood work and medical imaging.

Procedure Description

1. Pre-Procedure: The patient is positioned appropriately, usually in the left lateral position or lithotomy position.
2. Anoscopy: An anoscope, a lubricated tubular device, is gently inserted into the anal canal to provide visibility.
3. Bleeding Control:
   • Injection: A sclerosing agent is injected directly into the bleeding site to constrict blood vessels.
   • Cautery: Bipolar or unipolar cautery devices apply heat to coagulate blood vessels.
   • Laser: Delivers focused light to cauterize the tissue.
   • Heater Probe: A heated probe applies direct heat to the bleeding site.
   • Stapler: Specially designed staples are used to clamp bleeding vessels.
   • Plasma Coagulator: Uses ionized gas to coagulate bleeding tissues.

Anesthesia may be local, with minimal sedation being administered to ensure patient comfort.

Duration

The procedure typically takes 15 to 30 minutes, depending on the extent of bleeding and necessary interventions.

Setting

Anoscopies are usually performed in outpatient clinics, but they may also take place in hospital settings depending on the complexity.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurse
• Anesthesiologist if sedation is required
• Medical assistant

Risks and Complications

Common risks include minor discomfort, bleeding, and infection. Rare complications might involve significant bleeding, tissue perforation, or adverse reactions to anesthesia.

Benefits

The primary benefit is the immediate control of rectal and anal bleeding, leading to symptom relief. Diagnosing the source of bleeding enables timely and effective treatment for underlying conditions.

Recovery

• Mild discomfort or spotting might occur and can be managed with over-the-counter pain relievers and sitz baths.
• Avoid strenuous activity for 24-48 hours after the procedure.
• Follow-up appointments may be scheduled to monitor healing and effectiveness of the treatment.

Alternatives

• Medical therapy such as oral medications and topical treatments
• Rubber band ligation for hemorrhoids
• Endoscopic procedures
• Surgery in severe cases

Each alternative has its own risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

The patient may feel pressure and mild discomfort during the anoscopy. Post-procedure, some minor pain or discomfort is possible, which can be alleviated with pain relievers. Most patients can return to normal activities within a day or two, adhering to post-procedure care instructions.