Name of the Procedure:

Colorectal Cancer Screening; Flexible Sigmoidoscopy (G0104)
Common name(s): Sigmoidoscopy, Flex Sig
Technical / Medical term: Flexible Sigmoidoscopy

Summary

A flexible sigmoidoscopy is a procedure in which a doctor uses a flexible tube with a light and camera at the end (a sigmoidoscope) to look inside the lower part of your colon and rectum. It's usually done for colorectal cancer screening to detect polyps, cancer, or other abnormalities.

Purpose

This procedure primarily addresses the detection of early signs of colorectal cancer, polyps, and other abnormalities in the colon and rectum. The goals are early detection and prevention of colorectal cancer through timely removal of polyps and other precancerous growths.

Indications

• Routine colorectal cancer screening for individuals over 50 years of age.
• Symptoms such as rectal bleeding, chronic diarrhea, or unexplained abdominal pain.
• Family history of colorectal cancer or polyps.
• Follow-up on abnormal findings from other colon tests.

Preparation

• Patients may be instructed to follow a clear liquid diet 24 hours before the procedure.
• Laxatives or enemas might be used to clear the bowels.
• Patients should inform their doctor of any medications they are taking, especially blood thinners, and may need to adjust or stop certain medications as directed.

Procedure Description

1. The patient lies on their side on an examination table.
2. The doctor inserts the sigmoidoscope through the rectum into the lower part of the colon.
3. Air may be introduced through the tube to expand the colon for better viewing.
4. The camera transmits images to a monitor so the doctor can examine the lining of the bowel.
5. Biopsies or polyp removal can be done during the procedure, if necessary.

6. The sigmoidoscope is gently removed.

   Tools used include the sigmoidoscope, which is a flexible tube with a light and camera. Typically, no anesthesia or minimal sedation is needed.

Duration

The procedure typically takes about 10 to 20 minutes.

Setting

A flexible sigmoidoscopy is usually performed in an outpatient clinic or a hospital outpatient department.

Personnel

• Gastroenterologist or trained physician
• Nursing staff
• Medical assistant (sometimes)

Risks and Complications

• Mild cramping or bloating
• Small risk of bleeding, especially if a biopsy or polyp removal is done
• Rare risk of perforation of the colon
• Possible infection

Benefits

• Early detection and removal of precancerous polyps reduce the risk of colorectal cancer.
• Can help diagnose the cause of symptoms like bleeding or pain.
• Quick recovery time with minimal discomfort.

Recovery

• Patients can generally resume normal activities shortly after the procedure.
• Instructions may include avoiding strenuous activities for a day or so.
• Follow-up appointments may be scheduled to discuss results and any further treatment.

Alternatives

• Colonoscopy: A more comprehensive exam of the entire colon.
• Fecal occult blood test (FOBT): A non-invasive test that checks for hidden blood in the stool.
• Stool DNA test: Non-invasive test that detects DNA mutations in stool. Each alternative has its own pros and cons, such as varying levels of invasiveness, accuracy, and cost.

Patient Experience

• Patients may feel mild cramping or bloating during the procedure due to the air introduced into the colon.
• Most patients feel little to no pain, as minimal or no sedation is used.
• Post-procedure, there may be some gas or mild discomfort, which usually resolves quickly.

Pain management and comfort measures include advising patients to relax and providing reassurance throughout the procedure.