Procedure
Flexible Sigmoidoscopy
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Flexible Sigmoidoscopy
Indications
Colorectal Cancer Screening
Surveillance after previous polypectomy
Surveillance of
Inflammatory Bowel Disease
Rectal Bleeding
or
Hemoccult
positive stools
Unexplained
Anemia
, weight loss, or fevers
Change in
Bowel
habits
New onset or persistent
Constipation
Protracted
Diarrhea
Abdominal Pain
Contraindications
Absolute contraindications
Acute or severe Cardiac or pulmonary disease
Inadequate
Bowel Preparation
Active
Diverticulitis
Acute surgical
Abdomen
Marked bleeding dyscrasia
Relative contraindications
Recent bowel surgery or pelvic surgery
Active infection
Pregnancy
Efficacy
Colonoscopy
preferred for
Colorectal Cancer Screening
Sigmoidoscopy misses 25% of lesions (proximal)
Occult blood does not increase flex sig sensitivity
References
Lieberman (2000) N Engl J Med 343:207-8 [PubMed]
Lieberman (2001) N Engl J Med 345:555-60 [PubMed]
Preparation
Patient
See
Bowel Preparation
Preparation
Equipment
Flexible fiberoptic sigmoidoscope
Test air insufflation in basin water
Test suction in basin water
Water source connected
Confirm sigmoidoscope plugged into light source
Other equipment
Ive's Slotted Anoscope
with light source
Gauze (4x4) approximately 1 inch amount of gauze
One inch of K-Y Jelly or 5%
Lidocaine
ointment
Basin with water
Sigmoidoscope cleaning
Immediately immerse scope tip in water after procedure
Flush suction channel to prevent clogging with stool
See
Endoscope Cleaning
Procedure
Patient Position: Left Lateral Decubitus
Examiner Preparation
Double glove scope insertion hand (right hand)
Single glove other left hand
Initial Examination
Digital Rectal Exam
(and
Prostate
exam in men)
Anoscopy
Sigmoidoscope Control
Insert scope with right hand
Right hand also rotates the tip left and right
Left thumb controls inner knob for up-down control
Sigmoidoscope Insertion
Insert distal scope over top of lubricated finger
Avoid smearing jelly over top of lens
Insert scope 7 to 15 cm
Insufflate air
Sigmoidoscope advancement
Basic Insertion Technique
Attempt to insert scope only when lumen visible
Some continue insertion as long as wall moves
Do not continue to insert against resistance
Advanced Insertion Techniques
Torquing
Twist scope with insertion hand
Dithering
Rapid short back and forth motion
Accordionization (Hook and Pull Back)
Pull back on angled wall segments with scope tip
Sigmoidoscope Withdrawal
Inspect colonic mucosa while slowly withdrawing
Withdraw scope tip to rectal vault (10 to 15 cm)
Sigmoidoscope Retroversion
Confirm scope withdrawn to rectal vault
Maximally turn inner knob with left land
Insert scope with right hand
Visualize black scope in
Rectum
and anal canal
Study completion
Withdraw air from
Rectum
Remove scope from
Rectum
Findings
Polyps
Diminutive polyps (size <5 mm): Biopsy
Hyperplastic polyp on biopsy: No further evaluation
Adenomatous polyp on biopsy: Full
Colonoscopy
Large polyps (size >5 mm)
Perform full
Colonoscopy
with polypectomy
Suspected Cancer
Prompt referral for evaluation and treatment
Biopsy may provoke significant bleeding
Diverticulosis
Internal Hemorrhoid
s
References
Pfenninger (1994) Procedures, Mosby, p. 907-28
Zuber (2001) Am Fam Physician 63(7):1375-80 [PubMed]
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