Flexible Sigmoidoscopy

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Contents 1 Introduction 2 Indications 3 Contraindications 4 Procedure 5 Complications 6 Notes 7 More General Terms 8 Additional Terms 9 References

Introduction

• A procedure for viewing the rectum & sigmoid colon. 35 & 60 cm sigmoidoscopes are used.

Indications

• follow-up for rectal cancer
• screening for colon cancer*

• once, age 55-65 years, reduces colorectal carcinoma incidence & mortality [4]
• yield of screening depends on sigmoidoscopist [3]
• colorectal adenomas detected in 9-16% of screenings

• evaluation of change in bowel habits
• rectal bleeding
• abdominal pain
• decompression of sigmoid volvulus
• removal of foreign body

Contraindications

• patient refusal
• patient is dying or at the point of death ( moribund)
• unstable cardiac condition
• respiratory insufficiency
• peritonitis
• known or suspected perforation
• toxic megacolon
• sigmoid stricture
• fulminant colitis
• severe acute diverticulitis

Procedure

• Patient preparation:

• informed consent
• avoid eating red or orange gelatin the day prior to the procedure
• fleet enema* every 30 min beginning 2 hours before procedure until the return is clear
• left lateral position with right knee flexed more than left

• * see bowel preparation for colonoscopy or flexible sigmoidoscopy

Complications

• intestinal perforation
• bleeding
• vasovagal reaction
• transient bacteremia (< 1&)

Notes

• Caution:

• 10% of patients have combustible levels of hydrogen & methane in the bowel
• do NOT use electrocautery during sigmoidoscopy because of risk of explosion

More General Terms

• gastrointestinal endoscopy

Additional Terms

• bowel preparation (whole bowel irrigation, bowel evacuation)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 334-36
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Journal Watch 24(12):97, 2004 Atkin W, Rogers P, Cardwell C, Cook C, Cuzick J, Wardle J, Edwards R. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology. 2004 May;126(5):1247-56. PMID: [1]
4. Segnan N et al. Once-only sigmoidoscopy in colorectal cancer screening: Follow-up findings of the Italian Randomized Controlled Trial
   - SCORE. J Natl Cancer Inst 2011 Sep 7; 103:1310 PMID: [2]
5. Flexible Sigmoidoscopy [3]

flexible sigmoidoscopy