What is sigmoidoscopy?

 

Sigmoidoscopy can be performed using flexible endoscope or rigid endoscope. Flexible endoscope is a 60cm long and thin tube with a camera at the tip for producing images inside the sigmoid colon. It facilitates doctor investigating health condition of intestinal lining and making diagnosis. The endoscope is inserted through the anus into the rectum and then advanced slowly to the sigmoid colon. On the other hand, rigid endoscope is a long metal tube without camera. It cannot be bent, with 25cm in length which is shorter than flexible ones. It can, therefore, only be inserted up to the rectum. Sigmoidoscopy is commonly using flexible endoscope.

 

 

 

Indication

• Blood stained stool
• Chronic diarrhoea
• Constipation
• Abnormal bowel movement
• Polyps in the intestine
• Tumour
• Abdominal pain with unknown reasons

 

 

Preparation

 

Anticoagulants such as clopidogrel, ticlopidine and warfarin should be ceased. (Patients should follow the doctor’s instructions carefully)

 

Two days before examination – the patient should have low-fibre diet and avoid taking in hard-to-digest foods that contain high residue. For example, vegetable, nuts, fruit, wheat bread and oats should not be ingested.  

 

One day before examination – only fluid diet is allowed, such as congee and soup.

No food or drink up to six hours prior to examination.

 

The day of the sigmoidoscopy – the nurse will follow the doctor’s order to help patient empty the rectum.

 

 

 

Procedure

 

Doctor may use sedations or analgesia according to the condition of the patient.

Doctor will insert an endoscope through the anus into the sigmoid colon. The patient may experience abdominal distention or bowel movement during the procedure.

 

 

 

Diagnosis and Treatment

• Sigmoidoscopy is usually performed to assist the following procedures:
• Biopsy
• Haemostasis for colonic haemorrhage
• Removal of polyps
• Removal of foreign body

 

Post-procedure Care

 

The patient should lie in bed until full awake from sedation.

 

Any presence of complications including abdominal pain, vomiting and having blood stained stool should be reviewed by healthcare providers.

 

Since doctor will bloat air into the bowel of the patient for better observation, it is normal that the patient may expel gas, and/or experience subtle discomfort with crampy abdominal pain after the procedure.

 

Patients who has taken the biopsy test should book a follow-up consultation to check the medical report.

 

If the patient has received removal of polyps, he/she should follow the doctor’s instructions:

• Go on a fluid diet and stop anticoagulants.
• Avoid stimulating foods
• Avoid intense exercise.

 

Patients are recommended to stay in Hong Kong for 10 days for continued observation.

 

 

 

Complications

 

Bowel perforation or haemorrhage (<0.6%)

Hypotension and difficulty in breathing after sedation

Abdominal distention or bowel movement which can be alleviated one hour after procedure

 

 

 

Procedure Information Sheet

 

Expected outcomes

The expected outcome of this procedure is to obtain diagnostic information of a malignant tumour. Doctor may take biopsy for pathological examination, perform polypectomy and therapeutic haemostasis when necessary.

 

 

 

Potential Risks & Complications

 

1. During procedure

(a)    Injection of sedation may cause hypotension, respiratory difficulties. In severe cases, anaphylaxis and anaphylactic shock may be developed. The probability of developing such symptoms is higher for the elderly.

 

(b)    Perforation (2:1000); the probability of developing major complications is higher for patients who require the therapeutic procedure (e.g. endoscopic haemostasis and dilatation).

 

(c)    Perforation of bowel may lead to peritonitis. Laparotomy under general anaesthesia may be required for repair or resection of bowel. The death rate is 5 in 100.

 

2. After procedure

(a)    Patients may experience abdominal pain or distension etc. It will improve about one hour after procedure.

 

(b)    Bleeding might occur at the site of biopsy or polypectomy. It is usually minor and usually stop on its own.

 

 

 

Before the procedure

1. The procedure and possible complications will be explained by the doctor and a consent form must be signed prior to the procedure.
2. Please inform the doctor if you are or suspected that you are pregnant.
3. Please inform the doctor and nurse all your past medical history (including diabetes, hypertension, heart diseases), previous surgical operations, current medication and any complication with drug or anaesthesia. Please inform doctor if you are taking medications that affect blood coagulation, such as Aspirin, Warfarin, Xarelto or Pradaxa, iron supplements and Chinese medication.
4. Presence of stool inside the bowel will affect the view of the bowel wall. Therefore, the bowel must be cleansed thoroughly before the procedure. Use the prescribed laxative on the day of examination when necessary.
5. The procedure requires fasting for up to six hours before the appointment. Only few sips of water are allowed until 2 hours before the operation. No oral intake (any food or drink) is allowed for 2 hours before examination.
6. Please change into a surgical gown after removing all clothing including undergarments, dentures, jewellery and contact lenses.
7. Please empty your bladder before the procedure.

 

Procedure

1. You will ask to lie on your left side with both knees bending towards your chest.
2. Doctor may prescribe sedation or anaesthetics according to your condition.
3. Doctor will pass the colonoscope through the anus into the sigmoid colon. It is normal to feel mild abdominal distension and urging of bowel during the procedure.
4. The procedure usually takes about 15 minutes.

 

After the procedure

1. Sedation and anaesthetics might make you feel dizzy, you should stay in bed until the sedative effect of drug has been completely worn off. It usually takes 3 – 4 hours.
2. Sedation and anaesthetics may temporarily affect one's coordination and reasoning skills, patients should avoid driving, drinking alcohol, making important decisions or signing legal documents within 24 hours after the procedure.
3. You may be discharged home directly after recovery from sedation. You should have a responsible adult to escort you home.
4. As doctor will pump air into the colon to enhance the visualization, it is normal to pass gases after the sigmoidoscopy.
5. Mild abdominal discomfort is common after procedure and usually will subside a few hours after the examination.
6. If severe abdominal pain or bleeding occurs, medical personnel must be consulted immediately.
7. You are recommended to stay in Hong Kong for 10 days after the procedure for continued observation.

 

 

Follow Up

1. Patients are advised to enquire about the examination results and date of follow up. Patients should follow the instruction given by the medical staff in completing the drug treatment.
2. Patients can contact our centre (Enquiry Tel No. 3405-8288) during office hours for any postoperative discomfort, or for any enquiries about the examination result and drug treatment. However, if serious complications develop, such as heavy bleeding, severe abdominal pain, etc. patients should call our 24-hour emergency hotline or seek medical attention at the Accident and Emergency Department of a nearby hospital.

 

Remarks

 

This leaflet only provides general information pertaining to this operation / procedure. While common risks and complications are described, the list is by no means exhaustive, and the degree of risk could also vary between patients. Please contact your doctor for detailed information and specific enquiry.

 

 

 

*The above information is for reference only, please consult your doctor for detail.