II. 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
III. 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
IV. Efficacy
-
Colonoscopy preferred for Colorectal Cancer Screening
- Sigmoidoscopy misses 25% of lesions (proximal)
- Occult blood does not increase flex sig sensitivity
- References
V. Preparation: Patient
VI. 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
VII. 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
- Insert distal scope over top of lubricated finger
- 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
- Torquing
- Basic Insertion Technique
- 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
VIII. 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
- Diminutive polyps (size <5 mm): Biopsy
- Suspected Cancer
- Prompt referral for evaluation and treatment
- Biopsy may provoke significant bleeding
- Diverticulosis
- Internal Hemorrhoids
IX. References
- Pfenninger (1994) Procedures, Mosby, p. 907-28
- Zuber (2001) Am Fam Physician 63(7):1375-80 [PubMed]