Anoscopy and Rigid Sigmoidoscopy



Anoscopy and Rigid Sigmoidoscopy


Ana DeRoo, MD

John C. Byrn, MD



The routine use of colonoscopy or flexible sigmoidoscopy to examine the rectum and distal colon has not alleviated the need for physicians to become proficient in the use of the anoscope and the rigid sigmoidoscope. The anoscope allows diagnosis and evaluation of conditions such as fistula in ano, perirectal abscess, anal fissure, anal cancer, or perianal Crohn disease and treatment of lesions in the anal canal and distal rectum.1 Rigid sigmoidoscopy is useful for evaluation of and therapeutic maneuvers in the distal colon and rectum that cannot be performed with the flexible instrument, such as the topical application of formalin in radiation proctopathy and the removal of foreign bodies. In addition, rigid sigmoidoscopy can be performed anywhere there is an electrical outlet, with highly portable equipment that does not require expertise for cleaning or maintenance, as many components are disposable, and without the need for specially trained ancillary personnel. Therefore, rigid sigmoidoscopy is an expedient option in the intensive care unit, emergency department, or other situations requiring rapid use. This section will cover the techniques of anoscopy and rigid sigmoidoscopy.






PREPARATION



  • 1. Obtain informed consent.


  • 2. Have chaperone in room.


  • 3. Antibiotic prophylaxis is no longer recommended for patients undergoing GI endoscopy, unless a high-risk patient (e.g., prosthetic valve, previous infective endocarditis) has an established GI tract infection, at which point prophylactic antibiotics may be considered.4


  • 4. Most patients can be examined with no prior bowel preparation.


  • 5. If stool precludes an adequate examination, a bisacodyl suppository, tap water enema, or Fleet (or other proprietary small volume hypertonic phosphate) enema can be given and the examination carried out following evacuation. Outpatients may take the enema at home 1 to 2 hours prior to procedure.


  • 6. Very rarely, an oral preparation with polyethylene glycol electrolyte solution or phospho-soda will be required the day prior to the procedure.



  • 7. Premedication (sedation) is rarely necessary, although intravenous fentanyl and/or midazolam can be useful in unusual circumstances. Institutional sedation guidelines must be followed in such cases. Severely painful conditions may require scheduling examination with sedation or under anesthesia.


May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Anoscopy and Rigid Sigmoidoscopy
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