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SKILLS - Flexible Sigmoidoscopy

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WHAT IS IT?

Abstract

 

VOL: 99, ISSUE: 22, PAGE NO: 29

 

 

WHAT IS IT?

 


 

- Flexible sigmoidoscopy is an investigation that uses a flexible, fibreoptic endoscope to examine the rectum and sigmoid colon.

 


 

- It is usually performed in an outpatient clinic and is increasingly being carried out by nurse practitioners.

 


 

HOW DOES IT WORK?

 


 

- Videoscopes are now used. These consist of a camera-imaging tip that sends pictures from the endoscope to a high-resolution television screen.

 


 

WHY IS IT PERFORMED?

 


 

- As a diagnostic tool for patients with symptoms such as lower gastrointestinal bleeding or a change in bowel habit.

 


 

- To evaluate or follow up colitis affecting the rectum or descending colon.

 


 

- Up to 70 per cent of colorectal cancers are found within reach of a flexible sigmoidoscopy (Breeze, 2001).

 


 

CONTRAINDICATIONS

 


 

- Acute colitis/diverticulitis, severe cardiac and chest complaints, abnormal coagulation, liver cirrhosis and pregnancy.

 


 

PATIENT PREPARATION

 


 

- Take a full history from the patient.

 


 

- Explain the procedure and gain informed consent.

 


 

- The bowel is prepared, for example with a phosphate enema.

 


 

THE PROCEDURE

 


 

- Nurses support and monitor the patient and assist the endoscopist.

 


 

- Sedation is sometimes required.

 


 

- The patient is placed in a left lateral position.

 


 

- A digital rectal exam is carried out.

 


 

- Equipment is checked.

 


 

- The endoscope is lubricated and inserted into the anus.

 


 

- The lumen of the rectum and descending colon are followed using a selection of methods; torsion, withdrawal, twisting and untwisting.

 


 

- Air is insufflated to aid vision.

 


 

- Water may be passed down the endoscope to act as a wash and improve views.

 


 

- The endoscope is removed slowly, allowing full visualisation of the sigmoid colon and rectum.

 


 

- Biopsies may be also taken.

 


 

DURING THE PROCEDURE

 


 

- Observe the patient’s tolerance of the procedure.

 


 

- Provide reassurance, commentary and support.

 


 

- Watch out for any unexpected events for example vomiting, cardiorespiratory depression or vasovagal reactions.

 


 

- Assess and document the patient on completion of the procedure.

 


 

AFTER THE PROCEDURE

 


 

- Document all care given and any unusual events that have occurred.

 


 

- Provide written instructions on diet, medication, activity restrictions, follow-up and complications.

 


 

POTENTIAL OUTCOMES

 


 

- Normal mucosal appearance.

 


 

- Inflammatory bowel disease, diverticular disease, vascular abnormalities like angiodysplasia, strictures, neoplasm, colonic polyps, fissures or haemorrhoids.

 


 

- Flexible sigmoidoscopy is a good first examination. However, due to its limited view of the colon, further investigation is often required.

 


 

POTENTIAL COMPLICATIONS

 


 

- Major complications: colonic perforation, haemorrhage.

 


 

- Minor complications: incomplete procedure, abdominal discomfort, rectal bleeding.

 


 

WEBSITES

 


 

 


 

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