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SKILLS - Rigid Sigmoidoscopy (Proctoscopy)

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Abstract

 

VOL: 99, ISSUE: 30, PAGE NO: 27

WHAT IS IT?

- A rigid tube (or proctoscope) accompanied by a light source used to examine the rectum and sigmoid colon in investigations into lower gastrointestinal (GI) complaints.

- The procedure is usually performed in the outpatient clinic, increasingly by nurse practitioners.

- It may also need to be performed on the ward, for example before a barium enema (McLatchie and Leaper, 2002).

INDICATIONS

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

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

CONTRAINDICATIONS

- Painful perianal area.

- Pregnancy.

PATIENT PREPARATION

- Full explanation of the procedure should be given.

- Having such an intimate examination in an often busy and crowded clinic can be distressing for some patients. Privacy and dignity should be maintained at all times.

- Verbal consent must be obtained.

- Bowel preparation is rarely used.

PERFORMING A RIGID SIGMOIDOSCOPY

- A nurse should be available throughout the procedure to support and monitor the patient and to assist and chaperone the endoscopist.

- The patient is placed in a left lateral position.

- A digital rectal examination is carried out, using a lubricant, to ensure there is no obvious obstruction to a proctoscope.

- Equipment such as the light source and air insufflation are checked.

- The proctoscope is lubricated and inserted into the anus.

- A light source is attached to the proctoscope.

- Air may be insufflated to aid vision.

- Biopsies may be taken.

SAFETY CONSIDERATIONS

During the procedure:

- Observe the patient’s tolerance of the procedure, for example pain;

- Provide reassurance, commentary and support;

- Watch out for any unexpected events such as vomiting, cardiorespiratory depression and vasovagal reactions;

- Assess and document the patient’s status on completing the procedure.

After the procedure:

- Document all care given and any unusual events that occur;

- Provide written instructions regarding diet, medications, activity restrictions, follow-up and potential complications.

POTENTIAL RESULTS

- Normal mucosal appearance.

- Proctitis.

- Neoplasm.

- Rectal polyps.

- Fissures.

- Haemorrhoids.

POTENTIAL COMPLICATIONS

- Abdominal discomfort.

- Rectal bleeding.

CONSIDERATIONS

- There is debate about the use of rigid sigmoidoscopy in a modern gastroenterology/coloproctology service. With the increasing availability of outpatient flexible sigmoidoscopy, a more thorough and effective test, many outpatient clinics are using rigid sigmoidoscopy less frequently.

WEBSITES

British Society of Gastroenterology

Cancer Research UK (for patients)

FURTHER READING

Bateson, M., Bouchier, I. (1997)Clinical Investigations in Gastroenterology. London: Kluwer Academic Publishers.

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