Flexible Sigmoidoscopy Periprocedural Care

Updated: Feb 01, 2016
  • Author: Gaurav Arora, MD, MS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Periprocedural Care

Preprocedural Planning

Typically, a sigmoidoscopy does not require a full colon preparation. A clear liquid diet on the day before the examination, along with overnight fasting, is usually sufficient; one or two tap-water enemas may also be given on the morning of the examination.

For patients with chronic or severe constipation, administration of a pegylated balanced electrolyte solution (eg, GoLYTELY, Miralax, HalfLYTELY) on the night before the procedure may be considered.

Free fatty acid suppositories have been reported to be well tolerated, with no significant side effects and good bowel-emptying effect and rectal cleansing. The height of scope insertion was also found to be similar to that with the conventional enema bowel preparation. [9]

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Equipment

A flexible video sigmoidoscope is used for the procedure. However, other instruments, such as a standard upper endoscope or a colonoscope (limited insertion), can also be used. Some centers commonly use pediatric colonoscopes for flexible sigmoidoscopy.

The scope contains a shaft, a control head, and an umbilical (which is connected to the video processor). The control head contains the up/down and left/right dials, the suction valve, the air/water valve, and a working channel through which a biopsy forceps or other accessories can be inserted. This channel can also be used to hook a large syringe for pushing water inside the colon.

The images from the camera are projected on a video monitor.

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Patient Preparation

Typically, no sedation is required for flexible sigmoidoscopy. If sedation is needed, fentanyl (or meperidine) and midazolam may be given intravenously. The preferred position for the patient is the left lateral position, with the hip and knee joints partially flexed.

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