Rectoromanoscopy

Sigmoidoscopy is a diagnostic method that most of us have not heard of. Meanwhile, this research method is widely used to diagnose diseases of the urogenital area, rectum and sigmoid colon. Most often, the diagnostic procedure is prescribed by a proctologist.

Together with our experts, we found out how sigmoidoscopy is performed and to whom it is prescribed. They also learned about the nuances of preparing for sigmoidoscopy – diet, drugs and cleansing procedures.

What is sigmoidoscopy

Sigmoidoscopy is a study of the rectum and sigmoid colon. The procedure is performed using a special device – a rectoscope.¹. This is a tube or tube with a diameter of 1,8–2 cm and a length of approximately 35 cm with illumination, a camera, a magnifying lens and an air supply system¹. Tubes are made from different materials, but nowadays disposable plastic tubes are usually used.

The rectoscope is inserted into the anus of the patient to examine the condition of the intestinal mucosa to a depth of approximately 30 cm. During the examination, the image from the camera is transmitted to the monitor, the equipment also allows you to enlarge the picture and record.

Sigmoidoscopy can be combined with other diagnostic and therapeutic procedures. During the procedure, you can remove a foreign body, cauterize a bleeding vessel, remove a polyp and take tissue for a biopsy. In this case, a proctoscope with operating equipment is used.

Indications for sigmoidoscopy

With the help of endoscopic examination of the rectum and sigmoid colon, inflammatory processes, developmental anomalies, foreign bodies, injuries, hemorrhoids, benign and malignant neoplasms are detected². The procedure is prescribed for patients who have been diagnosed or suspected of having such diseases as:

• BPH;
• internal hemorrhoids;
• polyps of the rectum and sigmoid colon;
• ulcerative colitis;
• anal fissures, fistulas and abscesses;
• malignant tumors of the rectum and sigmoid colon.

As a rule, these pathologies are accompanied by characteristic symptoms: pain during defecation, bleeding from the rectum, chronic constipation. But it also happens that the disease is asymptomatic. In this case, the doctor may prescribe a preventive examination if the patient is at risk (age over 45 years old, oncological diseases of the rectum and sigmoid colon in the next of kin).

Sigmoidoscopy is often performed before surgery. For example, in patients diagnosed with rectal cancer, the localization of the tumor is determined with the help of a study in order to select the optimal tactics of the operation.

Contraindications for sigmoidoscopy

All contraindications to sigmoidoscopy are relative, that is, the procedure can be performed if the person’s condition improves. Endoscopic examination of the rectum and sigmoid colon is contraindicated in patients with acute heart and respiratory failure, massive intestinal bleeding, immediately after a stroke and traumatic brain injury. The study is not carried out with stenosing tumors of the anal canal, narrowing of the lumen of the rectum, thrombosis of hemorrhoids.

Preparation for sigmoidoscopy

Endoscopic examination can be performed only if there is no food, gases and feces in the intestines^2,3. Therefore, in preparation for sigmoidoscopy, they follow a diet, take laxatives and do cleansing procedures.^1,2.

Diet menu

During preparation for sigmoidoscopy, they switch to a low-slag diet^1,2. 2-3 days before the procedure, you need to give up products that cause gas formation. These are legumes, rye bread, fresh fruits, cabbage, beets, herbs, alcohol, kvass, juices and carbonated drinks.^1,2.

On a diet before sigmoidoscopy, you can eat:

• dietary meat;
• dairy products;
• cereals except barley, oatmeal and millet;
• weak broths.

On the eve of the examination, they do not have dinner, only tea is allowed. On the day of the procedure, food must be avoided.

Preparations

Colon cleansers are used as an alternative to enemas. To prepare for sigmoidoscopy, specialized drugs are used, such as Moviprep, Pikoprep, Phosphofleet. Forlax^1,2. Macrogol-based drugs are considered the most effective, a substance that retains water in the intestinal lumen and thereby increases osmotic pressure and peristalsis. The drugs from this group include Fortrans and Moviprep.

Enema

To cleanse the intestines, you can use ready-made microclysters, for example, Microlax and Enema-Clean^1,2. These are saline solutions for rectal administration, which have a laxative effect.^1,2. Microclysters are placed a few hours before the procedure.

You can use the classic method – put an enema using Esmarch’s mug^2,3. In this case, 1,5 liters of water with a temperature of about 36 ° C is injected into the rectum.^2,3. Purification is carried out until the washing water is clean. The procedure is performed on the eve of the study and again the next day, no later than 4 hours before the procedure.^2,3.

Where is sigmoidoscopy performed?

Endoscopy is performed on an outpatient basis and in a hospital. Sigmoidoscopy is done in public clinics and hospitals, private clinics and diagnostic centers.

How is sigmoidoscopy performed?

Before the procedure, the patient removes all clothing from the lower body, puts on disposable underwear and stands on a special couch in the knee-chest position or lies on his side. Then the doctor performs an external examination and palpation of the anal canal to identify eczema, external hemorrhoids, polyps, rectal prolapse. After that, a tube is inserted into the anus, which was previously lubricated with vaseline oil or a special gel. The device is introduced gradually with rotational movements, up to the distal sigmoid colon (to a depth of about 30 cm from the anus).

During the examination, air is injected through the tube so that the folds of the mucous membrane straighten out and all the examined areas become visible. After performing all the manipulations, the sigmoidoscope is carefully removed. On average, the procedure takes from 10 to 30 minutes, depending on the anatomy of the intestine and the complexity of the diagnosis.

How much does a sigmoidoscopy cost

The cost of the procedure depends on the region, clinic, equipment used and the amount of medical and diagnostic manipulations. Conventional diagnostic sigmoidoscopy is cheaper than medical or biopsy. In Moscow, prices for sigmoidoscopy start at 1800 rubles, the average cost of the procedure is about 3000 rubles.

Popular questions and answers

Sigmoidoscopy can be prescribed to people of all ages as part of a preventive examination and if a specific disease of the rectum and sigmoid colon is suspected. Therefore, it will not be superfluous to find out how painful this procedure is and what complications it can cause. Our experts answer readers’ questions: surgeon, coloproctologist Tatyana Gavrilova and candidate of medical sciences, surgeon of the highest category Maksud Magomedov.

Sources:

1. Rectoromanography. Standardization of procedure. Recommendations. Central Clinical Hospital No. 6 of Yekaterinburg https://endoexpert.ru/vse-dlya-raboty/sop-rektoromanografiya/
2. Preparation for endoscopic examination of the intestine. https://medexpert.website/download/podgotovka2.pdf
3. Journal “Actual issues of endoscopy”. Guidelines for preparing patients for endoscopic examinations. https://clck.ru/ajsmW