Proctosigmoidoscopy is a quick and normally painless examination which allows doctors to explore the walls of the rectum, the sigmoid colon and the lower part of the left colon (the so-called descending colon). It is not only useful for poser un diagnosticbut also for take samples or monitor the evolution of a pathology which affects the last centimeters of the large intestine. How is it going? What is the difference with a colonoscopy? What regarding pain? Answers from Dr Lucas Spindler, proctologist and hepato-gastroenterologist at St Joseph Hospital and member of the SNFCP (French National Society of Colo-Proctology) & Dr Aurélien Dupré, surgeon specialist in digestive oncology at the cancer center Leon Berard.
Definition: what is a rectosigmoidoscopy? What can be explored through this review?
Proctosigmoidoscopy is a common examination that allows to check the state of the rectum, the sigmoid colon, even the lower part of the left colon. Concretely, the doctors introduce a colonoscope (also called endoscope) in the anus of the patient (s) and make it progress slowly to the colon. As a reminder, this device takes the form of a flexible tube which makes it possible to visualize the mucous membranes, to use specific surgical instruments and to inject air into the digestive tract to distend the walls of the colon and ensure better visibility. In the presence of abnormal masses during the exploration, it can therefore make it possible to carry out a biopsy (a sample of tissue to be analyzed).
What is the difference between an anoscopy, a rectoscopy, a colonoscopy and a rectosigmoidoscopy?
Anoscopy, rectoscopy, colonoscopy and rectosigmoidoscopy all four make it possible to visualize the mucous membranes of the large intestine.
- anoscopy focuses on the anal canal;
- the rectoscope concentrates on the anal canal, the rectum and a few centimeters of the sigmoid colon;
- the rectosigmoidoscopy concentrates on the rectum, the sigmoid colon and a few centimeters of the left colon (the so-called descending colon);
- et colonoscopy allows you to examine the rectum, the entire colon and a few centimeters of the small intestine.
Rectosigmoidoscopy is less invasive than colonoscopy. It is therefore proposed when it is not necessary to examine the entire large intestine, says Dr. Spindler.
Nicknamed “short colonoscopy”, it is most often performed without general anesthesia and can go up more or less “high” in the colondepending on the patient’s discomfort and the effectiveness of the enema.
Colon cancer, bleeding, inflammation: what indications for a short colonoscopy?
“Rectosigmoidoscopy is both a diagnostic exam (in the face of proctologic symptoms), monitoring and treatment of certain pathologies“, emphasizes Dr. Dupré.
It can indeed be performed for diagnostic purposes in the presence of blood and / or mucus in the stool, diarrhea, abdominal pain, etc. But also in addition to dubious biological analyzes or in the face of the presence of a mass or a thickening of the wall of the rectum.
Cancer, IBD, diverticulitis… What diseases can it detect?
Rectosigmoidoscopy can participate in the diagnosis:
- of cancer du rectal ;
- of Colon Cancer (if the tumor is located on the sigmoid colon or the lower part of the left colon);
- chronic inflammatory bowel disease (sMALL) ;
- of one diverticulose or a diverticulitis ;
- of one infectious proctitis,
- of one ulcer in the rectum,
- of one angioma,
- etc.
Monitor and treat certain pathologies
Proctosigmoidoscopy may be necessary to remove polyps located in the rectum or sigmoid colon, but also for treat bleedingin case of hemorrhagic diverticulosis for example, specifies Dr Spindler.
Other cases sometimes justify a more or less regular follow-up by rectosigmoidoscopy to avoid complications or recurrences:
- the existence of a chronic inflammatory bowel disease (SMALL) ;
- of the history of polyps healing sigmoid colon or rectum;
- of the history of cancer of the sigmoid colon or rectum recently treated with surgery, chemotherapy and/or radiotherapy.
Preparation: what precautions should be taken before the examination (fasting, enema, etc.)?
Rectosigmoidoscopy does not require any restrictive preparation on the part of the patient: no need to fast or to adhere to a particular regime upstream. In other words, you can drink, eat and smoke before the examination, unless otherwise advised by the medical team.
Patients must be fully transparent regarding their medication history and consumption medications, including aspirin and blood thinners. A test the coagulation you sang may be requested to reduce the risk of bleeding.
On the other hand, two cleansing enemas at home will be required: one the day before the exam and the second a few hours before the exam. “This guarantees the cleanliness of the rectosigmoid, thus promoting visibility and precision during the examination, but also so as not to hinder the progress of the colonoscope”, specifies Dr. Dupré.
Note: the examination is rather quick and easy to bear, doctors do not normally prescribe neither painkillers nor anesthetic cream.
How is a rectosigmoidoscopy performed? With or without anesthesia?
Proctosigmoidoscopy is performed on an outpatient basis, without anesthesia. The medical team begins by installing the patient in a lying position on the left side (in lateral decubitus). Then the doctor perform a digital rectal examination to lubricate the area, relax the anal sphincter and detect any mass or lesion.
He then introduces the endoscope in the patient’s anus. As noted above, air (sometimes water) is introduced into the colon during the exam to smooth out the walls and samples can be made during exploration.
Note: “perform a rectosigmoidoscopy first does not prevent performing a colonoscopy at a later stage“, emphasizes Dr. Spindler.
What happens following the exam?
After the examination, patients may experience significant abdominal discomfort. He is invited to go to the toilet to evacuate the blown air. The discomfort and gas can last for a few hours.
Doctor then presents orally his first observations : possible presence of inflammation, lesions, polyps, etc. A more complete report is then written. Not to mention the results of any analyzes (in the event of a biopsy).
With regard to recovery, it is possible to eat and drink (light) right following the exam. Transit generally does not resume until the next day (the time that the intestines fill up following the enemas). You can resume your normal life without any problem.
Most of medications can be resumed the same day. However, antiplatelet and anticoagulants are generally resumed 24 to 48 hours following removal of a polyp. Similarly, avoid taking aspirin, NSAIDs and alcohol within 72 hours following rectosigmoidoscopy.
Anyway, if you present fever, chills, abdominal pain, blood in the stool in the days that follow, quickly contact your medical team or the emergency room (15, 112)
What regarding pain during the exam?
“The rectosigmoidoscopy is often badly experienced by patients for reasons of modesty”, concedes Dr. Dupré. It can cause discomfortdue to the blown air, but in any case it should not be painful. “We stop the progression of the endoscope as soon as the patient expresses pain”, insists Dr Spindler.
Are there any complications?
In the opinion of our two experts, the complications exceptional.
Endoscopic equipment is systematically disinfected to eliminate any risk of contamination and infection.
In rare cases, however, patients are victims of haemorrhage(s) or perforation(s) of the intestinal wall.
To limit the risks, do not hide your medical and surgical history and talk to your doctor regarding your current treatments!
