Sigmoidoscopy

What is flexible sigmoidoscopy?
Flexible sigmoidoscopy is a procedure, which enables the direct visualization of the lining of the rectum and a portion of the colon (large intestine). A flexible tube is inserted into the anus and slowly advanced to the lower part of the colon.

What preparation is required?
In general, preparation consists of one or two fleet enemas prior to the procedure. In some circumstances, you may be advised to forgo any special preparation.

Should I continue my current medications?
Most medications can be continued as usual. Inform us about medications that you’re taking, particularly aspirin products or anticoagulants (blood thinners). Also, inform of us of any allergies you have to medications.

What about Aspirin?
Do not stop aspirin.  You may have stopped aspirin before a previous Sigmoidoscopy. The latest research and guidelines tell us that it is safe to perform routine sigmoidoscopy and polyp removal while patients continue their aspirin.  The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about Plavix® (clopidogrel)?
Do not stop Plavix® (clopidogrel). You may have stopped Plavix® before a previous Sigmoidoscopy. The latest research and guidelines tell us that it is safe to perform routine sigmoidoscopy and polyp removal while patients continue their Plavix®.   The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

What about Pradaxa® (dabigatran)?
Please stop taking Pradaxa® (dabigatran) 36 hours before your EMR.  Pradaxa® (dabigatran) has an extremely short half-life, unlike Coumadin®, which means the blood thinning effect is gone after 24-36 hours after stopping the medication.

What about Coumadin®?
Do not stop Coumadin®.  You may have stopped Coumadin® before a previous Sigmoidoscopy. The latest research and guidelines tell us that it is safe to perform routine sigmoidoscopy and polyp removal while patients continue their Coumadin® as long as there INR is in the routine therapeutic range of between 2 and 3. The data also shows us that the risk of bleeding is very low and when compared with the risk of a stroke or other clotting event, bleeding is relatively easy to control.  Major clotting events, such as stroke can leave irreversible damage.

Will I need antibiotics?
No. Even if you have a prosthetic heart valve or other prosthesis, the latest recommendations by the Gastrointestinal and Cardiovascular societies do not recommend the use of antibiotics for routine sigmoidoscopy regardless of prosthetic devices.

What can I expect during flexible sigmoidoscopy?
Flexible sigmoidoscopy is usually well tolerated. You will be given a sedative, propofol, by our anesthesia team who will be present to monitor your vital signs during the examination.  You will lie on your left side during the examination.

What if the flexible sigmoidoscopy finds something abnormal?
If there is an abnormal area in the colon, a biopsy may be taken for further analysis. If a polyp if found, a biopsy is usually taken. A colonoscopy (a complete examination of the colon) is usually then recommended to remove the polyp and to search for additional polyps that may be present in areas of the colon that were not visualized by the sigmoidoscopy.

What happens after a flexible sigmoidoscopy?
The results of the examination will be discussed with you. If a biopsy was taken or a polyp was removed, the material is sent to a pathology lab and the results are available in approximately 5 business days. Your results will be given to you directly at a follow-up appointment or you will receive a letter via standard mail delivery with the results and recommendations for follow-up.  All of the results, including your pathology results and procedure reports will be forwarded to your primary care physician and the physician that referred you to Gastroenterology Consultants.

You will not be allowed to drive for 12 hours. You will need to arrange for someone to escort you home from our office. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You might have some cramping or bloating because of air that is introduced into the colon during the examination. This should disappear quickly when you pass gas.  Walking is the best way to pass the excess gas quickly.

What are possible complications of flexible sigmoidoscopy?
Flexible sigmoidoscopy and biopsy are considered very safe. Complications are rare, but it’s important for you to recognize early signs of possible complications. Contact us if you notice severe abdominal pain, fevers and chills, or rectal bleeding of more than one-half cup. Note that rectal bleeding can occur several days after a biopsy.