Flexible Sigmoidoscopy

HOW TO PREPARE FOR FLEXIBLE SIGMOIDOSCOPY

What is a Flexible Sigmoidscopy?

I think that there might be a problem with your anus and colon and therefore recommend that you have a procedure to examine these areas so that I can decide if you need any treatment. Occasionally this test is performed for those with gastrointestinal bleeding directly after a normal Gastroscopy.

During Flexible Sigmoidoscopy, I would pass a small tube with a camera from your anus for about 10cm into your sigmoid colon . I will usually take samples from your colon called biopsies, clip ulcers or band hemorrhoids that might be bleeding. 

Where do I go on the day of the procedure?

You will go directly to the endoscopy unit.

How do I prepare for the procedure?

There is no preparation required for Flexible Sigmoidoscopy. You DO NOT need to fast. However it is preferable that you evacuate your bowels before the procedure. You will normally be given 2 enemas to assist you to evacuate your bowels 30 minutes before the procedure. 

If I cannot drink or eat, can I take my medications?

Take all your medications as usual.

What other information should you inform me?

It is very important to inform me or the nurse if you are pregnant, have a pacemaker or have an implantable cardiac defibrillator. While endoscopy is safe in pregnancy, it is generally postponed until the second trimester unless absolutely necessary.¹ Patients with pacemakers and defibrillators will require consultation with a cardiologist. 

Drug Allergies.

It is very important to inform me or the nurse if you have any drug allergies especially to painkillers and antibiotics. However we do not administer any medications for Flexible Sigmoidoscopy.

Valuables

Please DO NOT bring any valuables on the day of the procedure such as jewelleries. You will be asked to remove it as metal items can interfere with our equipment.

Consent Form

A consent form should be signed before the test after being given all the important information as this allows you the opportunity to ask questions. This may be signed by yourself or may require to be signed by someone on your behalf. You can withdraw your consent anytime before the procedure. 

How are the scopes cleaned?

After each use they are thoroughly cleaned, disinfected and sterilised. The hospital cleans and

disinfects all scopes according to the specifications set by the manufacturer and International Guidelines.

Single Use Disposable Endoscope.

However, if you are concerned about the sterility of the endoscope, then you can now opt for single use disposable endoscope, this however costs significantly more. Please inform us if you wish to have a single use endoscope and we will give you a quotation.  

CONSENT

About the Condition

I would have explained the purpose for Flexible Sigmoidscopy such as inflammatory bowel disease or bleeding. 

Investigation Options and Alternatives

Flexible Sigmoidoscopy enables me to see the abnormality directly and take biopsies to determine the problem. 

Other options such as Barium Swallow and CT scan involve both radiation and contrast, but I will not be able to take biopsies. 

Treatment Options

Treatment options will depend on the nature of the problem.

Benefits

To diagnose and treat conditions involving the anus and colon. 

Risks

Complications following Flexible Sigmoidoscopy are rare, occurring in less than 1% of patients. These could be related to sedation, endoscopy, and complications related to diagnostic or therapeutic maneuvers.² 

Possible Adverse Effects or Complications

The most frequent and serious complications of sedation involve your heart and breathing. Adverse events from sedation include drop in oxygen level, slow breathing, low blood pressure, blocked breathing passage, irregular heartbeat and food particles going into lungs. Patients have rarely suffered heart attack or stroke, but these are usually very frail patients. We continuously monitor you throughout the procedure to reduce the risks.

The complications following Flexible Sigmoidoscopy are the same as Colonoscopy which include infection, bleeding, injury or tear to your colon. The risk of bleeding following Colonoscopy with biopsy is 0.41%. a tear to your colon or small bowel occurs in less than 0.1% of cases but this might require surgery to repair, and infection is rarely reported. Rarely, in patients who had polyps removed, there is a 0.16% risk of developing stomach pains after polyp removal called post-polypectomy syndrome. Complications typically are identified in the first 24 hours after the procedure.²

Residual Effects

Some minor blood spots are normal if polyps are removed or a lot of biopsies are taken. You might experience some pain or discomfort if your hemorrhoids were banded.  

Likely Results If Treatment Not Undertaken

Possibility to miss polyps, ulcers or cancers. 

Minors³

It is important to note that for the purposes of the Regulations, a patient who is unmarried and below 18 years of age does not have the capacity to give valid consent to any medical procedure or surgery in Malaysia.

Patients Who Are Incapable of, or Impaired with, Decision-Making Ability.³

Some patients might not be able to give consent such as those with dementia. When there is a relative, next-of-kin or legal guardian available, and the relationship well established or confirmed, the consent may be obtained from such a person if an elective or non-emergency operation is necessary according to the doctor.

Additional Procedures

I might occasionally take biopsies, burn or clip an ulcer, or remove a polyp. tie or inject glue into a swollen blood vessel leading to additional costs depending on findings during endoscopy. 

You can choose to perform diagnosis at first endoscopy and perform any treatment at a separate session but this costs more. Please inform me or the nurse if you wish to do so. 

Change of Mind

It is perfectly ok to change your mind even after you have signed the consent form. You can always inform me or the nurse if you no longer wish to have the procedure. Alternatively you can discuss your concerns with me such as pain and medication side effects.

WHAT TO EXPECT ON DAY OF PROCEDURE

Registration

On arrival, please take a number at the Registration Counter where you will be registered by the Counter Staff. You will then proceed to the Endoscopy Unit Counter where a nurse will perform a Safety Screening using a Checklist. 

Screening

The nurse will measure your blood pressure, heart rate, temperature, oxygen level and blood sugars if you are a diabetic. The nurse will also ask a series of questions regarding your health. Please inform the nurse if you are on blood thinners or if you have any concerns. 

Change of Clothes

You will be asked to remove your shirt and change into a hospital gown. You may keep your pants but you will have to remove your belt. 

Preparation for Procedure

The test can be carried out with a local anaesthetic throat spray to numb the throat or a conscious sedation (to make you drowsy and relaxed). However patients often prefer to be sedated for a pain free procedure.

A nurse will put a tube in the back of your hand if you are going to have some sedation. 

Waiting

You will then be taken into the waiting area and asked to lie down on a bed. You will wait for your turn. Occasionally emergency cases might cut the cue depending on their urgency. 

WHAT TO EXPECT DURING PROCEDURE 

Chaperone

All female patients will have a female nurse chaperoning them at all times during the procedure.

Monitoring Equipments

You will be connected to the monitoring machine for continuous monitoring of blood pressure, heart rate and oxygen level throughout the procedure.If you are having sedation, oxygen will be given via a small tube in your nose.

Exposure

Next your bum / backside / behind will be exposed fully to enable safe insertion of endoscope into the anus. This is especially important for female patients in order to minimize the risks of inserting the Colonscope into the vagina (female private parts). You are welcome to use a gauze or tissue paper to cover up if you wish to do so to protect your modesty. 

Flexible Sigmoidoscopy Procedure

I will pass the camera into your anus for about 10-15cm so that I can examine your rectum and sigmoid colon.

Small tissue samples (biopsies) of the lining of the rectum and colon will be taken to check especially in patients with diarrhoea and additional samples taken if needed to help find out what is wrong.

The whole process takes 5-10 minutes.

WHAT TO EXPECT AFTER PROCEDURE

Recovery

When the test is finished you will go to the recovery area, the recovery nurse will take your blood pressure, temperature, heart rate and oxygen level a few times and look after you until you go home. 

It is important for you to stay in your bed until the nurse tells you to go home. The sedation might not have fully worn off and you can fall and hurt yourself. 

You will be given something to drink and something to eat, then you can go home

Discharge 

I will briefly explain your results and a nurse will provide a copy of the report. You will then settle the outstanding bill before returning home. 

Follow-up

You will normally be given a follow-up appointment to see me as you might not remember the explanation given at the Endoscopy Unit due to the effects of the sedative. 

Biopsy Results

If you had any biopsy taken during the procedure, the results of the biopsy will be explained during the follow-up appointment. 

After Sedation

If you have had sedation it is advisable not to drive, drink alcohol, sign any legal documents or go to work for 24 hours 

After Endoscopy

It is normal to have some spotting after the procedure, however if you are bleeding a lot or worried, please contact the clinic.

REFERENCE

1. Savas N. Gastrointestinal endoscopy in pregnancy. World J Gastroenterol WJG. 2014;20(41):15241-15252. doi:10.3748/wjg.v20.i41.15241

2. (PDF) Colonoscopy-related complications in a nationwide immunochemical fecal occult blood test-based colorectal cancer screening program. Accessed January 9, 2025. https://www.researchgate.net/publication/328904320_Colonoscopy-related_complications_in_a_nationwide_immunochemical_fecal_occult_blood_test-based_colorectal_cancer_screening_program

3. Consent_Guideline_21062016.pdf. Accessed December 4, 2024. https://mmc.gov.my/wp-content/uploads/2019/11/Consent_Guideline_21062016.pdf