Flexible Sigmoidoscopy & Procedure Instructions
Flexible sigmoidoscopy is an endoscopic technique for visually inspecting the lower third of the colon and rectum with the use of a flexible tube with a light on the end. The examination is usually performed when visualization of the whole colon is not required. Examples include the evaluation of rectal bleeding, checking the status of an established patient with inflammatory bowel disease, or an abnormality seen on barium enema/CAT scan. Although flexible sigmoidoscopy was previously used as a tool for colon cancer screening, a full examination of the colon with a colonoscopy is now preferred and recommended.
What can I expect for sedation with my procedure?
Oregon Endoscopy Center (OEC) offers two different types of procedural sedation for endoscopic procedures: moderate sedation (also referred to as conscious sedation) and deep sedation. Both are safe for most patients, and your vital signs and breathing are monitored throughout the procedure during both types of sedation. Please note that these types of sedation are NOT general anesthesia that you would expect during surgery but are known as procedural sedation. Your doctor will determine which of these types of sedation is right for you when you are scheduled for your procedure, and it will also be run through your insurance to see which one is covered on your plan. Both modes of sedation aim to keep you comfortable enough to tolerate the procedure and to lie still enough so your doctor can examine your colon or upper GI tract organs (esophagus, stomach, and small bowel) thoroughly and safely. The vast majority of patients prefer deep sedation over moderate sedation due to a much faster recovery from the sedating effects of the sedatives.
Moderate Sedation
If you are scheduled for moderate sedation, you will have medications administered through your IV by a sedation-qualified registered nurse (RN) whose main role is to ensure you are comfortable and safe during the procedure. They will monitor your vital signs and breathing throughout the procedure. All RNs and physicians at Oregon Endoscopy Center are certified in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS).
Moderate Sedation Medications. RNs use a combination of medications that help you relax and decrease pain so you are comfortable during the procedure. The two most common medications used are fentanyl and midazolam, but other similar medications can be used if you have an allergy to these medications. The RN will give you small doses of medication at a time before the start of the procedure to make you drift off to sleep. The RN will administer more medication if you become uncomfortable during the procedure. Near the end of the procedure, they will allow you to wake up naturally. During the procedure, you should be able to open your eyes and respond if your nurse talks to you, and you should be able to follow their directions, i.e., rollover or take a deep breath. However, because of how these medications work, you will most likely not remember being briefly awakened during the procedure.
Breathing and Monitoring. As the medications start to work, they will make you sleepy, and your heart rate, breathing, and blood pressure may slow down or decrease. You will have an oxygen tube in your nose to keep your oxygen levels normal. Your vital signs, including blood pressure, heart rate, breathing rate, and oxygen levels, will be monitored continuously by the RN throughout the procedure.
Recovery. After the procedure, you will be brought back to the recovery area and monitored for another 20-30 minutes by the nursing staff. You will start to wake up near the end of the procedure and then even more in recovery. Conscious sedation medications wear off quickly, but everyone is different; some people are affected longer than others. You may feel sleepy, lethargic, woozy, foggy, forgetful, dizzy, light-headed, or “out of it” for many hours after this type of sedation. It is important to have a responsible driver to drive you home after the procedure and remain with you for a few hours, if possible. You should not drive, operate machinery, climb ladders, do any strenuous activities, drink alcohol, or use marijuana products after receiving conscious sedation. You may drive and return to normal activities the day after your procedure.
Deep Sedation
If you are scheduled for deep sedation, you will have medications administered through your IV by a certified registered nurse anesthetist (CRNA) whose main role is to ensure you are comfortable and safe during the procedure. They will monitor your vital signs and breathing throughout the procedure. All CRNAs are certified in Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS).
CRNAs are registered nurses who have received higher education focusing on anesthesia. They are not medical doctors.
Deep sedation. CRNAs mainly use a medication called propofol that will allow you to sleep during the procedure. Occasionally, the CRNA may give other medications, such as a strong narcotic, sedative, or medication to decrease pain at the IV site, in addition to propofol. It is not the norm in most cases, but it may be necessary in some cases to make sure you are comfortable. The CRNA will administer a dose of propofol to get you to sleep quickly to achieve deep sedation, then give you more throughout the procedure to keep you asleep. Near the end of the procedure, they will stop giving you the propofol, so you wake up naturally. You will be unaware of the procedure or discomfort while under deep sedation.
Breathing and Monitoring. Deep sedation will make your heart rate, breathing, and blood pressure slow down or decrease, but typically only a small and inconsequential amount. However, you will be breathing on your own, as breathing tubes/machines are unnecessary, and you will have oxygen tubing in your nose to assist with oxygen levels. Your vital signs, including blood pressure, heart rate, breathing rate, and oxygenation status, will be monitored continuously by the CRNA throughout the procedure.
Recovery. After the procedure, you will be brought back to the recovery area and monitored for another 20-30 minutes by the nursing staff. You will start to wake up near the end of the procedure and even more in recovery. Propofol wears off quickly, but everyone is different; some people are affected longer than others. Propofol is known to have people feeling back to normal much quicker, unlike other types of sedation, but it is still quite individualized. You may feel sleepy, lethargic, woozy, foggy, forgetful, dizzy, light-headed, or “out of it” for many hours after this type of sedation. However, all patients do not experience these effects after propofol. It is important to have a responsible driver to drive you home after the procedure and remain with you for a few hours, if possible. You should not drive, operate machinery, climb ladders, do any strenuous activities, drink alcohol, or use marijuana products after receiving propofol sedation. You may go back to normal activities the day after your procedure.
Because a 2-foot-long mechanical instrument is being inserted into the bowel, there is a risk of lacerating or perforating the bowel wall during this procedure. The estimated risk of this happening is 1 in 1,000 cases. Perforation of the bowel wall is a serious complication that requires surgical attention.
Alternatives to flexible sigmoidoscopy include a barium enema, which is an X-ray study of the colon. However, if the barium enema is abnormal, this usually leads to a follow-up examination with a flexible sigmoidoscopy or colonoscopy. Of note, biopsies and polyp removal cannot be performed during a barium enema.
Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.
