Rectoscopy (Rectal Endoscopy)

Rectoscopy (synonym: rectoscopy) is an invasive, non-invasive endoscopic procedure for examining the rectum (rectum) and the sigmoid colon (sigma). With the help of studies, it has been demonstrated that rectoscopy can be considered diagnostically groundbreaking in the detection of inflammatory changes on the one hand and tumor-related changes on the other.

Indications (areas of application)

  • Chronic inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis) – both for monitoring the course and detecting the disease In Crohn’s disease, there is segmental involvement of individual bowel segments caused by an autoimmune process. Ulcerative colitis is characterized by frequent sigmoid infestation, but it is continuous.
  • Exclusion of stenoses (narrowing) and diverticula (protrusions of the intestinal wall).
  • Blood spotting in the stool – to clarify the cause of bleeding.
  • Hemorrhoids – for control examination.
  • Polyps in the intestinal area – for detection and removal.
  • Constipation (constipation) – unclear cause.
  • Mucus discharge during defecation

Contraindications

  • A crucial criterion for a contraindication (counterindication) for the use of this method is a too low quick value (reduced blood clotting).
  • In a severely deteriorated general condition, a rectoscopy should be refrained from.

Rectosigmoidoscopy is the safest and most accurate procedure for detecting all rectal cancers and a variety of the sigmoid cancers.

The procedure

Rectoscopy is now often performed as a combination examination of the rectum and sigmoid colon and is consequently referred to as rectosigmoidoscopy. If an entire colonoscopy is to be performed, it is referred to as a colonoscopy. With the help of this procedure, which is used especially for findings that are difficult to clarify, it is possible to make the entire rectum, which is about 15 cm long, including the distal sigmoid (end section of the sigmoid), visible to the examiner’s eye. In this visible area, it is therefore also possible to perform a biopsy (removal of body cells for examination, for example, for degeneration in the case of cancer). If one compares rectosigmoidoscopy with a conventional digital examination method, in which the physician performs a palpation examination with the aid of his fingers, it becomes clear that by using rectoscopy it is possible to penetrate into apically (further up) located sections of the rectum. Furthermore, even an X-ray image of the intestinal section to be examined is not sufficiently informative to dispense with rectoscopy. To the procedure of rectoscopy:

  • As preparatory measures of rectoscopy, it is necessary to inform the patient about the procedure of the examination as well as about the risks of the method. Once this has been done, the actual preparation for the examination can begin. About half an hour before the scheduled procedure, the area of the rectum to be examined is cleaned with the help of an enema. However, it is also the opinion of some doctors that the bowel cleansing is not useful, because the clysma fluid needed for this could mix with the existing stool and this would worsen or even prevent the intraluminal view (“reduced vision”).
  • Possible sedation (anesthesia) depends on the patient’s wishes and the experience of the treating physician.
  • Decisive for the performance of the examination procedure is the position of the patient. The preference of doctors is the knee-elbow position in which the patient bends his knees, so that the air distribution in the intestinal lumen (interior of the intestine) is optimal. The rectoscopy/proctoscopy chairs used today improve the quite uncomfortable posture and, if necessary, make it possible to maintain the assumed position even during longer examinations. Because of this, rectoscopy can also be performed on elderly or physically impaired persons. For bedridden persons, there are also special positioning techniques such as the Sims position.
  • In the actual examination procedure, the rectoscope is inserted into the anus using a specific lubricant and overcome the approximately 4 cm of the anal canal without additional image control.Simultaneously with the insertion of the rectoscope, the prevention of the closing reflex at the musculus sphincter ani externus (sphincter muscle) is performed with the help of the thumb. Following this passage, further examination is performed under image control. After about 15 cm, the rectosigmoidal flexure (bend) is reached, at which the guidance of the examination device must be particularly precise in order to prevent possible bowel perforation (tearing open of the bowel wall). With the help of the rectosigmoidoscope, an assessment can be made up to a distance of 30 cm after entering the anus.
  • Depending on the need for treatment (ablation of polyps, etc.), each examination procedure usually takes ten minutes, provided that there is a normal rectoscopic findings.

Possible complications

  • Injury or perforation (puncture) of the intestinal wall with injury to adjacent organs (e.g., spleen)
  • Injury to the sphincter (sphincter muscle) with the endoscope (very rare).
  • Injuries to the intestinal wall that lead to peritonitis (inflammation of the peritoneum) only after a few days.
  • More severe bleeding (eg, after polyp removal or tissue removal).
  • Accumulation of gases in the intestine possible, which can lead to colicky pain.
  • Hypersensitivity or allergies (e.g., anesthetics/anesthetics, dyes, medications, etc.) may temporarily cause the following symptoms: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
  • Infections resulting in severe life-threatening complications in the area of vital functions (e.g., heart, circulation, respiration), permanent damage (e.g., paralysis) and life-threatening complications (e.g., sepsis/blood poisoning) are very rare.