Ano-/rectoscopyMedical editor Arild Nesbakken MD
Oslo University Hospital
Ano- /rectoscopy is done when:
- proven blood (visible or occult) or other symptoms suggestive of cancer in the rectum.
- postoperative control after earlier bowel cancer operation.
- Uncover polyps or infiltrating cancer in the rectum.
- Consider tumors exact location of the rectum, which is important in preparing the type of operation.
- Consider the exact location of the tumor , which is important in preparing the type of operation.
- Rectoscope, possibly anoscope
- Biopsy forceps
- Swabs on pole
- Fasting or change of diet is not necessary.
- The colon is emptied the day of the examination with enema, possibly with two Toilax® tablets the day before and enema directly prior.
- If the patient uses anticoagulants and it is necessary to take biopsies or slinging polyps (usually), the patients should consult their doctor to ensure the safety of taking a break in the medication according to the following rules:
- Plavix® and equivalent antiplatelet is not to be discontinued if they have been in use < 1 year, otherwise stop may be considered.
- Pradaxa®, Xarelto® and Eliquis® must be stopped two days before the examination, earlier if renal impairment.
- Restarted after two days if a sling resection or another examination that can cause bleeding is performed.
- Marevan® (warfarin) is stopped five days before the examination. INR is measured an hour before the procedure and should be below 1,8. If the patient has a high risk of thrombosis (heart valve and others) low molecular weight heparin must be considered. Start with double dose of Marevan® (warfarin) the same evening.
- Albyl-E® (Acetylsalicylic Acid) can be continued.
- Any other medications in the morning can be taken as usual.
If it is contraindicated to discontinuate (for example dual antiplatelet agent), and there is an indication to perform the examination as soon as possible, a tailored program should be made in collaboration with the general practitioner and possibly a cardiologist/haematologist.
- The anal canal is lubricated and palpated with a finger to ensure that the canal is open.
- A 25 cm long rigid scope with a diameter of approximately 2cm is inserted through the analcanal with oburator in place. Blind insertion approximately 4cm, direction towards umbilicus.
- Obturator is retrieved and further insertion is performed by using the eyes. First in the direction of 90 degrees backwards relative to the anal canal, then gradually more forward, follows the curve of rectum. A trained examiner can usually insert the scope into sigmoidum in a level 25 cm above the anal opening.
- Air is inflated into the bowel for dilation, the scope is retrieved and a full inspection is performed.
- Any polyps/tumors are identified and described in the best possible way
Exact location (level above anal opening and spread around circumferences).
- Biopsies are taken by neoplasms or inflammations.
The patient can leave the hospital immediately and start with regular medications the same day.
Examining physician follows up test results and informs the patient of any further investigation and control.