Patients with diverticulosis are often told to avoid nuts and seeds in their diet to prevent an undigested seed from clogging a diverticular opening, although there is little evidence suggesting this. Patients with diverticulosis can be offered stool-bulking agents to soften the stools and reduce stool transit time. Prompt referral is suggested.ĭiverticulosis is believed to result from the colon's exposure to excessive intraluminal pressure. If a suspected cancer is encountered (an irregular, obstructing, friable or bleeding mass), it may be sampled for biopsy, but vigorous bleeding of the lesion may ensue. Polypectomy is performed during colonoscopy to facilitate the search for any additional polyps. Larger polyps (larger than 5 to 10 mm in diameter) generally are adenomatous and do not require a biopsy at sigmoidoscopy because they should be completely removed. If the polyp is adenomatous (tubular, villous, etc.), a full colonoscopy should be performed to look for synchronous proximal polyps. If the polyp is hyperplastic, no further treatment is necessary, because hyperplastic polyps are not associated with polyps in the proximal (right) colon. All polyps smaller than 5 mm should be sampled for biopsy. Use of preprocedural benzodiazepines can be helpful in reducing patient discomfort.ĭiminutive polyps (less than 5 mm in diameter) cannot be classified by visual inspection. Diverticulosis, hemorrhoids, nonspecific colitis and pseudomembranes may also be encountered during inspection. Polyps 5 to 10 mm or greater can be assumed to be adenomatous, and follow-up colonoscopy for complete polypectomy is required. Polyps less than 5 mm in diameter should be biopsied. Once the sigmoidoscope has been appropriately advanced, the scope is slowly withdrawn, allowing for the inspection of colon mucosa during withdrawal. The procedure involves the insertion of the sigmoidoscope through the anus and distal rectum and advancement of the scope tip to an average depth of 48 to 55 cm in the sigmoid colon. Most physicians report comfort performing the procedure unsupervised after 10 to 25 precepted sessions. Extensive training in endoscopic maneuvering, colorectal anatomy and pathologic recognition is required. Most organizations recommend screening at three- to five-year intervals beginning at age 50 for persons with average risk. Flexible sigmoidoscopy remains a common tool used for the periodic screening of colorectal cancer.
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