Anoscopy
Anoscopy is a diagnostic procedure that allows healthcare professionals to examine the anus, anal canal, and lower end of the rectum using an instrument called an anoscope. This examination is vital for identifying conditions such as hemorrhoids, anal fissures, abscesses, and tumors, including both benign and malignant types. Preparation for the procedure typically involves clearing the stool from the rectal vault, which may require a laxative or enema. During the procedure, patients are positioned to facilitate the examination, and a digital rectal exam is performed before the anoscope is gently inserted.
While some discomfort may occur, especially if the patient has pre-existing conditions like hemorrhoids, the procedure is generally considered low-risk. Results can vary, with normal findings showing no abnormalities and abnormal findings indicating potential health concerns. Recent advancements, such as high-resolution anoscopies and the potential use of artificial intelligence, are enhancing cancer detection and treatment strategies. Overall, anoscopy plays a crucial role in the early diagnosis and management of various anal and rectal conditions, allowing patients to return to normal activities shortly after the procedure.
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Subject Terms
Anoscopy
DEFINITION: Anoscopy is the examination of the anus, anal canal, and lower end of the rectum with an endoscope.
Cancers diagnosed:Anal cancer, rectal cancer, cancer of an unknown primary site
Why performed: Anoscopy is a diagnostic procedure to evaluate the presence of hemorrhoids, anal fissures, abscess, inflammation, tumors (malignant and benign), foreign bodies, infection such as condyloma or warts caused by human papillomaviruses (HPV), and anal squamous skin lesions associated with the human immunodeficiency virus (HIV).
Patient preparation: The patient is instructed to clear stool from the rectal vault. A laxative, enema, or other preparation may be necessary for complete emptying of the rectum. For pediatric patients, their parents should be counseled on proper preparations for the procedure so that the patients’ anxiety may be reduced. In emergency cases, preparation for the procedure may not be possible.
Steps of the procedure: The patient is asked to use a medical examination gown and to remove underwear. The position during the examination is either bending forward over the examining table or lying on the examination table on the patient’s left or right side with both lower limbs drawn up to the chest. The doctor performs a digital rectal examination wherein a gloved, lubricated index finger is inserted into the rectum to check for abnormalities and structures that can block visualization; the prostate is also examined in male patients. The external area of the anus is examined prior to the anoscope insertion. The doctor then uses the anoscope, a tubular instrument with a light source, to view the anus, anal canal, and lower rectum. The anoscope is lubricated prior to its insertion into the anus and anal canal; the patient may be asked to “bear down” during the insertion, as during a bowel movement. During the procedure, the patient may feel some pressure and the urge to defecate. A biopsy may be obtained during the procedure, as needed. The doctor slowly withdraws the anoscope as the anal canal is viewed carefully.
After the procedure: Patients can return to normal activities. If a biopsy was taken, then the patient may be instructed to have a sitz bath daily to relieve mild pain.
Risks: No significant risk is associated with anoscopy. A small amount of bleeding and mild pain may occur if the patient has hemorrhoids or if a biopsy was obtained.
Results: Normal results will show no structural or color abnormalities. Abnormal findings include hemorrhoids, fissures, infections, abscess, inflammation, or tumors.
In the 2020s, high-resolution anoscopies, essentially an anoscopy with magnification, were an advancement for cancer detection efforts. Another impending innovation was the use of artificial intelligence (AI). AI applications had the promise of not only assisting in detection but also in determining treatment options and for the early identification of relapses.
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