PATIENT INFORMATION
ANOSCOPY
REVISED DECEMBER 2004
The purpose of this document is to provide written information regarding the risks, benefits and alternatives of the proce-
dure named above. This material serves as a supplement to the discussion you have with your physician. It is important
that you fully understand this information, so please read this document thoroughly.
The Procedure: Anoscopy is a procedure that enables a physician or gastroenterologist to view the anus and anal can-
al. First, the doctor performs a digital rectal exam. The doctor inserts a lubricated, gloved finger into the anal canal to
check for any surface irregularity. The doctor then inserts a lubricated plastic anoscope a few inches into the anal canal.
This allows the doctor to view the entire anal canal using a light/magnification. A tissue biopsy can be taken if needed. As
the scope is removed, the surface of the anal canal can be carefully inspected. This test is commonly used to determine if
a patient has hemorrhoids, anal polyps, abscesses, inflammation, fissures, dysplasia, cancer or an infection.
Benefits
You might receive the following benefits. The doctors
cannot guarantee you will receive any of these benefits. 1. Improved accuracy of diagnosis.
Only you can decide if the benefits are worth the risk.
Risks
Before undergoing one of these procedures, understand- 2. The rectum may be punctured, necessitating further
ing the associated risks is essential. No procedure is treatment.
completely risk-free. The following risks are well recog- 3. There may be injury to adjacent organs.
nized, but there may also be risks not included in this list 4. If an anal biopsy is taken there may be excess bleed-
that are unforeseen by your doctors. ing or an infection may develop.
1. There may be some bleeding.
Alternatives
The alternatives to this procedure include: If you decide not to have this procedure, there may be
1. Not undergoing anoscopy. associated risks to this decision. Please discuss it with
your doctor.
If you have any questions regarding the procedure, risks, benefits, or alternatives to
this procedure, ask your physician prior to signing any consent forms.
11/10/04 1
You should inform the clinician prior to TREATMENT:
the procedure if you: The best treatment for high-grade anal
have an abnormal or artificial heart dysplasia is currently being assessed. ANAL DYSPLASIA:
valve Options such as surgery or the applica-
are taking Coumadin tion of Trichloroacetic acid to the area ANAL CYTOLOGY AND HIGH-
have a low platelet count have been used. Newer treatments RESOLUTION ANOSCOPY (HRA)
have a low white blood cell count such as Infra Red Coagulation may INFORMATION SHEET
prove also to be useful in this area. Ad-
The entire procedure including biopsies ditionally a therapeutic vaccination for BACKGROUND:
should take around 30-45 minutes. anal dysplasia is in development. The cells of the anal canal can develop
varying degrees of abnormality (dys-
FOLLOW-UP: plasia) ranging from mild to severe
The subject of anal dysplasia is a rela- changes that are related to infection
tively new one and treatment and fol- SYMPTOMS: with genital wart virus (human papillo-
low-up strategies for anal cytology and It is important for all persons with mavirus or HPV).
biopsy results are still being researched anal dysplasia to report symptoms
Lesions showing moderate or severe
and developed. In general terms the that may indicate progression to anal (high-grade) dysplasia are thought to
following will be discussed with the re- cancer. This includes pain, bleeding, eventually lead to anal cancer in some
levant diagnosis: and the development of a new mass people. Currently it is impossible to
CYTOLOGY: or lump. predict who will progress from high-
Normal -Repeat cytology in grade dysplasia to cancer.
one year While these symptoms are common
Abnormal -Refer for HRA and anal and most often NOT associated with The development of high-grade dys-
anal cancer, in the setting of anal plasia and anal cancer, although still
biopsy rare, happens more frequently in the
BIOPSY: dysplasia a clinician should still as-
presence of HIV infection. It is thought
Normal - Repeat cytology in one sess you. that by screening for anal dysplastic
year lesions, that progression to anal cancer
Low-Grade - Repeat HRA and biopsy may be prevented in much the same
in 6 months way as abnormal cervical changes in
High-Grade - Offer treatment. women can be screened for and
treated to avoid the progression to cer-
vical cancer.
Alternatively, the dysplasia can be mo-
nitored by regular HRA examinations.
ANAL CYTOLOGY:
The exam is performed lying in a fetal
Anal cytology screening is a method of position on the left hand side. No seda- Any immediate bleeding will be stopped
sampling the cells of the anal canal to tion is necessary as the procedure is by the clinician, but lesions may bleed
detect any cellular abnormality, which not painful. slightly with bowel movements for up to
can then be more accurately assessed ten days. It is advisable to refrain from
by HRA. Firstly the clinician examines both the receptive anal sex or inserting toys or
The cytology procedure involves insert- external anal area and the anal canal fingers until the bleeding stops.
ing a moistened ‘Q-tip’ 2 inches into the with a finger.
anal canal and removing it slowly with a
spiral motion against the surface of the An anoscope is lubricated with local
anal canal to collect as many cells as anesthetic gel and inserted. The anos-
possible. cope is a plastic tube through which a
Q-tip wrapped in gauze and soaked in As with any other biopsy, complica-
Anal cytology will give an indication of diluted vinegar is inserted. tions such as excess bleeding or in-
‘abnormality’ that can then be more ac- fection are possible but very rare.
curately assessed by HRA and anal bi- The vinegar is important as it makes
opsy. any abnormal anal cells more obvious,
HRA: but may feel cold or sting mildly. Normally you should expect to see
some blood with bowel movements or
HRA allows any dysplastic areas in the The swab is removed after one minute on wiping for 7 to 10 days. If there is
anal canal to be mapped and biopsied and the anoscope re-inserted. The clini- ever blood dripping from the biopsy
to assess the severity of dysplasia. cian can then identify any abnormal area, or if you develop a constant or
Before an anal exam it is important not anal changes, usually by using more throbbing pain in the area with fever,
to put anything in the anal canal for 24 vinegar and an Iodine stain, which contact the clinician immediately.
hours beforehand. This includes should then be biopsied to assess their
sex/douching/dildoes/ fingers as all of degree of abnormality.
these activities may alter the anal ap-
pearances and so give a less satisfac- An anal biopsy takes a piece of tissue
tory exam. There is no need to worry the size of a pin-head (2mm3) from the
about being clean, as this is not an is- anal canal. The procedure is painless,
sue in the anal canal (the first 2 inches although a tugging sensation may be
inside) as it would be for an exam fur- felt at the time of the biopsy.
ther up in the colon.