Colonoscopy

Your doctor has advised you to have a special camera test to help find the cause of your symptoms or check your bowel because of a family history of problems. The test is called a Colonoscopy. This leaflet has been designed to tell you how to prepare for the examination and also to answer some commonly asked questions, if you have any concerns please contact the Endoscopy Unit on (01535) 292341.

Please inform the unit if you are unable to keep your appointment as it may be given to someone else.

The Endoscopy Unit deals with out-patients and in-patients including emergencies from wards and other departments.

The appointment time you are given for the day of your procedure is the time we would like you to arrive at the Endoscopy Unit and not the time you should expect to have your procedure performed. You should expect to be in the department 2-4 hours.

If a relative or friend is collecting you after the procedure, it is advisable that you provide the nurse with their contact telephone number so that we can call them when you are nearly ready to leave the Unit; this will prevent them waiting for a long period of time.

The Endoscopy waiting room has limited seating room; if your relative or friend wishes to remain in the hospital until you are ready to go home please ask them to wait in another area such as the cafeteria so that patients have access to the seats.

The hospital has a training commitment and the Endoscopy Unit is a training unit. Your procedure may be performed by a trainee endoscopist who will be supervised by an experienced endoscopist. If you do not wish to have your procedure performed by a trainee, then please let the nurse know at your pre-assessment appointment.

A Colonoscopy is a test which allows the Endoscopist to look directly at the lining of the large bowel (colon). A long flexible tube about the width of your finger is inserted into the back passage (anus). The tube is passed around the entire length of the colon and pictures are displayed on a television screen allowing the Endoscopist to detect any abnormal areas.

The test takes approximately 30 minutes to complete but can take a little less and in some cases a little longer.

Biopsy – tissue samples may be taken and sent to the laboratory for analysis. You will not usually feel any pain when this is done.

Polypectomy – polyps (abnormal growths) can also be removed during colonoscopy and sent for analysis. You will not usually feel pain when this is done.

Endoscopic Mucosal Resection (EMR) may be used to remove larger polyps. EMR does increase the risk of perforation but is still considered to be a safe procedure.

Colonoscopy is an established and safe procedure but very rarely it can result in complications. Some of these can be serious and can even cause death (1 in 15,000). The possible complications are listed below.

Pain – the test can be uncomfortable and even painful at times, but every patients experience will be different. You will be offered a choice of pain relief

Perforation (risk: less than 1 in 1,000). The risk is higher if a polyp is removed (risk: less than 1 in 500). This is a serious complication; you may need surgery which can involve forming a stoma (bowel opening onto the skin).

Bleeding from a biopsy site or from minor damage caused by the endoscope (risk: less than 1 in 1,000). This usually stops on its own.

Bleeding, if a polyp is removed (risk: 1 in 100). Bleeding usually stops soon after a polyp is removed. Sometimes bleeding can happen up to two weeks after the procedure. Let the Endoscopist or nurse know if you are on Warfarin, Clopidogrel or other blood-thinning medication. You may need to stop your medication before having a polyp removed. If you have not been given instructions about your medication please contact the Endoscopy Unit.

Incomplete procedure – This is when we cannot complete the test on the day. Your doctor or the Endoscopist may recommend another Colonoscopy or a different test.

Missed pathology – a very small percentage of the colon is not seen during colonoscopy so there is a small risk that abnormalities could be missed. However, colonoscopy is the best and most accurate available examination of your bowel.

1. Entonox – Entonox is a medical gas; it is a mixture of 50% Oxygen and 50% Nitrous Oxide.

Entonox is used for pain relief during childbirth, acute trauma such as broken bones and other medical procedures and it is very effective for pain relief during Colonoscopy.

You will be given a mouthpiece through which you will breathe in Entonox. The mouthpiece is connected to a demand valve system which only delivers Entonox to you as you breathe in.

Entonox will begin to take effect after 2 or 3 inhalations of the gas. You should take these initial breaths just before the procedure begins and you can continue to breathe the Entonox as much as you need throughout the procedure, you are in control of how little or how much you take. You will still be able to hear and talk with the staff and follow instructions.

The advantage of Entonox is that the effects wear off quickly once you stop taking it so you will be able to take yourself home after your procedure and you do not need anybody to look after you. You can drive 30 minutes after taking Entonox and continue your day as normal.

Like all medicines, Entonox may cause side effects, although not everybody will experience these.

Common side effects that are generally minor and rapidly reversible are: dizziness, light-headedness, sickness, tingling, and disorientation.

Less common side effects are: problems with the ear due to increased pressure inside the ear, tiredness, bowel enlargement due to trapped gas.

You cannot use Entonox if you have a condition where air may be trapped in some part of your body, collapsed lung, decompression sickness (the bends), or if you have been diving within 48 hours, severe lung disease such as bullous emphysema, head injury within 24 hours, colonic volvulus or blockage, suspected or known increased pressure on the brain, an inability to hold the apparatus or understand how to use it, decreased levels of consciousness, if you have had a laryngectomy or if you have had recent surgery to your eyes or ears where injections of gas have been used.

2. Conscious Sedation and Analgesia – Sedation is given via a cannula and helps to relax you but it does not put you to sleep. It is usually given together with a painkilling medication. You will still be able to hear and talk with the staff and follow instructions. After the procedure you will be taken to the recovery area to rest and you will be given refreshments.

If you have sedation you must have a responsible adult to collect you from the Endoscopy Unit to take you home and stay with you for 24 hours as the medication can stay in your system during this 24 hour period. You cannot drive, drink alcohol, operate heavy machinery, look after small children by yourself or sign legal documents during this 24 hour period. You are not permitted to travel home on public transport.

Side effects and risks – because the sedative tends to make your breathing slower and shallower, your oxygen levels can drop. You will be given extra oxygen through nasal cannula during and after the procedure and your oxygen levels will be monitored. It can also cause irregularities in your heart beat, therefore your pulse will also be monitored.

Pre-assessment clinic

Prior to the day of your procedure, you will have a pre-assessment (usually by telephone). The nurse will ask you a number of questions about your health to ensure you are able to prepare safely for your procedure. It is important that you have a list of all your medications to hand to give to the nurse. If you are unsure about your medication, contact your GP practice and ask them to provide you with a list. You will be able to ask any questions you may have about the procedure.

Interpreters – Family members and friends cannot be used to interpret. Please inform the Endoscopy Unit if you require an interpreter before you attend for your appointment. Failure to do this can result in cancellation or delay.

Pacemakers or Implanted defibrillators – If you have one of these devices you must tell the nurse at the pre-assessment clinic as your pacemaker or defibrillator may need to be checked before the procedure and arrangements need to be made for this. Failure to do this can result in delay or cancellation. Please bring your pacemaker/device identification card with you.

Blood thinning medication – If you are taking medication to ‘thin’ your blood e.g. Warfarin, Clopidogrel, Ticagrelor, Rivaroxaban or Dabigatran you may need to stop this prior to your procedure.

The nurse at pre-assessment will advise you about this. Please ensure you tell the nurse you are taking this medication. If you are taking Warfarin your INR will be checked on the day.

Bulking agents – If you are taking bulking agents such as bran or Fybogel you should stop taking these one week prior to the test. Ask the nurse at pre-assessment if you are unsure about this.

Iron tablets (e.g. ferrous sulphate) – If you are taking iron tablets you should stop taking these one week before your test. Please ensure you inform the nurse at pre-assessment . If your doctor has told you that your procedure is urgent and will take place within two weeks, stop your iron tablets immediately and inform the nurse in pre-assessment.

Other medication (except diabetic medication, see below) – You may take any other medication as normal even on the day of the test. It is particularly important that you take your medication if you suffer from conditions such as epilepsy, heart problems or hypertension (high blood pressure) as your procedure may be cancelled if your blood pressure is too high or your heart rate is irregular. Please tell the nurse what medication you are taking so that he / she can advise you what to do.

Diabetic patients – If you have diabetes, the nurse in pre-assessment will give you advice and a written information sheet about your diet and medication.

To allow a clear view, the colon must be completely empty of waste material. The nurse at pre-assessment will arrange for you to collect some special laxative drinks to take prior to your test from the hospital and will provide you with information on how and when to take them. The purpose of the bowel preparation is to clear your bowel, diarrhoea is to be expected therefore you will need ready access to a toilet. We would advise you not to work during this period. You will also be told about dietary restrictions.

It is important that you follow these instructions carefully. Failure to do so may result in an unsuccessful examination.

Please follow the bowel preparation instruction as instructed by the nurse in pre-assessment. This may be different to the instructions contained in the box you have been given.

Whilst taking the preparation and following the dietary restrictions it is important to increase your intake of clear fluids to stop you becoming dehydrated and will also help to clean the bowel. You can continue to take clear fluids up until 2 hours before your procedure. If you suffer from renal problems, you should inform the nurse at pre-assessment clinic.

Side effects of the bowel preparation include nausea, vomiting, bloating, abdominal pain, anal irritation and sleep disturbance. If you experience severe vomiting, severe diarrhoea with dizziness, headache and confusion or feel generally unwell, please either contact the Endoscopy Unit or your GP.

You may be sent a copy of the consent form; please take the time to read the form in conjunction with this information so that you fully understand what you are agreeing to. The consent form will be signed when you attend for your procedure.

If you are caring for someone who is unable to give consent for the procedure themselves, you will not be able to sign the consent form for them even if you are their next of kin. The consent form should have been completed with the Consultant in clinic. If you are aware that the consent has not been done and the person you are caring for is unable to give consent please contact the Endoscopy Unit.

Withdrawal of consent – you can withdraw your consent at any point. If you withdraw your consent, the test will not end immediately as we will need to safely remove the instrument. If you have had sedation, you may not remember withdrawing your consent after the procedure.

Minimal make up should be worn when attending and it is also important that you do not wear nail varnish or false nails as these interfere with monitoring equipment used during the test. Wear only minimal jewellery e.g. wedding ring.

Arriving at the Endoscopy Unit

Report directly to the Reception Desk in the Endoscopy Unit, do not take a seat until you have given your name to the receptionist. If you need to speak to the receptionist in a more private area, please ask.

On the unit

A nurse will check your details with you and complete a short health questionnaire as well as check your pulse, blood pressure, oxygen level and temperature. An identity band will be placed on your wrist.

You will be asked to get undressed and change into a procedure gown. Shorts that can be worn during the procedure to maintain your dignity are available. Please ask the admitting nurse if you wish to wear the dignity shorts and they will provide you with a pair.

After the test

You will be taken to the recovery area where you will be monitored and assessed by the recovery nurse. The length of time spent in recovery will depend on whether you have Entonox or sedation and on how you feel following your procedure. Prior to leaving the recovery area you will be offered something to eat and drink. If you opt to have Entonox and are driving home you must wait at least 30 minutes after your last inhalation of Entonox before driving.

If you opt to have sedation a responsible adult will need to collect you from the Endoscopy Unit, take you home and stay with you for the next 24 hours. The effects of the sedation can last 24 hours, therefore it may be necessary to take the following day off work. During this 24 hour period you must not drive, drink alcohol, operate machinery, look after small children on your own or sign any legal documents.

On discharge the nurse will explain the results of the procedure and will give you a short written report.

Q. Will the test hurt?

A. The test can be uncomfortable and even painful at times even with pain relief. If you are finding the procedure very painful you can tell the staff who will try to reduce your discomfort and the procedure can be stopped if you wish.

Q. Will I be asleep if I have sedation?

A. No, you will not be asleep. The sedative helps to relax you and may make you feel drowsy, but does not put you to sleep.

Q. Will my relative be able to come in the room when I have my procedure?

A. No. Your relative or friend will not be able to go into the procedure room with you.

Q. What if I don’t have a responsible adult to look after me following sedation?

A. If you don’t have a responsible adult to look after you there is the option of  Entonox. However if you are adamant you want to have sedation you will need to be admitted to hospital overnight. If this is the case please inform the nurse at your pre-assessment.

Q. Will I need to get changed?

A. Yes, you will need to remove your clothing including your underwear. You will be given a procedure gown to wear. There is the option of wearing a pair of shorts to help maintain your dignity during the procedure.

Q. Will I get my results on the day of the test?

A. We will tell you as much as we can after the procedure however we may not be able to give you the full result. If specimens are taken or polyps are removed these need to go to the lab to be analysed and it can take a few weeks for these results to be available.

If you have any further questions please do not hesitate to contact the unit.