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1 The Quadrant Colonoscopy
Colonoscopy
The time of your arrival will be indicated on your letter. This is to allow time for your assessment and admission to be completed by the nurses. Your actual procedure time will therefore differ from your arrival time and you may well be in the hospital for the whole morning or afternoon. Please be prepared for what may be a long wait if unforeseen alterations to the consultant’s list occur. Bring a good book with you!


What is Colonoscopy?
A colonoscopy is a procedure in which the doctor uses an instrument called a colonoscope to look directly at the lining of the bowel. A colonoscope is a long, flexible tube, about the thickness of your little finger, which transits a picture to a TV screen.


Current Medication
You are advised to bring all your current medication with you on the day of your colonoscopy. If you are having sedation, your medication will be either locked away or given to an accompanying adult.


Preparation
You will have received a bottle of Senna and two sachets of Picolax which will cause the bowel to empty. Please follow the instructions carefully to ensure a good result, which is essential for a proper examination.


7 days before your colonoscopy
Stop taking any iron tablets or medications to control diarrhoea.

If you are taking Warfarin, your consultant will discuss with you whether or not you should continue your Warfarin prior to the procedure. Some patients are sometimes asked to stop this medication for a few days, to reduce the likelihood of bleeding. Should your consultant suggest continuation of Warfarin prior to the procedure, he/she will make sure that a blood test to check your INR (clotting time) is performed at an appropriate time before conducting the colonoscopy. If you have not received clear instructions or if you have any doubts, please contact The Quadrant and we will advise you.

Aspirin does not need to be discontinued.

If you are diabetic and have not received clear instructions regarding your medication prior to the procedure then please contact The Quadrant and we will advise you.

You may continue to take any other medications.


3 days before your colonoscopy
Follow the dietary advice below. You can continue to eat but avoid high fibre foods and choose low fibre alternatives.


2 days before your colonoscopy
Continue your low fibre diet. Drink plenty of fluids.

For morning appointments take the full bottle of Senna at 6pm with a drink of water.


1 day before your colonoscopy
For morning appointments – take the first sachet of picolax at 8am and the second at 4pm.

For afternoon appointments – take the full bottle of Senna with a drink of water at 8am and then take the first sachet of picolax at 4pm (you will take your second sachet tomorrow morning).

Stir the contents of the sachet into a cup or glass of cold water and allow to dissolve. Follow this with a litre of clear fluid over the next 2 hours. Following this you will experience a period of frequent bowel actions and diarrhoea.

STOP all solid food 24 hours prior to your appointment time. For example if your appointment is at 10.30am stop eating at 10.30am today.


The day of your colonoscopy
For afternoon appointments – take the second sachet of Picolax at 8am. Please continue to take plenty of clear fluids (water/clear sugary drinks e.g. lemonade) up until 2 hours before your appointment time. This will prevent you from becoming dehydrated. Please avoid drinks containing milk or cream. Soups are allowed as long as they don’t contain thickening agents.


Dietary advice
The following information may be helpful in choosing your diet during your preparation for your colonoscopy:

CHOOSE AVOID
Cereals: Cornflakes, Rice Crispies, Ricicles, Sugar Puffs, Coco Pops Wheat bran, All Bran, Weetabix, Shredded Wheat, oat bran, branflakes, wheatflakes, muesli, Ready Brek, porridge
White bread Wholemeal, high fibre white, soft grain or granary bread, oatbread
White pasta, white rice Wholemeal pasta, brown rice
White flour Wholemeal or granary flour, wheatgerm
. Fruit and vegetables
Savouries: chicken, turkey, fish, cheese and eggs All red meats
Puddings, pastries, cakes, etc: milk puddings, mousse, jelly (not red), sponge cakes, madeira cake, rich tea, marie or wafer biscuits Those containing wholemeal flour, oatmeal, nuts, dried fruit, etc. Fruit cake, Ryvita, digestive or Hobnob biscuits
Preserve and sweets: sugar, jelly jam, jelly marmalade, honey, syrup, lemon curd. Jam or marmalade with pips, skins and seeds, sweets and chocolates containing nuts and fruit muesli bars
Soups: clear or sieved soups Chunky vegetable, lentil or bean soups
Miscellaneous: salt, pepper, vinegar, mustard, gelatine, salad cream, mayonnaise Nuts, quorn, fresh ground peppercorns, houmous

If anything is unclear, please contact The Quadrant.


The procedure
When you arrive in the hospital, you will be taken to the ward where the staff will explain the procedure and you will be given the opportunity to ask questions before signing the consent form (if you have not already done so).

You will be asked to undress and change into a hospital gown. Please keep jewellery to a minimum. If at all possible, only wear wedding bands in order to avoid loss or damage occurring. Please do not bring excessive amounts of money with you. You may bring your own dressing gown if you wish.

You will be taken to the Endoscopy Suite (where the procedure will be performed). After you have asked the consultant any further questions, you will be made comfortable. A plastic clip will be placed on your ear or finger to monitor your pulse rate and oxygen levels. The doctor will give you a sedative injection which will make you feel sleepy and relaxed.

Oxygen will be administered to you via a mask. The doctor will pass the colonoscope carefully through the anus and into the large bowel (colon). Air will then be passed through it to distend the colon and give a clear view of the lining. This may cause some initial discomfort which should soon pass.

Sometimes the doctor will take a very small piece of tissue (biopsy) for analysis in the laboratory. Should you have a polyp (a wart-like projection of tissue) the doctor may remove this.


After the procedure
You will normally be able to go home 1-3 hours after the procedure. As you have been given a sedative injection, you must have someone to collect you from the hospital to take you home. For the next 24 hours you should follow the instructions as laid out below headed 'IF YOU HAVE HAD SEDATION'.

You may feel a little bloated with wind pains but these usually settle quite quickly. If you have had a biopsy or polyp removed, you may notice a small amount of bleeding. If this continues after 24 hours, or you are at all concerned, seek advice from your GP.


Results
Sometimes the consultant will be able to give you the results as soon as you have recovered from the sedation. However, if a biopsy was taken or a polyp removed, a follow-up appointment will be arranged by your consultant or the results forwarded to you.


Risks
Colonoscopy can result in complications such as reactions to medication, perforation (tear) of the intestine, bleeding. These complications are very rare (less than one in 1000 examinations), but may require urgent treatment, and even an operation. Colonoscopy may very rarely be fatal (less than 1 in 2000 examinations). Be sure to advise your GP if you have any severe pain, bloody stools, or troublesome vomiting in the hours or days after colonoscopy.


IF YOU HAVE HAD SEDATION
As you have had sedation, it is important for the next 24 hours to have someone stay with you and to observe the following instructions.
You should make arrangements for someone to take you home by car or taxi (public transport is not appropriate) and to stay with you for the next 24 hours.
Do not drive a car or any other vehicle, including bicycles (note that your insurance is invalid if you do so).
Do not operate machinery or appliances such as cookers and kettles.
Do not drink alcohol.
Do not make important decisions or sign important documents.
Do not lock the bathroom or toilet door, or make yourself inaccessible to the person looking after you.
Drink plenty of fluids and eat a light diet.
Take things easy for the next 24 hours, and if you have any problems, please contact your GP.
After 24 hours, the effects of the sedation should have worn off and you should be able to resume normal activities.


For further information on any aspect of the procedure, please contact The Quadrant.

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The above guidelines are derived from the Royal Devon & Exeter Foundation Trust information leaflet "Colonoscopy"



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Created and maintained by Dr Reuben Ayres, 1 The Quadrant, Wonford Road, Exeter, EX2 4LE, Devon