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!

Why do I need to have a colonoscopy?

Investigation of your large bowel may be necessary to help find the cause of your symptoms, help with treatment and, if necessary, to decide on further investigation.
Follow-up inspection of previous disease.
Assessing the clinical importance of the abnormality seen on an x-ray.
A barium enema examination or a CT scan are alternative investigations to colonoscopy, but samples of the bowel cannot be taken if an abnormality is found. A subsequent endoscopic examination may be required.

What is Colonoscopy?
A colonoscopy is a very accurate procedure in which the doctor uses an instrument called a colonoscope to look directly at the lining of the large bowel (colon). A colonoscope is a long flexible tube about the thickness or your index finger which transmits a picture to a TV screen. This allows the endoscopist to have a very clear view to establish if there is any disease or inflammation present.

The test also allows samples of tissue (biopsy) from the lining of the bowel to be taken and sent to the pathology department if necessary. The collection of tissue is painless and these samples are retained for further testing should this be required.

A video recording and/or photographs may be taken for your records. The procedure will be performed by your consultant and we will make the examination as comfortable as possible for you. When you are having your colonoscopy you will usually be given sedation.

Current Medication
If you are taking Warfarin or Clopidogrel please make sure that your consultant is aware of this. If in doubt, ring The Quadrant on 01392 272951 at least 1 week before your appointment. This is necessary to allow time for arrangements regarding your Warfarin or Clopidogrel medication to be made prior to the appointment. Your consultant will need to know why you are being prescribed the drug and will inform you regarding these medications prior to the procedure. You are advised to bring all your current medication with you for your admission. If you are having sedation, your medication will be kept with you or given to an accompanying adult.

Preparation
It is necessary to have a clear view of the bowel. Please follow the bowel preparation leaflet carefully to ensure a good result, which is essential for a proper examination. Do not follow the ‘Directions for the preparation of Picolax’ on the information leaflet in the Picolax box.

When taking these preparations some intestinal cramping is normal. If you feel clammy and faint, or if you vomit, please take no more preparation and ring The Quadrant on 01392 272951 for advice or contact your GP.

If you have diabetes and require further advice please ring The Quadrant on 01392 272951.

Please follow these steps to prepare for your colonoscopy
i) Five days before your colonoscopy or flexible sigmoidoscopy
If you take iron tablets or medications to control diarrhoea, please stop taking them until after your colonoscopy. You should continue to take any other medication, including laxatives.

ii) Three days before
You may eat your normal meals for the whole day but avoid high fibre foods such as fruit, vegetables, wholemeal bread and ‘All-Bran’ (please see dietary advice below).

iii) Two days before
You may continue to eat as yesterday until 1400, then you should stop eating solid food until after your appointment. You should drink plenty of clear fluids (aim for two cups an hour) and try to vary the drinks you take. Clear fluids include water, tea and coffee without milk, carbonated drinks, clear soups and broths made without thickening agents, beer, wine and spirits. Clear jellies and boiled sweets are allowed too, but avoid red ones as they may stain your bowel! Please see the full list of permitted clear fluids below.

You may have been provided with Senna liquid to help prepare your bowel for colonoscopy. If so, at 1800 take 50mls of Senna liquid and wash it down with water.

iv) One day before
You have been provided with Picolax to cause the bowel to empty. Please take the first dose of Picolax at 0800 and the second sachet at 1600. Please follow the instructions provided within this booklet carefully to ensure a good result.

Please continue to drink plenty of clear fluids but do not eat any food (please see list of clear fluids below). You will need to be in close proximity to toilet facilities and you may find it necessary to spend the day at home.

Instructions for taking Picolax

Dissolve the contents of the sachet in a cup of cold water, it will warm up, but drink it when it has cooled down, followed by a litre of clear fluid over the next two hours. You should experience frequent bowel actions followed by diarrhoea 2-3 hours after taking Picolax.

v) The day of your colonoscopy
On the day of your examination continue to drink clear fluids until 2 hours before the procedure. You should then remain nil by mouth until your procedure.

Please follow these steps to prepare for your colonoscopy
You may find this information 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

Clear fluids
Below is a list of items that can still be taken after you have stopped eating solid food. They can be taken right up until 2 hours before the procedure.

All types of water.
Lucozade and any other “sports drinks”.
Black tea and coffee, this includes fruit and herbal teas.
Fizzy drinks e.g. coke, ginger beer, tonic water.
Clear fruit juice such as apple, cranberry, pomegranate, red and white grape juice. Not orange juice.
Any fruit squash.
Hot honey and lemon.
Oxo, Marmite, Bovril.
Consommé (clear soup).
Any sugar based sweets e.g. Jelly Babies, fruit pastels, wine gums, Foxes Glacier Fruits and mints, Polos. Jellies and dextrose tablets may also be taken, but avoid red colours.
Please do not have milk based drinks such as milkshakes and cappuccino or fruit smoothies.

Current medication
It is important that you make your nurse aware if you are taking any of the following medication so that they may decide if bowel preparation is suitable for you to take.

Diuretics (water tablets)
Corticosteroids for example Prednisolone
Lithium
Digoxin
Non steroidal anti-inflammatory medicines, for example Diclofenac and Ibuprofen
Tricyclic anti-depressants, for example Amitiptyline, Clomipramine, Trazodone
Antipsychotic drugs, for example Chlorpromazine, Clozapine, Risperidone
Carbamazepine
Antiepileptics
Diabetes medications
Antibiotics

Please also let the nurse know if you have any of the following conditions:

Gastrointestinal obstruction or perforation, Ileus, gastric retention, acute intestinal or gastic ulceration,toxic colitis or toxic megacolon.
Severe acute inflammatory disease.
Renal impairment.
Congestive heart failure.
Difficulty swallowing.

How long will I be in the Hospital?
This largely depends on how quickly you recover from the sedation, if you have requested it, and how busy the department is. You will normally be able to go home 1-3 hours after the procedure.

If you have been given a sedative injection, you must have someone to collect you from the Hospital to take you home.

What happens when I arrive?
When you arrive in the Hospital you will be seen by a qualified nurse or healthcare assistant who will explain the procedure and you will be given the opportunity to ask questions.

You will also be asked some questions about your travel arrangements for getting home. If you have requested sedation you will not be able to drive (your car insurance is invalid for 24 hours) or use public transport, so you must arrange for a family member or friend to collect you. The nurse will need a contact number so they can arrange for your collection once you are ready for discharge. If you have been given a sedative injection you must have someone to collect you from the Hospital to take you home.

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 and slippers if you wish.

Intravenous sedation
You will be taken to the Endoscopy treatment room (where the procedure will be performed). After you have asked the doctor any further questions, you will be made comfortable. A plastic clip will be placed on your finger or ear to monitor your pulse rate and oxygen levels during the procedure so that any changes can be dealt with quickly. A cuff may be placed on your arm to monitor your blood pressure.

If you have chosen to receive intravenous sedation, the doctor or a nurse will insert a small cannula (small plastic tube) into a vein in either the back of your hand or your arm, through which the sedation will be given. The sedative injection will make you feel sleepy and relaxed but not unconscious. Oxygen will be administered to you via a mask.

Sedatives and painkillers may be administered into a vein in your hand or arm and you will be in a state called conscious sedation. You will still be able to hear what is said to you and so will be able to follow simple instructions during the investigation, but you will feel drowsy. After the examination you may not remember anything because the sedation can affect your memory.

It is important to remember that after sedation you must not drive, take alcohol, operate heavy machinery or sign any legally binding documents for 24 hours, and someone will have to take you home after the procedure.

The procedure
The nurse looking after you will ask you to lie on your side and put the plastic oxygen monitoring clip on your finger. The sedative drugs, if used, will be given to you at this time.

The doctor will pass the colonoscope carefully through the anus and into the large bowel (colon). The colonoscopy involves manoeuvring the colonoscope through the entire length of your large bowel. There are some bends that occur naturally in the bowel and negotiating these may be uncomfortable for a short period of time.

Air is passed through the colonoscope to distend the colon. This helps the scope move through the colon and gives a clear view of the bowel. This can also cause some initial discomfort but it should soon pass.

The sedation and pain killers should minimise any discomfort experienced during these short uncomfortable periods.

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 the polyp. This is called a polypectomy. Some polyps are attached to the intestinal wall by a stalk and look like a mushroom whereas others are flat without a stalk. Polyps are generally removed when they are found as they may grow and later cause problems.

After the procedure
You will be allowed to rest for as long as necessary. Your blood pressure and heart rate will be recorded and, if you have diabetes, your blood glucose will be monitored. If you have underlying breathing difficulties, or if your oxygen levels were low during the procedure, we will continue to monitor your breathing. You will be offered light refreshments 30-60 minutes after your procedure. Before you leave the department the doctor or nurse will discuss any findings, medication and further investigations or appointments with you. You will be given a copy of the report to take home with you.

If you have been given a sedative injection, you must have someone to collect you from the hospital to take you home. This is because you have had sedation and the drug can remain in your system for about 24 hours. You may feel drowsy later on, with intermittent memory lapses. You must arrange for someone to stay with you, or, if possible, arrange to stay with family or a friend. The nursing staff will telephone the person collecting you when you are ready for discharge.

For the next 24 hours you should follow the instructions as laid out at the end of this leaflet.

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 or phone The Quadrant on 01392 272951.

The bowel preparation you have taken may continue to work for up to 24 hours after your test. Please be aware that this may cause symptoms such as urgency, loose bowel motions and wind.

Results
Sometimes the doctor or another member of the team 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, the results should be available within 10 working days.

Risks of endoscopic procedure
Colonoscopy is classified as an invasive investigation, and it has the possibility of associated complications, such as reactions to medication, perforation (tear) of the intestine, bleeding or rarely death. These complications occur extremely infrequently (less than one in 1,000 examinations), but we wish to draw your attention to them so that you can make an informed decision on whether to go ahead with the procedure.

There is a 1 in 10,000 chance of procedure related mortality.
The main risks are from mechanical damage such as perforation or tearing of the lining of the bowel and bleeding. These complications are rare but may require urgent treatment and even an operation.
The risk of a perforation or tear is rare (1 in every 1,000 examinations). An operation is nearly always required to repair the hole. The risk of perforation is higher with polyp removal.
The risk of bleeding is approximately 1 in 100-200 examinations which involve polyp removal or biopsy. Bleeding of this type is typically minor with bleeding stopping on its own, or, if it does not, it can be controlled by cauterization or injection treatment.
Sedation can cause problems with breathing, heart rate and blood pressure. These problems are usually short-lived and are carefully monitored by a fully trained endoscopy nurse. Close monitoring means that any problems can be acted on quickly.

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 are unable to speak to your doctor you must go immediately to the Accident and Emergency department, informing them you have had an endoscopy.

Consent
This leaflet has been written to enable you to make an informed decision about agreeing to have your procedure. With this information you may have been given a consent form. The consent form is a legal document so please read it carefully.

Once you have read and understood all the information, including the possibility of complications, and you agree to undergo the investigation, please sign and date the consent form. If there is anything you do not understand or wish to discuss further do not sign the form but bring it with you and sign it after you have spoken with a healthcare professional.

You will notice the consent form includes a carbon copy, or duplicate, so that you can keep a copy for your records. Please bring both copies of the consent form with you when you have your procedure.

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.

Download printable version of this document.

The above guidelines are derived from the Royal Devon & Exeter Foundation Trust information leaflet "Colonoscopy - A Guide to the Procedure".