COLONOSCOPY Patient Information Leaflet
Your Health. Our Priority.
www.stockport.nhs.uk
Endoscopy Unit | Stepping Hill Hospital
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Information for Patients This leaflet aims to explain what you need to know about your Colonoscopy. Please read the whole leaflet so that you are fully aware what this involves. If you have any questions, please feel free to ask a nurse on the Unit. The telephone number for the Endoscopy Unit is (0161) 419 5240. We are here 8am - 6pm, Monday to Friday. Before you arrive: Be aware of the possible risks linked to the procedure. Follow the instructions about fasting and bowel preparation before the procedure. Follow our advice to temporarily stop some of the drugs that you may be on. Give us details of your recent drugs, medical conditions and any allergies.
How long will I be in the Unit? This depends on if you have sedation and how busy the Unit is. You should expect to be with us for about 2-4 hours. We also look after emergencies and these can take priority over outpatient lists.
What if I’m pregnant? If you think you may be pregnant please contact the unit to speak with one of the qualified nurses.
Menstruation: The procedure can still go ahead if a woman is having her period. Tampons can be worn during the procedure. Please let the nursing staff know if this is the case.
Drugs: You must stop taking Iron Tablets 7 days before your test. ( If you have not stopped them, please phone the nurses before you start taking the bowel preparation. We will need to give you a further appointment for your Colonoscopy). If you take clopidogrel, sinthrome or warfarin to thin your blood please contact the unit and you will be given advice on when to stop them. You can take your other drugs as normal unless we have told you to stop them. On the day you start your bowel preparation, you must stop taking any diuretic tablets (water tablets). If you take the contraceptive pill you must take further precautions for the rest of the month from the time bowel preparation is started. Epilepsy drugs will not be absorbed as readily as usual. If you are on drugs for any medical conditions which you normally take first thing in the morning - it is advised that you do so, with a small amount of water on the day of your procedure.
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Endoscopy Unit | Stepping Hill Hospital
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Diabetics: The required change in your diet may upset your diabetes. Do not worry as this will not do you any long term harm. You may sip sugary drinks such as Lucozade up to 2 hours before your procedure. This must only be in small amounts (110 mls per hour). Please check your blood sugars to make sure that your level does not drop below 4. If we know of your condition, we will have attached a separate advice sheet for you to follow. If you have not received this sheet please contact us on 0161- 419 (5945) or (5925) or (4039).
What is a Colonoscopy? A Colonoscopy is a test performed by an endoscopist to look at the lining of the whole of the large bowel. A long flexible tube, about as thick as your finger, with a microchip at the end will be passed into your back passage. We get a clear view of the lining of the bowel and can check if any disease is present. Some air will be put into your bowel during the examination. This makes it easier to see its lining. A Colonoscopy is usually done to evaluate symptoms of: bleeding from the back passage a change in bowel habit persistent lower abdominal pain. It is sometimes done if you or someone in your family has had a growth (polyps or cancer) in the bowel. Colonoscopy is more accurate than x-ray films for detecting inflammation of the bowel. It can detect early cancer and can tell between benign and malignant (cancerous) conditions when biopsies of suspect areas are taken. Biopsies are taken for many reasons and do not mean that cancer is suspected. A variety of instruments can be passed through the Colonoscope that allows many abnormalities to be treated at the time with little or no pain. These include: removing polyps (usually benign growths) treating lower gastrointestinal bleeding Treating the source of such symptoms has reduced the need for surgery in many patients.
What are the alternatives to Colonoscopy? Barium enema: This is an x-ray where some dye is inserted into the back passage. It allows us to assess the rectum and entire colon. However, it is less precise at picking up slight changes in the left colon and tissue samples cannot be taken. It can be done in addition to flexible Sigmoidoscopy (which is like a limited Colonoscopy procedure). Scans: CT scans are not really an alternative, but they are often helpful in finding large tumours in the bowel. A CT scan involves a dose of radiation.
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Endoscopy Unit | Stepping Hill Hospital
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What are the Risks of Colonoscopy?
During Colonoscopy there is a very small chance of piercing the bowel. About 1 in 1000 people will be affected. There is a small chance of bleeding after treatment. Missed pathology is a possibility with all endoscopies. There are folds that can hide small lesions. Endoscopists are trained to thoroughly look at the colon but still there is a known small miss rate.
Will I have the procedure under sedation? You will be offered a choice to have the procedure with or without sedation. If you choose to have sedation: It will make you slightly drowsy and relaxed but not unconscious. You will be in a state called conscious sedation. This means that although drowsy, you will still hear what is said to you and will be able to follow simple instructions during the investigation. The effects of the sedative may result in permanent or temporary forgetfulness of the procedure. The effects of the sedation may take longer to wear off than you think or appreciate. You must not: go home alone . go back to work. Drive, operate any machinery or sign legally binding documents for 24 hours after sedation You must: have a responsible adult with you for the following 4 hours. If you do not arrange this, your procedure will only be undertaken without sedation or rescheduled for another date. Rest for the remainder of the day. Some patients are now opting to have their procedure without sedation. If you opt to do this you will be offered Entonox gas to inhale as pain relief during the procedure. You will be able to drive 30 minutes afterwards.
Risks from Sedation A small number of patients may have a reaction to the sedation used. This may result in a fall in blood pressure or slower breathing. In order to minimise this risk, for most patients we can: Give you the choice of having the procedure without any sedation. Use the smallest dose of sedation and monitor you closely. If a reaction does occur after sedation, the use of certain drugs can reverse the effects of sedative.
Four days before Colonoscopy Stop taking any constipating agents i.e. loperamide, codeine phosphate etc. which you may be prescribed.
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Endoscopy Unit | Stepping Hill Hospital
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Continue all other medication and any laxatives until your appointment. Stop Fybogel. Stop eating: High fibre foods such as fruit, vegetables, cereals, salad, mushrooms, nuts, sweet corn, whole meal bread. Also stop red meat. Start eating: Low fibre foods such as breads made from white flour, cereals like Rice Krispies and Corn Flakes, white rice, pasta and noodles, fruits without their skins and seeds, vegetable juices, fish, eggs, milk and milk products like yogurt (but without the nuts).
Two days before your procedure: Start to follow the bowel preparation leaflet in your pack.
The day before the procedure: Continue to follow the bowel preparation leaflet in your pack. Have a good breakfast of foods from the allowed list above. After this do not eat any solid food until the procedure is over. Do drink plenty of clear fluids which are classed as tea, coffee, squash or carbonated drinks (not red coloured), water, clear soups, Bovril, Oxo. You may have small amounts of milk in tea and coffee. Clear jelly (not red coloured) and sorbet are allowed. It is important to keep hydrated. Continue to drink other fluids from the above list (at least one and half litres). Remember – do not eat any solid food from the time that you start the bowel preparation, until after your procedure. You should expect frequent bowel actions and then diarrhoea within 3 hours of the first dose. Some tummy cramping is normal. Please use a barrier cream such as Zinc and Caster Oil or Vaseline on your bottom from your first toilet visit to prevent soreness. Stay within easy reach of a toilet after you start the preparation. If at any stage you vomit the preparation mix, or you have any other concerns, please phone us on 0161 419 5240. To prevent this, sip the bowel preparation; do not gulp it down.
Procedure Day: At 6 hours prior to appointment time reduce your fluid intake. You may drink enough clear fluids to quench your thirst (110 mls per hour) up to 2 hours before the test.
Who will carry out my Procedure? Advanced Nurses and Doctors who have specialist skills carry out the procedure. Some doctors may still be within their Registrar training period, but will have an experienced trainer with them. As we are an associated teaching hospital, Nursing and Medical students may be present as observers, but will not undertake any procedures themselves.
www.stockport.nhs.uk
Endoscopy Unit | Stepping Hill Hospital
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What happens during the procedure? In the Admissions area the endoscopist will explain the procedure and answer any questions. You will be asked to read and sign a consent form to give permission for us to do this test. Once in the room the nurse will ask you a set of safety questions. You will be asked to lie in a comfortable position on your left-hand side, and taught to use the Entenox analgesia. If you are having sedation this will be given via your cannula (small needle in your arm). You will not be asleep but will feel very relaxed. Monitoring equipment will be attached e.g. blood pressure, pulse, oxygen levels. A nurse will stay with you throughout the test. Before starting the procedure the endoscopist will check your back passage with a finger. Then the thin scope will be passed into your back passage. Some air will be put into your bowel. During the procedure you will often be asked to turn on to your back and sometimes on to your right side or stomach. This makes it easier and safer to pass the scope. As scope is withdrawn, the lining of the bowel will be carefully examined. The examination usually lasts 20 to 40 minutes. The endoscopist will be checking for any area that looks different from the rest of the bowel. If any are found, a tiny piece (a biopsy) of the lining of the bowel can be taken and sent to the laboratory for more tests. This will not hurt. Sometimes polyps are found. Polyps are small growths on the lining of the bowel. Some polyps need to be removed because if they are left they can cause problems later. It is often possible to do this at the same time as your test. If you wish, you will be able to view your procedure on the screen as the scope progresses.
Will it hurt? Air is passed down the Colonoscope to make the lining of the bowel easier to see. This may cause you to feel bloated or cause some moderate “wind” pains. The scope can sometimes loop within the colon and cause discomfort. This will usually ease when the endoscopist removes the loop. This is normal and will pass quickly, as will the feeling of bloating. You will be offered pain relief should you require it. This will be in the form of inhaled gas (Entonox). If you have sedation, a pain relief drug will also be given. Colonoscopy is usually well tolerated and rarely causes severe pain.
When do I know the results of my Procedure? Before you leave, a member of staff will go through your results with you and may give you a copy of the report. If a biopsy has been taken it may take 1 to 2 weeks for the results to return from the lab to confirm a diagnosis. The results will also be sent to your GP, which may contain some advice on your further treatment. If the endoscopist decides to bring you to clinic for a follow up appointment, this will be sent to you by post.
www.stockport.nhs.uk
Endoscopy Unit | Stepping Hill Hospital
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Contact us The Endoscopy Unit is on the ground floor of the main hospital building. From main reception, take a left turn and follow the corridor to the end. Please book in at Day Surgery reception which is on the right. You will notice that maps are available on the main corridor for your assistance. To check or change an appointment, please contact us on the following numbers (0161) 419 extensions (5945): (5925): (4039) For all other enquiries please contact the Nursing Staff on (0161) 419 5240 between 8am and 6pm Monday to Friday.
www.stockport.nhs.uk
Endoscopy Unit | Stepping Hill Hospital
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If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email:
[email protected].
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Leaflet number Publication date Review date Department Location
www.stockport.nhs.uk
OUT13 February 2013 February 2015 Endoscopy Unit Stepping Hill Hospital
Endoscopy Unit | Stepping Hill Hospital
