Colonoscopy

A Patient Guide

Important information

• The time on your appointment letter is the time you need to arrive at the Day Treatment Centre. It is not the time your procedure will happen.
• You may have to wait for a few hours before your procedure starts. Please come prepared. It's a good idea to bring something to read.
• Please tell the hospital as soon as you can if:
• You need a translator or interpreter.
• You take blood thinners or diabetes medicine.
• Tell the Nurse or Doctor if you have a pacemaker, defibrillator, artificial hips, or any other metal implants.
• If you don't have someone to take you home after your procedure, please tell the endoscopy Nurses as soon as possible.
• Endoscopy is a restricted area. Friends and family cannot come inside. We have a trained team of Nurses and Doctors to look after you. If you need an interpreter, we can arrange one by phone or in person.
• If you need a different appointment time, or if you cannot come, please contact the Booking Services team on 020 7288 3822 or email whh-tr.endoscopy@nhs.net.
• If you have questions about your test or medicines, please call the hospital switchboard on 020 7272 3070 and ask for bleep 2711 (Monday-Friday, 8:30-17:30). You can also call 020 7288 3811/3819 or email whh-tr.endoscopypreassessment@nhs.net.
• Please do not bring valuables to the hospital. We cannot look after them and there are no lockers available.

What is a Colonoscopy?

• A colonoscopy is a camera test that looks inside your large bowel (colon).
• The instrument used is called an endoscope. This is a thin, flexible tube about 1cm wide. It has a camera and a light on the end.
• The Doctor or Nurse will gently pass it through your back passage and move it around your bowel.
• The test usually takes about 30 minutes.
• You may feel some cramping or bloating during the test. This is normal.
• To help keep you comfortable, you can choose to have sedation or gas and air.

Intravenous sedation

• You will be given an injection in your vein. This will include medicine to help you relax and reduce any pain.
• The sedation will make you feel calm and a bit sleepy, but you will not be fully asleep. You may still notice what is happening and be able to follow simple instructions.
• We will check your heart rate, breathing and blood pressure during the test.
• If you choose sedation, you must have someone to take you home afterwards. If you cannot find someone, please tell one of the endoscopy Nurses using the phone numbers given.

Entonox (gas and air)

• Entonox is the name for a gas mixture of 50% oxygen and 50% nitrous oxide. It is also called 'gas and air'. It can be used instead of sedation.
• It is a strong painkiller and works quickly to help with pain.
• The gas leaves your body within a few minutes, so it wears off quickly. If you use Entonox, you do not need someone to take you home.
• Tell the endoscopy Nurses if you have breathing problems, as sometimes Entonox cannot be used.

How do I prepare for my procedure?

• For 3 days before your test, you will need to eat a low fibre diet. You will be given a bowel preparation leaflet containing the diet you need to follow.
• You will also be given laxatives to take the day before. The laxatives will help to empty your bowel. You will get separate instructions about this.
• It is very important that you follow all the instructions. If your bowel is not empty, your test may need to be cancelled or repeated.
• Please tell the endoscopy team if you take:
  • Blood thinning medicines
  • Iron tablets
  • Medicines for diabetes
• Keep taking your regular medicines unless you are told otherwise by the endoscopy Nurse or your Doctor.

What happens when I arrive in the Endoscopy unit?

• When you arrive, we will ask you to fill in a short form with your details and information about your medicines.
• Please bring the medicines you are taking, or an up-to-date prescription list. If you cannot fill in the form, we will help you.
• A Nurse will see you and ask a few questions about your health. This is to make sure you are well enough to have the test.
• The Nurse will also check your heart rate, blood pressure, and oxygen levels. If you have diabetes, we will also check your blood sugar.
• The Nurse will ask how you are getting home. If you are having sedation, you must have someone to take you home.
• If you have chosen sedation, the Nurse will put a small tube (cannula) into your arm.
• If you have chosen gas and air, the Nurse will show you how to use it before the test starts.
• Some patients may also need a small tube (cannula) in their arm, even if they do not have sedation. This is because we sometimes give a medicine called Buscopan, which helps to relax the bowel.
• You will be taken to a changing area where you will need to remove your lower clothes and put on a hospital gown and special shorts. You can bring your own dressing gown and slippers if you like.
• You will then wait in the changing area until the team is ready for you.
• Remember: The time on your appointment letter is the time you need to arrive, not the time of your test.

What happens during the procedure?

• A team member will take you outside the procedure room. The Doctor (Endoscopist) will explain the test and ask you to sign a consent form. This is your chance to ask any questions.
• When everything is ready and all the checks are done, you will be asked to lie on your left side.
• The Doctor or Nurse doing your procedure will do a quick rectal examination, then gently put the camera into your back passage to start the test.
• Carbon dioxide gas is gently passed into your bowel. This makes it easier for the Doctor or Nurse to move the camera around.
• You may feel a bit uncomfortable when the camera goes around the bends in your bowel, and you may also feel bloated.
• The Nurses will encourage you to pass wind during the test to help with the discomfort.
• Please note: Whittington Health is a teaching hospital. Sometimes a student Doctor or Nurse may watch your procedure.

Why do I need a Colonoscopy?

• You may be asked to have a colonoscopy for one of these reasons:
  • To find the cause of your symptoms, such as bleeding from the back passage, diarrhoea, constipation, or tummy pain.
  • If you already have a bowel disease such as Crohn's or colitis.
  • If someone in your family has had bowel cancer.
  • To check an abnormal result seen on a CT or MRI scan.
  • To remove polyps. Polyps are small growths on the bowel wall. Some are harmless, but others need to be removed and looked at in the lab. This is called a polypectomy.
• A colonoscopy is a safe test. Serious problems are very rare.
• Please read this leaflet carefully and think about the benefits and the risks before you decide. You will need to sign a consent form before the test.

The main risks are:

• There is a small chance of a tear or hole (called a perforation). This happens in about 1 in 1000 cases.
• If a polyp is removed, the risk goes up to about 1 in 600 cases. Surgery may be needed to repair the tear.
• There is a small risk of bleeding, about 1 in 1500 cases. If a polyp is removed, the risk goes up to 1 in 50 to 1 in 100 cases. Sometimes a blood transfusion is needed.
• There is a small chance (up to 10%) that large polyps may be missed.
• Sometimes the test cannot be completed. This can happen if the test is too uncomfortable or if your bowel is not empty enough. If this happens, we may reschedule your test or suggest a different type of camera test.
• About 1 in 200 people may have trouble breathing if they have sedation. You will be given oxygen, and your heart and breathing will be checked during the procedure to help keep you safe.

What are the alternatives?

• CT pneumocolon: a special scan of your large bowel, but if biopsies (small samples) are needed, you will still need a colonoscopy.
• Flexible sigmoidoscopy: a camera test that looks only at the left side of your large bowel.
• Stool sample: a test of your poo to check for blood. But if blood is found, you may still need a colonoscopy.

What happens after the procedure?

• The Nurses will keep checking your breathing, heart rate, and oxygen during and after the test.
• If you had sedation, you would rest for about 30 minutes while we keep monitoring you.
• When you have recovered, you will be offered something light to eat and drink. You can also bring your own food if you prefer.
• You should not feel pain, but you may have some wind (bloating). This usually goes away after a few hours.
• Before you leave, the Nurse or Doctor will give you a copy of the report. They will explain what was seen and if you need any medicines or another test.
• If you live alone, you must arrange for someone to stay with you overnight.
• For the next 24 hours after sedation, you must not:
  • Drive
  • Drink alcohol
  • Use heavy machines
  • Sign any important documents
• Most people feel completely normal again after 24 hours. If you still feel sleepy, wait another 24 hours before driving.

After you go home

• If you have stomach pain that doesn't go away, bleeding from your back passage or fever within the 2 days (48 hours) after your procedure, please go to your nearest Hospital Emergency department - please take a copy of your endoscopy report with you.
• For any other queries, you can contact the endoscopy department:

Endoscopy Department

Tel.: 020 7288 3811/3819

Email: whh-tr.endoscopypreassessment@nhs.net