Gastroenterology
Your consultant or doctor has advised you to have a Colonoscopy.
What is a Colonoscopy?
A colonoscopy is a test that examines the lining of your large bowel. It involves passing a long thin tube through the bowel via your anus (back passage). The tube has a tiny camera that allows the endoscopist to examine your bowel.
We are a large teaching Trust and so we are involved in teaching students and in research work. Qualified doctors and nurse practitioners in training to perform endoscopy may perform your test under supervision by a skilled endoscopist.
You may also be asked to take part in research. If you do not feel happy about this, please tell a member of staff. You have the right to refuse, and your decision will not affect your treatment in anyway.
What are benefits of a Colonoscopy?
This test is the most accurate way we have of looking at the large bowel (colon) to find out if there is any disease present. It also allows for a sample of tissue (biopsy) to be taken for examination by the pathology department and removal of polyps that can grow on the bowel wall.
What are the risks of a Colonoscopy?
For most people, colonoscopy is straightforward. But as with most medical procedures, complications can happen. In rare cases, colonoscopy can harm the bowel. Possible complications include:
- hole or tear (perforation) in the bowel caused by the colonoscope (around 1 person in 1700); around half of people with a perforation will need surgery to repair it.
- Bleeding during or after the procedure 1 in 200 patients, this can often be stopped right away but can be more serious if it happens a few days after the procedure.
- Heavy bleeding needing a blood transfusion (around 1 person in 2,400)
- The risk of missing a cancer, polyp or other pathology is around 3 patients in 100.
If you have bleeding that is difficult to stop or a hole in your bowel that needs surgery, we will admit you to hospital straightaway.
Are there any alternatives to this procedure?
This is the best test to examine the large bowel (colon). We use alternative tests such as CT scans for some patients, but these are not always as useful as a direct examination of the bowel which also has the advantage that samples can be taken at the same time.
What will happen if I don’t have this procedure done?
Doing nothing may result in your signs and symptoms getting worse over time and may result in you needing an operation. It may also mean that you will not be getting the treatment you need.
What sedation will I be given?
You will be offered the choice of intravenous sedation, inhaled pain relief (gas and air), or without sedation.
Intravenous sedation involves an injection given into your vein, which will make you slightly drowsy and relaxed. You will not be unconscious.
The drugs used in sedation may affect your memory or concentration for up to 24 hours. Many patients remember nothing about the procedure or even what the doctor has said to them afterwards.
For these reasons you must arrange for a friend or relative to collect you from the unit and we recommend they stay with you afterwards.
For next 24 hours you must not
- Travel alone
- Drive any vehicle e.g. car, scooter or ride a motorcycle or bicycle
- Operate machinery (including domestic appliances such as a kettle)
- Climb ladders
- Make important decisions, sign any business or legal documents
- Drink alcohol
- Return to work within 12 hours of treatment. Your general health and any medicines you are taking may increase the time you need off work.
You should
- Take it easy for the rest of the day, avoid strenuous activity.
- Take your medications as usual.
- Let someone else care for anyone you usually look after, such as children or elderly or sick relatives.
A side effect of these drugs is to slow your breathing – this should not normally happen but sometimes patients can be oversensitive to the drug. This is the main reason we do not give high doses of these drugs. We also will give you oxygen during the test.
Inhaled pain relief (gas and air) involves breathing in a medical gas through a mouth piece. It can be used to help you manage your discomfort/pain during your bowel investigation. It consists of 50% Oxygen and 50% Nitrous Oxide. Nitrous Oxide is sometimes used for anaesthetics but in this combination, it works as a short acting painkiller. As it is short acting, it can be used as a painkiller for any treatment that requires short-term pain relief.
The potential side effect is that it can make you feel drowsy and a little light-headed. Other possible side effects include dizziness, nausea and a dry mouth. All these sensations disappear rapidly after you stop using it. Most patients find that if they concentrate on breathing slowly, then they quickly get used to these sensations
Due to the short acting nature of this pain relief the effects should wear off quickly and therefore does not require the same arrangements as intravenous sedation. However, we advise that you should be cautious about getting up and walking around until your balance has fully returned. You must wait a minimum of 30 minutes before attempting to drive, but this will be longer if you have been given in conjunction with medicines that might cause sedation or drowsiness.
If you are worried about any of these risks, please speak to your consultant or a member of their team before you are due to have this treatment.
Getting ready for your Colonoscopy
- You will have received an instruction leaflet and bowel preparation (to be taken orally) in the post.
- Please remember if you are taking iron tablets to stop them one week before your appointment.
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If you are unwell while taking the bowel preparation, please contact the Gastroenterology Unit on Tel: 0151 706 2726 for advice.
Text phone number: 18001 0151 706 2726
- To get ready for the examination you will be asked to undress and wear a gown. You may bring a dressing gown and slippers if you wish.
- Please do not bring in large amounts of cash or valuables, as the Trust cannot be held responsible for them.
- When you come for your colonoscopy, it is important to tell the healthcare team about any medicines you are taking and whether you need to take antibiotics for your heart and in particular, about any allergies or bad reactions you may have had.
- If you routinely take medicines (including blood pressure medication) please continue to do so with the exceptions of the ones listed below. You may take your medication in the morning of your procedure with a very small amount of water.
Your Colonoscopy
- You will be taken to the endoscopy room, where you will be made comfortable lying on your left side with your knees drawn up. You may also be required to change position during the procedure.
- A needle will be placed in your vein (usually in the arm) to allow for administration of medications if required.
- You may be given oxygen through your nose.
- When you are comfortable, the telescope is passed into your anus and the examination commenced.
- A mixture of air and water is administered down the telescope and into your bowel, so that it can be seen clearly. The endoscopist will view your bowel on a television monitor.
After your Colonoscopy
After the test has finished, you will be taken to a recovery area while the sedation and/or pain relief wears off. After which you will be able to get up, get dressed and have something to eat and drink.
You may notice some windy pains due to the air that has been put into the bowel at the time of the examination, which is done to allow the doctor/nurse to get a clear view of your bowel. This should disperse once you are up and about walking around.
You may have some spotting of blood if you have had any polyps or large pieces of tissue samples removed.
Serious post procedure symptoms
If you experience any severe pain in your neck, chest or abdomen or if you are bleeding heavily you must return to the Emergency Department (A&E) and bring this, and any other information leaflet you are given with you so as to inform the staff what you have had done.
Results
Sometimes after the test, the doctor or nurse can let you know what the results are. Sometimes biopsy, photography or other information is taken which may need to be assessed further and the result may not be available for a week or two. In this case the result will be sent to your family doctor (GP) or be available to discuss with you during your next clinic appointment.
Cancellations
If you are unable to keep this appointment, please let us know as soon as possible on Tel: 0151 706 2720 Text phone number: 18001 0151 706 2720. We will be able to give your appointment to another patient and arrange another for you.
Transport
- Transport has not been arranged for this appointment so it will be necessary for you to make your own arrangements.
- Parking for patients and visitors is available at the Q-Park multi storey car park opposite the main hospital entrance on Prescot Street. The entrance by car is on Epworth Street off Erskine Street. The car park is open 24 hours a day, seven days a week. This is a private car park and charges apply. The car park is continually monitored by parking hosts, and CCTV. There are disabled spaces within the car park. If you need help, please speak with a parking host at the car park entrance.
- If you have been referred to us from clinic and usually have an ambulance to bring you for your appointment, please contact us on Tel: 0151 706 2720 Text phone number: 18001 0151 706 2720 as soon as possible.
- If you have been referred to us by your family doctor and need an ambulance please contact their surgery.
When will I be allowed home?
Once you have completed the recovery stage, your escort has arrived and you have been given information, you may go home once the nurse has discharged you.
Further appointments
If you need a further appointment to be reviewed by the clinic that sent you for this test, this may be arranged at the end of your procedure and will either be given to you or sent to you in the post.
Important: If you have:
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Diabetes
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Are taking: (Warfarin tablets, Clopidogrel (plavix) tablets)
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Anticoagulants:
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Warfarin
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Heparin/Low molecular weight heparin (including enoxaparin/dalteparin)
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Dabigatran
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Rivaroxiban
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Sinthrome
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Apixaban
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Fondaparinux
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Edoxaban
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Antiplatelet therapy:
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Clopidogrel (Plavix)
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Prasugrel (Efient)
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Ticagrelor (Brilique)
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Dipyridamole (Persantin) and aspirin
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Are on dialysis
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Have suffered a heart attack within the last three months
You must contact the Gastroenterology Unit as soon as you receive this information leaflet.
Tel: 0151 706 2720
Text phone number: 18001 0151 706 2720
Feedback
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Following your discharge from hospital or attendance at your outpatient appointment you will receive a text asking if you would recommend our service to others. Please take the time to text back, you will not be charged for the text and can opt out at any point. Your co-operation is greatly appreciated.