Gastroenterology
Your consultant or doctor has advised you to have a Flexible Sigmoidoscopy.
What is a Flexible Sigmoidoscopy?
This is an examination of the lower bowel in which a flexible telescope is inserted into your back passage, allowing inspection of the left bowel (colon). The scope has a lens on its end, which allows the person performing the test to view the inside of your bowel on a television screen.
What are benefits of a Flexible Sigmoidoscopy?
This test is the most accurate way we have of looking at the left side of thelarge bowel (colon) to establish whether there is any disease present. It also allows a sample of tissue (biopsy) to be taken for examination by the pathology department if necessary. Sometimes larger pieces of tissue such as small polyps are removed at the time of the test but often if these are found, you may need a more extensive examination later.
What are the risks of a Flexible Sigmoidoscopy?
Perforation
It is possible to damage the large bowel lining making a hole, but this happens rarely. This allows bowel contents to escape causing severe inflammation in the abdomen (peritonitis).The risk of this happening is approximately one in every 4000 examinations. Often the tear can be treated during the procedure however, you would be required to stay in hospital so you can be monitored, In some cases it may be required for the tear/ hole to be repaired with surgery.
Bleeding
If a polyp is found, it may need to be removed, but the endoscopist will decide at the time of the test if the polyp should be removed. Sometimes a biopsy is taken and you may be rebooked for another procedure for the polyp to be removed.
A polyp is usually removed using a small electric current to burn through the base and then separate it from the bowel wall.
The risks of removing the polyp include bleeding. This can often be stopped straight away but may occasionally be more serious or even happen a few days later.
Depending on the size of the polyp, this may occur for every one in 200 polyps removed.
Are there any alternatives to this procedure?
This is the best test to examine the lowest part of your bowel. If your symptoms indicate it, you may need similar or different tests to examine your bowel more extensively but this is not necessary for everyone. 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 anaesthetic or sedation will I be given?
The majority of examinations are undertaken without sedation. If you do have sedation, 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.
A side effect of these drugs is they can 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 if you choose to have sedation
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.
If you have sedation, you must have a friend or relative collect you from the Gastroenterology Unit and we recommend they stay with you afterwards.
Getting ready for your Flexible Sigmoidoscopy
- You will need to take either an oral bowel preparation that you will have received with your appointment or be asked to have an enema preparation to clear the lower bowel. Sometimes we instruct patients about a different preparation.
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If you are taking iron tablets, please stop taking them one week before your appointment.
- Please bring a dressing gown and slippers
- 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.
- When you come to the department, please tell the doctor or nurse about any medicines you are taking, possible allergies or bad reactions you may have had, or heart valve problems requiring antibiotics.
Your Flexible Sigmoidoscopy procedure
- During the test, you will be asked to lie on your left side on a couch with your knees bent.
- A rectal examination will be performed with a gloved finger, which will help to relax the muscle. After this, the telescope will be lubricated and inserted into your bottom.
- Air and a little water is then blown down the telescope and into your bowel, so that it can be seen clearly.
After your Flexible Sigmoidoscopy
You will be able to walk back to the area you came from to get dressed. You may wish to have a friend or relative call to collect you.
If you have had sedation you must have a friend or relative collect you from the Gastroenterology Unit and 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.
Minor post procedure symptoms
You may notice some wind 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 Accident and Emergency Department 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
Results of the examination will either be given to you before you leave or at your next clinic appointment. 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. A copy of the report will be sent to your family doctor (GP).
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 ten disabled spaces on the entry level of 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 (GP) and require an ambulance, contact your family doctor to book the ambulance.
Further appointments
You may be given a follow up appointment before leaving or one will be sent to you in the post to attend the clinic of the doctor who referred you.
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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Further information
If you have any questions or queries, please contact: The Gastroenterology Unit during the following hours
Monday – Friday 1000 – 1700hrs Tel: 0151 706 2720
Saturday/Sunday/BH 0800 – 1600hrs Tel: 0151 706 2726
Text phone number: Monday – Friday 18001 0151 706 2720
Saturday/Sunday/BH 18001 0151 706 2726
Endoscopy appointment queries Tel: 0151 706 2720
Text phone number: 18001 0151 706 2720
The Emergency Department (A&E) is open 24 hours Tel: 0151 706 2049/2050.
Text phone number: 18001 0151 2049/2050