Endoscopy - Colonoscopy

Colonoscopy information

You have been advised by your GP or hospital doctor to have an investigation known as a colonoscopy.

If you are unable to keep your appointment, please notify the department as soon as possible. This will enable the staff to give your appointment to someone else and they will be able to arrange another date and time for you.

This patient information has been written to enable you to make an informed decision in relation to agreeing to the investigation therefore please read it carefully.

A colonoscopy requires your formal consent. 

If you require more help or information you can discuss this with the endoscopist when you attend for your procedure and sign the consent form at that time. 

Should you wish to change your mind and withdraw your consent you can do this at any time even when the procedure is taking place. The endoscopist will stop and clarify the problem with you. If you still wish and safe to do so the endoscopist will start to remove the endoscope. Please do note that this may not be done immediately as this needs to be removed in a safe manner.

A colonoscopy is an examination of your large bowel (colon). It will be performed by or under the supervision of a trained doctor or clinical endoscopist and we will make the investigation as comfortable as possible for you.

There is the option to have a sedative and painkilling injection to help make the colonoscopy procedure more comfortable. If you prefer we may be able to offer you Entonox (‘gas and air’) instead of injections. Entonox is an inhaled effective painkiller which has a sedative effect without loss of consciousness.

Colonoscopy is often performed satisfactorily without any injections or Entonox. If you opt not to have any injected analgesia or sedation for this test nor Entonox you may still have to have a small cannula inserted into a vein, in case we need to give you any other intravenous medication.

Why do I need to have a colonoscopy?

• You may have been advised to undergo this investigation of your large bowel to try and find the cause for your symptoms, help with treatment, and if necessary, to decide on further investigation.

• Follow-up inspection of previous disease.

• Assessing the clinical importance of an abnormality seen on an X-ray.

• A CT colonography is an alternative investigation. These tests expose you to a small amount of radiation. They are not as informative as a colonoscopy and have the added disadvantage that a tissue sample cannot be taken if any areas of concern are identified.

What is a colonoscopy? 

This test is a very accurate way of looking at the lining of your large bowel (colon), to establish whether there is any disease present. This test also allows us to take tissue samples (biopsy) for analysis by the pathology department if necessary: this is painless. The samples will be retained. Photographs may be taken for your records.

The instrument used in this investigation is called a colonoscope, and is flexible. Within each scope is an illumination channel which enables light to be directed onto the lining of your bowel, and another which relays pictures back, onto a television screen. This enables the endoscopist to have a clear view and to check whether or not disease or inflammation is present.

Preparing for the investigation

Eating and drinking

It is necessary to have clear views of the lower bowel.

Two to three days before the examination

• You can follow a normal diet but we recommend that you avoid eating foods containing whole nuts or seeds such as granary breads.

The day before the examination

• You will need to take a laxative which you should have received along with clear instructions on how and when to administer it. If you have not already received this please contact the endoscopy unit and someone will assist you.

On the day of the examination

• You may continue taking clear fluids until you attend for your appointment.

What about my medication?

Routine medication - Your routine medication should be taken.

If you are taking iron tablets you must stop these one week prior to your appointment. If you are taking stool bulking agents (e.g. Fibogel, Regulan, Proctofibe), Loperamide (Imodium) Lomotil or Codeine Phosphate you must stop these 3 days prior to your appointment.

People with diabetes

If you have diabetes controlled on insulin or medication, please ensure the Endoscopy department is aware so that the appointment can be made at the most appropriate time. Please see guidelines printed at the back of the book.

Anticoagulants/allergies

If you are taking anticoagulants or blood thinning medication such as warfarin, clopidogrel, ticragelor, prasugrel, Dabigatran, Phenindione, or Rivaroxaban (Xarelto), apixaban and edoxaban and have not discussed this with your doctors or GP please contact the unit.

Patients with implanted medical devices

If you have an implanted medical device such as a cardiac defibrillator or cochlear implant please bring any information about the type of device you have with you. We will need to know this information so that we can be aware of any precautions or provisions that we need to take whilst you are having your procedure.

How long will I be in the endoscopy department?

This largely depends on what type of pain relief you require, how quickly you recover from the sedation and how busy the department is. You should expect to be in the department for approximately 3 hours. The time given on your letter is your admission time not the time for your procedure.

The department also looks after emergencies and these can take priority over our out-patient lists.

What happens when I arrive?

When you arrive in the department, you will be met by a trained member of staff who will ask you a few questions, one of which concerns your arrangements for getting home. You will also be able to ask further questions about the investigation.

The nurse will ensure you understand the procedure and discuss any outstanding concerns or questions you may have. As you may need to have sedation they might insert a cannula (small plastic tube) in the back of your hand through which sedation will be administered later.

If you need to have intravenous sedation or pain relief you will not be permitted to drive or use public transport unaccompanied so you must arrange for a family member or friend to collect you. The nurse will need to be given their telephone number so that they can contact them when you are ready for discharge.

The endoscopy nurse will ask you some questions regarding your medical condition and any surgery or illnesses you have had to confirm that you are fit to undergo the investigation.

Your blood pressure, oxygen levels and heart rate will be recorded and if you have diabetes, your blood glucose level will also be recorded.

Intravenous sedation and Entonox explained

The sedation and a painkiller will be administered into a vein via a cannula in your hand or arm which will make you lightly drowsy and relaxed but not unconscious. You will be in a state called cooperative sedation. This means that, although drowsy, you will still hear what is said to you and therefore will be able to follow simple instructions during the investigation. Sedation often prevents you from remembering much about the examination.

Please note if you have had sedation you must not drive, take alcohol, operate heavy machinery or sign any legally binding documents for 24 hours following the procedure and you must have someone to accompany you home and stay with you for at least 12 hours.

Entonox is a short acting painkiller which you inhale. It is a mixture of nitrous oxide and oxygen. The effects last no more than 10 minutes. If you do not have someone to stay with you after the procedure you may find this a good alternative to intravenous sedation and pain relief. Following the use of entonox you would need to remain in the unit for a short while and you would not be able to drive for at least 30 minutes.

During the procedure we will monitor your breathing and heart rate so changes will be noted and dealt with accordingly. For this reason you will be connected by a finger probe to a pulse oximeter which measures your oxygen levels and heart rate during the procedure. Your blood pressure may also be recorded.

The colonoscopy investigation

Your consent to the procedure will be confirmed by the endoscopist and you will be given the opportunity to ask any further questions before you are escorted to the treatment room.

The nurse looking after you will ask you to lie on your left side. The nurse will then place the oxygen monitoring probe on your finger and if you have opted for sedation insert a small tube into your nose so you can be given a little bit of oxygen to assist your breathing.

If you require sedative drugs these will be administered into a cannula (tube) in your vein. Should you wish to try the procedure without either sedation, intravenous pain relief or entonox to start with these drugs can still be given at any time during the test if you change your mind.

The colonoscopy involves manoeuvring the colonoscope around the entire length of your large bowel. There are some bends that naturally occur in the bowel and some people may find that negotiating these is rather uncomfortable for a short period of time but pain relief should minimise any discomfort. Your nurse looking after you will help you cope with this. You may be asked to change your position to help with this.

Gas and/or water is gently passed into the bowel through the scope during the investigation to facilitate the passage of the colonoscope.

During the procedure samples may be taken from the lining of your bowel for analysis in our laboratories. These will be retained.

Risks of the procedure

Lower gastrointestinal endoscopy is classified as an invasive investigation and because of that it has the possibility of associated complications. These occur extremely infrequently; we would wish to draw your attention to them and so with this information you can make your decision.

The doctor who has requested the test will have considered this. The risks must be compared to the benefit of having the procedure carried out.

The risks can be associated with the procedure itself and with administration of the sedation.

The endoscopic procedure

The main risks are of mechanical damage;

• Perforation (risk approximately 1 for every 1,500 examinations) or making a hole in the wall of the bowel. This is a serious and potentially life threatening complication for which an operation is nearly always required to repair the hole. The risk of perforation is higher with large polyp removal, especially from the right side of the bowel.

• Bleeding may occur at the site of biopsy or polyp removal (risk approximately 1 for every 150 examinations where this is performed). Typically minor in degree, such bleeding may either simply stop on its own or if it does not, be controlled by cauterization or injection treatment.
• There are other extremely rare complications which can occur during a procedure. Most of these are related to specific people or conditions. Should you have any particular concerns or worries regarding this please discuss this with your endoscopist when you attend and before you sign your consent form.

• There are occasions when the endoscopist may fail to detect abnormalities in the bowel. This most often occurs when the bowel preparation is inadequate although small lesions can also be missed in a fully cleansed bowel.

Sedation

Sedation can occasionally cause problems with breathing, heart rate and blood pressure. If any of these problems do occur, they are normally short lived. Careful monitoring by a fully trained endoscopy nurse ensures that any potential problems can be identified and treated rapidly.

Older patients and those who have significant health problems (for example, people with significant breathing difficulties due to a bad chest) may be assessed by a doctor before having the procedure.

What is a polyp?

A polyp is a protrusion from the lining of the bowel. Some polyps are attached to the intestinal wall by a stalk, and look like a mushroom, whereas others are flat without a stalk. Polyps when found are generally removed or sampled by the endoscopist as they may grow and later cause problems. Flat polyps are generally a little more difficult to remove.

Polypectomy

Various removal techniques are available to remove polyps in the large bowel. Most involve removing them with a wire loop or biopsy forceps, sometimes using an electric current. This is called a polyp resection or polypectomy.

It will depend on the size of the polyp, the location of the polyp in the bowel and the appearance of the polyp as to what method the endoscopist uses to perform the polypectomy.

For large polyps with a stalk, a snare (wire loop) is placed around the stalk of the polyp, a high frequency current is then applied and the polyp is removed.

Flat polyps (without any stalk) may need to be lifted up from the lining of the bowel. This involves injecting the lining of the bowel that surrounds the flat polyp. This raises the area and allows the wire loop snare to capture the polyp.

For smaller polyps biopsy forceps (cupped forceps) may be used.

The risk of making a hole in the bowel during a polypectomy can be as high as one in every 750 examinations.

After the procedure

You will be allowed to rest for as long as is necessary. Your blood pressure, oxygen levels and heart rate will be recorded and if you have diabetes, your blood glucose will be monitored. Once you have recovered from the initial effects of the procedure (which normally take 30-60 minutes), you will be offered a hot drink and something to eat and may be moved to a comfortable chair. Before you leave the department, the nurse or endoscopist will discuss the findings and any medication or further investigations required. They will also inform you if you require further appointments.

The sedation may temporarily affect your memory, so it is a good idea to have a member of your family or friend with you when you are given this information although there will be a short written report given to you.

If you have had sedation, the drug remains in your blood system for about 24 hours and you may feel drowsy later on, with intermittent lapses of memory.

If you live alone, you will need to arrange for someone to stay with you for at least 12 hours after the procedure or, if possible, arrange to stay with your family or a friend for this time.

If the person collecting you leaves the department, the nursing staff will telephone them when you are ready for discharge.

What if I choose not to have this procedure?

If you decide not to proceed with the examination, your doctors will still treat your symptoms, however they may find it harder to identify the underlying cause of your problems. This may affect their ability to provide a long-term solution or treatment for your condition or exclude conditions like cancers.

General points to remember

• It is our aim for you to be seen and investigated as soon as possible after your arrival. However, the department is very busy and your investigation may be delayed. If emergencies occur, these patients will be given priority over the less urgent cases.

• The hospital cannot accept any responsibility for the loss or damage to personal property during your time on these premises.

• If you are unable to keep your appointment please notify the endoscopy department as soon as possible.

• Because you may need to have sedation, please arrange for someone to collect you from the department.

• If you have any problems with persistent abdominal pain or bleeding please contact your GP immediately informing them that you have had an endoscopy.

• If you are unable to contact or speak to your doctor, you must contact the casualty department.

Dietary instructions for colonoscopy preparation

You should have received the medication required to clean out your bowels in the pack you received along with this information.  If not, please contact the Endoscopy appointments booking team on 01228 210430 who can arrange for this to be supplied to you. Please read the instructions carefully and follow them as appropriate for the time of your appointment. To enable a more effective examination, we would be grateful if you would take a clear fluid only diet for the period of time stated on the attached instruction sheet.

Fluids allowed

Twenty-four hours before your examination you should take clear fluids only (no food):

tea (no milk), black coffee, water, strained fruit juice, strained tomato juice, fruit squash, soda water, tonic water, lemonade, Oxo, Bovril, Marmite (mixed into weak drinks with hot water), clear soups and broths, consomme.

• You may eat clear jellies.
• You may suck clear boiled sweets and clear mints.
• You may add sugar or glucose to your drinks.

Foods and fluids not allowed

For 2-3 days before your colonoscopy avoid eating nuts and seeds or foods such as granary bread which contain whole seeds.

Whilst taking your preparation do not take drinks or soups thickened with flour or other thickening agents.

Guidance from the Diabetes team for people with Diabetes having bowel preparation

This guidance is provided to assist with your preparation for your endoscopic procedure. If you feel unclear about how to proceed after reading this information, please contact your diabetes specialist nurse, or practice nurse or general practitioner for personalised advice.

Do I need to inform the endoscopy department?

In preparing for your procedure it is important to inform the endoscopy department that you have diabetes; you may have already discussed this with the hospital doctor in clinic. If you are not sure we know about your diabetes please contact whoever you receive your diabetes care from at your GP Practice.

This information is for people with type 1 diabetes and type 2 diabetes who are on medication for their condition. If you have type 2 diabetes managed by diet alone you do not need to read this.

Diabetes treatments

What type of medication am I on?

• Oral diabetes medication (tablets): Metformin, Gliclazide/ Gliclazide MR, Glibenclamide, Glimepiride, Pioglitazone, Sitagliptin, Saxagliptin, Vildagliptin, Lingaliptin, Repaglinide, Dapagliflozin, Empagliflozin and Rybelsus.

• Long acting insulin: Lantus/Glargine, Levemir/Detemir, Tresiba/degludec, Abasaglar, Toujeo.

• Intermediate acting insulin: Insulatard, Humulin I, animal isophane.

• Short acting insulin: Novorapid, Humalog, Apidra,Humulin S, Fiasp, animal neutral.

• Mixed insulin: Novomix 30, Humulin M3, Humalog Mix 25 or 50.

• Other injectable treatment (GLP-1): Exenatide (Byetta), Liraglutide (Victoza), Lixisenatide (Lyxumia), Dulaglutide (Trulicity), Bydureon, Semaglutide (Ozempic).

If you are not clear on your insulin type or other diabetes medications please contact your diabetes specialist nurse, or practice nurse or general practitioner for personalised advice.

How do I adjust my medications the day before a colonoscopy?

• Continue to take Metformin and Pioglitazone as usual

• Do not take any other ORAL diabetes medications

• Continue to take GLP-1 injections as usual

• Check your blood glucose level before all insulin injections

• Long-acting and intermediate-acting insulin doses do not need adjustment

• If you have type 2 diabetes, halve the usual dose of short-acting or mixed insulin

• If you have type 1 diabetes and are carbohydrate counting, you can continue this. Otherwise, halve the usual dose of short-acting or mixed insulin

On the day of the procedure

If your procedure is in the morning

• Continue liquid diet with clear fluids such as black tea or coffee, sugar-free squash, clear soups or water up to up to 5am

If your procedure is in the afternoon

• Drink clear fluids such as black tea or coffee, sugar free squash or water up to 10am. When you travel to and from the hospital for your procedure carry some glucose tablets or 200mls (a small carton) of smooth orange juice.

What to do if you have a ‘hypo’?

• If you have any symptoms of a low blood sugar such as sweating, dizziness, blurred vision or shaking please test your blood sugar if you are able to do so.

If it is less than 4mmol/L (or if you are not able to check your blood sugar), take 4 glucose tablets or 200ml carton of smooth orange juice or 4-5 jelly babies. Please tell staff at the hospital that you have done this because it is possible that your endoscopy (if you are having a combined procedure) may have to be rearranged.

Remember to bring with you to hospital

• Glucose tablets or smooth orange juice
• Blood glucose testing equipment (if you usually monitor your blood glucose)
• The tablets or injections you usually take for your diabetes, and prescription if available.

The following tables will guide you on how to adjust your diabetes medication ON THE DAY of your procedure.

If you are able to check your blood sugar, you should monitor this closely (e.g. on waking, on arrival at the hospital, after the procedure).

What to do with your oral diabetes medications

 

Tablets	If your procedure is in the morning	If your procedure is in the afternoon
Metformin	Omit your morning dose. If only taken at this time take at lunchtime	Omit morning and lunchtime Take again with evening meal
Sulphonylureas Gliclazide/Gliclazide MR Glibenclamide, Glimepride	Omit your morning dose. If only taken at this time take this dose at lunch time	Omit your morning dose
Pioglitazone	Delay until after the procedure	Delay until after the procedure
Meglitinide (repaglinide or nateglinide)	Omit your morning dose	Omit your morning and lunchtime dose Take again with evening meal
DPP-IV inhibitors (sitagliptin, Saxagliptin, Vildagliptin, Linagliptin)	Omit your morning dose. If only taken at this time take at lunch time	Omit your morning dose. If only taken at this time, delay until after the procedure
SGLT2 (Dapaglifozin Canagliflozin Empaglifozin)	Delay until after the procedure	Delay until after the procedure
Rybelsus (semaglutide)	Delay until after the procedure	Delay until after the procedure

 

 

Injections	If your procedure is in the morning	If your procedure is in the afternoon
Once daily insulin ONLY (type 2 diabetes) Glargine (Lantus) Levemir (Detemir) Insulatard Humulin I Toujeo	Continue your usual dose*         *See below	Halve your normal dose if taken in the morning
Twice daily mixed insulin Novomix 30 Humalog Mix 25 or 50 Humulin M3	Halve your usual morning dose.   Resume your normal insulin regimen with your next meal	Halve the usual morning dose.   Resume your normal insulin regimen with your next meal.
Twice daily – separate injections of short-acting (e.g. animal neutral, Humulin S, Fiasp, Novorapid, Humalog, Apidra) and intermediate-acting (e.g. animal isophane, Insulatard, Humulin I )	Calculate the total dose of both morning insulins and give half as intermediate acting only in the morning.   Leave the evening meal dose unchanged.	Calculate the total dose of both morning insulins and give half as intermediate acting only in the morning.   Leave the evening meal dose unchanged.
Three times daily mixed insulin Novomix 30 Humalog Mix 25 or 50 Humulin M3	Halve your usual morning dose.   If you miss lunch do not take your lunchtime dose.   Resume your normal insulin regimen with your next meal.	Halve your usual morning dose.   Omit lunchtime dose.   Resume your normal insulin regimen with your next meal.
Basal bolus regimens: Combination of once or twice daily background (basal) long acting insulin with short acting insulin at meal times (see page 1 for insulin types)	Basal (long-acting): Continue with your normal dose*   Short-acting: Omit morning dose   Resume your normal insulin regimen with your next meal   *see below	Basal (long-acting): Continue with your normal dose*   Short-acting: Omit morning dose Omit lunchtime dose   Resume your normal insulin regimen with your next meal
Exenatide (Byetta)	Omit morning dose	Omit morning dose
Liraglutide (Victoza) Lixisenatide (Lyxumia)	Delay until after procedure	Delay until after procedure
Bydureon, Semaglutide (ozempic) and dulaglutide (trulicity)	Delay by one day if due	Delay by one day if due

*If you normally graze through the day or normally eat snacks without taking extra insulin you should reduce this insulin dose by one third (e.g. if on 30 units normally, take 20).

What if I have an insulin pump?

• Maintain your usual basal rate, and only give boluses if you need to correct for a significantly elevated reading.

• If you have any concerns about hypoglycaemia, you can use a temporary basal rate that is 80% of your usual rate.

• You can contact your diabetes specialist nurse, or practice nurse or general practitioner for personalised advice.

After the procedure

How do I manage my diabetes after the procedure?

• After your procedure you can drink when you feel able to.

• Once you are eating and drinking you should resume taking your diabetes medications as normal.

• Your blood glucose levels may be higher than usual for a day or so.

• When you get home, if you feel nauseated or vomit and are unable to eat, please refer to the ‘What should I do if I am unwell?’ section below.

What should you do if you are unwell?

• NEVER stop taking your insulin or tablets – illness usually increases your body’s need for insulin

• TEST your blood glucose level every 2 hours, day and night

• TEST your urine for ketones every time you go to the toilet or your blood ketones every 2 hours if you have type 1 diabetes and have the equipment to do this

• DRINK at least 100 mls water/sugar free fluid every hour – you must drink at least 2.5 litres per day during illness (approximately 5 pints)

• REST and avoid strenuous exercise as this may increase your blood glucose level during illness

• EAT as normally as you can. If you cannot eat or if you have a smaller appetite than normal, replace solid food during illness, with one of the following:
• 400 mls milk
• 200 mls carton fruit juice
• 150-200 mls non-diet fizzy drink
• 1 scoop ice cream

When should you call the Diabetes Specialist Nurses or your GP?

• CONTINUOUS diarrhoea and vomiting, and / or high fever

• UNABLE to keep down food for 4 hours or more

• HIGH blood glucose levels with symptoms of illness (above 15 mmol/L – you may need more insulin)

• KETONES in type 1 diabetes at ++2 or +++3 in your urine or 1.5 mmol/L blood ketones or more – you may need more insulin. In this case, contact the person who normally looks after your diabetes immediately.

• OUTSIDE NORMAL WORKING HOURS consult the local out of hour’s service or go to your local hospital A&E department.

Am I prepared for my endoscopic procedure?

• Write down your medication plan for the 2 days before, the procedure day, and the day after your endoscopic procedure. Sedation can affect your thinking, so it may be helpful to write your plan in the table below.

• If you are unclear you can contact your diabetes specialist nurse, practice nurse, the endoscopy department or general practitioner for personalised advice.

Contact details

Cumberland Infirmary Endoscopy Unit: 01228 814289

West Cumberland Endoscopy Unit: 01946 523061

Endoscopy booking/appointments: 01228 210430

 

 

 

 

 

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For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

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