COLONOSCOPY. Travelling to London Bridge Hospital A GUIDE FOR PATIENTS. Please ensure you read this booklet as it contains important information

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1 Travelling to London Bridge Hospital Directions: London Bridge Hospital is situated on the south side of the River Thames. We are next to London Bridge mainline and underground stations with easy access to the City. Train: London Bridge Station is serviced by trains from Kent and Surrey and offers direct connections to Charing Cross, Cannon Street, Waterloo East and Blackfriars Stations. Trains also connect directly on the Thameslink line. Underground: London Bridge Station is on the Jubilee Line and Northern Line (Bank Branch). Please take the Tooley Street exit, located opposite the London Dungeons. By Car: There are no car parking facilities available at the hospital. There is limited parking nearby. Patients can be dropped off and collected by car or taxi outside the main door of the hospital, where 15 minutes parking is available. Taxi: The hospital reception can book taxis for patients and visitors through our local taxi company, alternatively black cabs are available at London Bridge Station. COLONOSCOPY A GUIDE FOR PATIENTS Buses: There are numerous buses that pass by the hospital on Tooley Street, from London Bridge, or from outside the main entrance of the London Bridge Station Tooley Street, London SE1 2PR Tel: Web: Please ensure you read this booklet as it contains important information

2 Welcome You have been advised to have an investigations of the lower bowel (Colonoscopy) at a single appointment. This booklet gives information about the procedure. We will do everything we can to make your stay as comfortable as possible and prepare you for your visit. Please take the time to read this booklet, as it contains important information about: How to prepare yourself for your procedure. What to expect during your stay. Being discharged home. Advice for carers Your formal consent is required before carrying out this examination. This booklet explains how the examination is carried out and what the risks are. This will help you to make an informed decision in agreeing to the examination and having sedation. If there is anything you do not understand, or anything further you wish to discuss please call either your Consultant or the Endoscopy Department. The purpose of this information booklet is as a guide for your procedure. Your Consultant may have given you specific instructions to follow. Please then follow your Consultant s requests.

3 Before you come into hospital Please bring in with you: You will have already seen a doctor in an outpatient clinic and they have decided that you require this procedure as a day case. If you have been sent a Patient Self Assessment form, or admission/registration form, please complete it making sure all details are correct. If you do not think either document will reach us in time for your admission, please bring the form with you. Prior to admission, it is imperative that you advise your insurance company of your admission to gain pre-authorisation. If you are self-funding, full payment must be made prior to admission. If you have any questions about your insurance or payment methods, you can contact our Pre-Admissions Officer on If the intended operation or procedure is being carried out under general anaesthetic or sedation, you must make arrangements in advance for somebody to take you home and also stay with you overnight. Your procedure may not go ahead if you have not made suitable or safe discharge arrangements. If you have any queries about your admission date or time, please contact your Consultant, your Consultant s secretary or our Reservations Department. Telephone or /2180. Privacy and accommodation In the Day Surgery Unit, all rooms are shared. Each room will accommodate two to four patients. The bed spaces are separated by curtains and partitions to provide some privacy. Each room will only ever be single-sex. All tablets, medications, inhalers that you are currently taking in the original packaging or any prescriptions you have. Please do not bring in your dosette box. Any toiletries you require. Glasses/contact lenses, cases and solutions. Something to help you pass the time, such as books, magazines, puzzles etc. X-rays, scans and any other appropriate reports or letters. Insurance documents. HCA Hospital ID Card if you have been a patient of an HCA hospital before. Credit/debit card or other payment method. Valuables Please do not bring jewellery or large sums of money. If this is unavoidable, please ask a relative or friend to look after them. London Bridge Hospital cannot be held responsible for any loss or damage to property brought into the hospital. In the Day Surgery Unit, you will have a locker next to your bed space for your personal possessions. This will be locked and the nurse will look after the key for you whilst you are having your procedure. This space is limited; please only bring with you what you will need. What should I wear? Wear loose, comfortable clothes, cotton underwear and flat or low-heeled shoes. 2

4 What to expect during your stay Waiting time Although you will have been given a provisional time for your procedure, the order of the operating list is not confirmed until the day of admission by the Consultant. Any investigation time may also be subject to change. On the day of your procedure, you must allow time for the admission process, procedure and your recovery time. You should expect to spend up to three hours with us. If you feel that you want to discuss your proposed treatment in a more private place, ask the nurse assigned to you. Please do not hesitate to contact us if you have any questions you wish to discuss further with a nurse prior to your admission. Do I keep taking my normal medication? If you are presently taking tablets to reduce the acid in your stomach please discuss this with your Consultant. Your Consultant may wish for you to discontinue them. If you are diabetic and taking medication (either tablets or insulin), you will have to reduce/modify your tablets or insulin dose when you start avoiding solid food as below. You should test your blood or urine for glucose before you start your bowel preparation, and then at least every four hours until you leave home for your appointment. If the result is higher than 10mmol/L, continue with your medication. You may drink sugary drinks to maintain your blood sugar level up to two hours before your appointment time. If it is lower than 10mmol/L, delay your medication until you start eating again. You may need to take just your normal dosage of medication according to blood sugar level. If you take iron tablets, remember to stop these SEVEN days before the examination. If you take Warfarin, Aspirin, Clopidrogrel (Plavix), any anti-inflammatory tablet or Heparin, you may continue them. However, you should discuss this with your consultant. For example if you have a known colonic polyp which will need to be removed then you must discontinue the blood thinning medication. Please remember to tell the staff about the drug before your test. Take other medication either an hour before or an hour after bowel prep as the bowel prep is designed to speed up passage through your bowel. Specific instructions for taking your bowel prep are included in this booklet in the Colonoscopy section. Intravenous Sedation Please note that if you are given sedation a responsible adult must accompany you home and you must have someone to stay with you overnight. You may wake up fairly quickly or more slowly each person reacts differently. You will probably remain on the unit for about two hours, but the effects of the sedation will last for much longer, up to 24 hours. Your thinking processes and movements will be slower than usual. It is very likely that you will not remember anything about the examination afterwards.

5 What happens when I arrive You will be asked to arrive at London Bridge Hospital one hour before your scheduled procedure time to allow the administrative and nursing staff ample time to complete your admission and any pre-test tasks. You will see a member of staff from the accounts team. They will check your admission and account details with you. You will then be sent up to the appropriate ward area, where you will be greeted by a member of the nursing team. They will show you to your room or bed space. A nurse will complete the admission process with you. This will include confirming your identity, completing paperwork, asking you questions about yourself and your health, (this is made shorter if you complete the Self Assessment Booklet), taking your blood pressure, pulse and temperature. You will be given two hospital identity bracelets with your name and details on them. If you are allergic to anything such as some foods, types of medication or latex, please tell your nurse and a red allergy bracelet will be used. You will be asked to wear a hospital gown. You will see your Consultant prior to your procedure. Feel free to ask any questions at this time. You will then sign a consent form, unless you have already done so in your outpatients clinic. You will be given a copy of the consent form for your own records by your Consultant or nurse. The nurse will also ask you about your arrangements for getting home reminding you of the importance of having someone accompanying you if you have had sedation. The nurse will check your personal details again before taking you to the endoscopy room. Why do you keep asking me the same questions? What is a Colonoscopy? A Colonoscopy is a test that allows the doctor to look directly at the lining of the large bowel (also called the colon or large intestine), from the rectum (back passage) through the large bowel to the lower end of the small bowel (also called the small intestine). During the procedure a thin flexible tube called a colonoscope is passed through the anus (opening to the back passage) into the large bowel. The end of the colonoscope contains a light and conveys images to a viewing screen allowing the doctor a clear view of the bowel lining. As well as looking at the lining, biopsies (small pieces of tissue samples - for examination under a microscope) can be taken and polyps (small protruding growths) can be removed. Why do I need a Colonoscopy? You may have been advised to have a Colonoscopy for the following reasons: To try and find the source of your symptoms such as: - bleeding from the anus - changes in bowel movements - abdominal pain or - abnormalities revealed by other investigations, such as barium enema or CT (Virtual) Colonoscopy As a follow-up inspection of a previous disease To remove polyps The results will help your Consultant to decide on the best treatment for your problem or whether to carry out any further examinations. We have to confirm certain details are correct as part of our checking procedure. This is standard practice for any patient having a procedure as we have to ensure the correct procedure is carried out. We do know who you are and why you are in hospital, but we want to double check our information.

6 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. If a polyp is found, or if we already know you have a polyp, it is usually removed by your consultant as it may grow and cause problems later. Alternatively, some samples maybe taken for further examination. Polypectomy involves using a high frequency electric current to remove or destroy the polyp. What are the alternatives to Colonoscopy? A barium enema examination is an alternative to Colonoscopy. It has the disadvantage that tissue samples cannot be taken if an abnormality is found in which case a subsequent endoscopy examination maybe required. CT scanning with bowel prep (Virtual Colonoscopy) is appropriate for some patients, but again tissues samples cannot be obtained and a follow up Colonoscopy may be required. What are the risks? According to the British Society of Gastroenterology the main risks associated with Colonoscopy are: Bleeding: this may occur at the site of any biopsies taken (1:16,000) or polyps removed (1:100). This is usually very minor and stops of its own accord. Perforation: a tear in the lining of the bowel wall. Nationally this happens to approximately 1 in 1000 patients or 1 in 500 when a polyp is removed. Reaction to sedation: problems with breathing, heart rate and blood pressure happen occasionally. 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. These risks do increase for elderly patients and those who have significant health problems. Allergic reactions to sedation are very rare.

7 Bowel Preparation and Dietary Instructions SEVEN DAYS BEFORE Stop any iron tablets if you are on any FOUR DAYS BEFORE Stop any lomotil, codeine or anti-diarrhoea tablets if you are on any. TWO DAYS BEFORE You will need to be on a low fibre diet and increase your fluid intake. A diet sheet is included at the back of this booklet. ONE DAY BEFORE You should take clear fluids only (no solid food) e.g. glucose drinks, Bovril, tea and coffee (without milk), clear soup and fruit jelly. You will now need to take your laxative bowel prep your consultant as provided. If you have any queries do not hesitate to contact the endoscopy unit and someone will assist you How to Take the Bowel Preparation You have been given bowel preparation. This consists of two sachets of Picolax or equivalent which must be taken as instructed below. For a successful examination, it is important that the bowel is completely clear of faeces. If the bowel is not completely clear, your consultant will not be able to obtain a good enough view and will have to repeat the examination. Important Note: Try to have between two to three litres [six pints] of fluid with your Bowel Preparation. We suggest that you drink a glass or cup full of water each hour. Take note of the time of your appointment the preparation instructions are different for morning and afternoon procedures (If you are a diabetic on insulin please advise your Consultant). The bowel preparation is designed to empty the bowel and will cause diarrhoea-like watery bowel movements. The first of these liquid bowel movements should occur within one to two hours of drinking the solution, so you will need to be close to a toilet. It is also common to experience some abdominal cramping. You should drink lots of clear fluid to replace the fluid you will lose (remember between two and three litres), and can continue to drink clear fluid up to two hours before the procedure. FOR MORNING APPOINTMENTS On the day before your appointment No breakfast (and nothing to eat until after your test the following day) but you may continue to drink clear fluids. 5pm: dissolve the first sachet of Picolax in 500mls (one pint) of water. The Picolax may make it warm so you can ice it if you want. Follow this with the same amount (500mls, one pint) of water or permitted clear fluid. You may take this slowly over half an hour. 8pm: drink the second sachet of Picolax in 500mls (one pint) of water Follow this with the same amount (500mls, one pint) of water or permitted clear fluid. You may take this slowly over half an hour. If you feel sick, try drinking the solution at a slightly slower rate. On the day of your colonoscopy We advise you continue to drink plenty of clear fluids up to two hours before your test. Chewing gum is not permitted. FOR AFTERNOON APPOINTMENTS On the day before your appointment You may have a very light breakfast i.e. tea without milk and a slice of white toast. Nothing to eat after this until after your test. 6pm: dissolve the first sachet of Picolax in 500mls (one pint) of water. The Picolax may make it warm so you can ice it if you want. Follow this with the same amount (500mls, one pint) of water or permitted clear fluid. You may take this slowly over half an hour. On the day of your colonoscopy 8am (or at least six hours before the time of your procedure): drink the second sachet of Picolax in 500mls (one pint) of water. Follow this with the same amount (500mls, one pint) of water or permitted clear fluid. You may take this slowly over half an hour. You should aim to finish taking the bowel preparation at least four hours before your appointment. We advise you continue to drink plenty of clear fluids up to two hours before your test. Chewing gum is not permitted. If you experience any problems whilst taking your bowel preparation contact your Consultant or the Day Surgery Unit on

8 What happens during a Colonoscopy? Your Consultant will move the colonoscope around the length of your large bowel. During the test air will be passed into your bowel to allow us to see better and this may make you feel bloated and uncomfortable. This is normal and you may pass wind freely at any time. If we find you have a polyp we will remove it during the procedure if possible. A photograph of the inside of your bowel may also be taken to record the abnormality. It will be kept in your medical records and sent with your biopsy and can be shown to you later to help you understand what is wrong What happens after the procedure? After the test you will return to the Day Surgery Unit on your trolley to continue your recovery. The nursing staff will check your pulse, blood pressure and oxygen levels, and generally assess how you have recovered from the test. You may feel a little bloated and experience wind pains, due to the air passed into the stomach and colon during the test, please don t feel embarrassed if you need to belch or pass wind, this will help relieve the discomfort quite quickly. If you are in pain, please inform your nurse as soon as possible. You will be given something to eat and drink about an hour after returning to the ward. Your Consultant will explain what was seen during the examination either before you leave or in your follow up appointment. If you haven t already got a follow up appointment this is when you will discuss this with your Consultant. Discharge Advice Side effects Many people who have a colonoscopy will experience some effects for up to two days following your procedure including: mild abdominal discomfort like cramping; soreness in the back passage; diarrhoea or slight bleeding from the back passage if a tissue sample or polyp have been taken. The effect of the sedative can last up to 24 hours. It can make you forgetful and drowsy even though you may feel fully alert. Once home, it is important to rest quietly for the remainder of the day. Furthermore you should avoid the following activities for at least 24 hours after the procedure: going to work driving operating machinery drinking alcohol signing any legally binding documents carrying out any activities involving heights caring for young children (sole responsibility) Queries and concerns If you have problems you wish to discuss following your procedure, please telephone the ward where you were cared for. You will be given this number on discharge. If you require advice out of hours (between 9pm and 7am), please telephone and ask to speak to the site bleep holder (on 000 ). This connects you to the senior nurse in charge of the hospital who can assist you. If you feel you need to be seen by a doctor in an emergency, please contact your Consultant, GP or go to your nearest Accident and Emergency Department.

9 Fire At London Bridge Hospital we take the safety of our patients, visitors and staff very seriously. Our staff undergo regular training, we have the latest evacuation equipment, our buildings are constructed to the very highest standards and are subject to frequent and regular external inspection. Test and drills Alarms are tested every Tuesday starting at 10.00am, and drills are conducted annually. Your nursing staff will inform you when a drill is taking place; you will not be expected to participate. In the unlikely event of a fire, we would like you to observe the following procedure: On discovering fire raise the alarm by either informing a member of staff or by using a break glass alarm and shouting fire, fire. Then contain the fire by shutting the nearest fire rated door and evacuate the immediate area. On hearing a continuous alarm this indicates that the fire is in your area. Your visitors and non-essential personnel will be evacuated to an assembly area outside the hospital. You are to remain in place until a member of the nursing staff evacuates you to a place of safety. On hearing the intermittent alarm this indicates that the fire is in your building but not in your area. Again, your visitors and non-essential personnel will be evacuated to an assembly area outside the hospital. Remain in your room until a senior member of the nursing staff tells you what to do. PLEASE DO NOT ATTEMPT TO LEAVE THE BUILDING UNLESS DIRECTED TO DO SO BY A MEMBER OF STAFF. Visitors and Escorts There are no restrictions on visiting times, but please remember that other patients may wish to rest or sleep. However, in consideration for other patients, please restrict your visitors to a maximum of two at any one time. Children are welcome to visit, but must be supervised by an adult at all times. Calls from friends or relatives can be made to the private phone by your bed. Please ask your callers to call the ward you are staying in, and a nurse will put them through (see useful telephone numbers at the back of this booklet). Alternatively, they can call the main switchboard on and ask to be put through to the room. The person taking you home is welcome to phone the hospital to check what time you will be ready to go home. Telephone: Comments, suggestions and complaints We welcome your views on our services to help us meet patients needs. We hope that your hospital visit will be a pleasant one and our staff will do all they can to ensure that this is the case. If you have a comment, suggestion or complaint about any aspect of our service, please approach a member of staff in the department and they will attempt to resolve things as quickly as possible. You will be given a Patient Feedback booklet to complete and we encourage your participation. Useful telephone numbers Main Reception Patient Accounts /2395/2061/2946 Day Surgery Unit /2631 Middle East Department X-ray Outpatients

10 Dietary instructions for Colonoscopy Preparation Diagram of Digestive Tract LOW FIBRE DIET Fibre is the indigestible part of cereals, fruit and vegetables. Please commence a low fibre diet two days before your procedure. FOODS ALLOWED Lean tender lamb, beef, pork, chicken, turkey, offal, bacon, lean ham, fish, Yorkshire pudding, pancakes, bread sauce; clear and puréed soups, potato (no skins), boiled and mashed; tomato pulp (no skins or pips); fruit juice (if tolerated); pastry made with white flour, white bread, white flour, cornflakes, rice krispies, icing smooth biscuits, e.g.: Marie, Osborne; spaghetti and pasta; white rice, crisps; rosehip syrup, Ribena; sugar or glucose in small amounts; boiled sweets, toffees; plain or milk chocolate; shortcake, cream crackers, water biscuits; sponge cake, Madeira cake; iced lollies; plain or flavored yoghurt; jelly; marmalade; honey, syrup; tea and coffee (without milk). Oesophagus FOODS TO BE AVOIDED Wholemeal, wheatmeal, granary bread, wholemeal flour; bran biscuits, cocunut biscuits; all cereals containing bran or whole wheat, e.g. Shredded Wheat, bran flakes, bran buds, muesuli; digestive biscuits; Ryvita, Vita Wheat, Oat Cakes, etc. FLUIDS ALLOWED 24 hours before your examination you should take clear fluids only (no food): Tea or coffee (no milk), water, strained fruit juice, strained tomato juice, fruit squash/ cordial, soda water, tonic water, lemonade, Oxo, Bovril, Marmite (mixed into weak drinks with hot water), clear soups and broths, consommé. Transverse colon Ascending colon Caecum Stomach Duodenum Small Intestine Descending colon Sigmoid colon IN ADDITION You may eat clear jellies You may suck clear boiled sweets and clear mints. You may add sugar or glucose to your drinks. You may NOT chew chewing gum two hours before your procedure Rectum Anus FLUIDS NOT ALLOWED Drinks or soups thickened with flour or other thickening agents.