Having a lower GI endoscopy colonoscopy / flexible sigmoidoscopy

Having a lower GI endoscopy colonoscopy / flexible sigmoidoscopy A guide to the test Information for patients Endoscopy

Welcome to The Endoscopy Unit Sheffield Teaching Hospitals NHS Foundation Trust has two Endoscopy Departments. One is at the Northern General Hospital and the other at the Royal Hallamshire Hospital You may have your test at either hospital depending on current waiting lists. When you book your test you will be told which hospital you need to go to. It may not be your own consultant who undertakes the procedure. It may be another doctor or a nurse endoscopist. At Northern General Hospital there are four Endoscopy rooms and at the Royal Hallamshire Hospital there are three Endoscopy rooms in operation at any one time, performing different procedures; therefore other patients may be seen before you. Please feel free to write where your appointment is and the date and time in your booklet. Hospital:... Date:... Time:... If you are unable to keep your appointment, please tell the department you are attending as soon as possible. This will allow us to give your appointment to someone else and arrange another date and time for you. page 2 of 20

Introduction You have been advised to have a lower gastrointestinal endoscopy to help find the cause of your symptoms. There are two types of test: 'colonoscopy' and 'flexible sigmoidoscopy' We have written this booklet to help answer some of the concerns you may have about the test. It may not answer all your questions so if you have any worries please don't hesitate to ask. The staff involved in doing your test will be available to answer any queries. Not every hospital does things in exactly the same way. The Endoscopy Suite telephone number is: Northern General Hospital: 0114 226 9174 / 0114 226 9730 Royal Hallamshire Hospital: 0114 271 2990 You may get an answer machine, if so please leave a message and contact number and someone will get back to you. The aims of this booklet are: to explain what happens on the day of your test. to answer some of the questions you may have about the test. page 3 of 20

What is a lower GI endoscopy? Colonoscopy and flexible sigmoidoscopy are tests that allow the Endoscopist to look directly at the lining of the large bowel (the colon). An endoscopy of the lower bowel is called sigmoidoscopy. An endoscopy of the whole bowel is called a colonoscopy. The instrument used for this is called a colonoscope, which is a long flexible tube about the thickness of your index finger, with a bright light at the end. The colonoscope allows us to see a picture of the lining of your bowel on a TV screen. large bowel (colon) appendix rectum (back passage) anus (opening into the bowel) page 4 of 20

Can there be complications or risks? The majority of colonoscopies are straightforward. However, as with any procedure there is a small risk of complications: A reaction to the sedative: The sedative can affect your breathing, making it more slow and shallow. Perforation: When polyps have been removed the risk of causing a perforation may occur in 1 in 500 cases. When polyps have not been removed, there is less than 1 in 1000 chance of causing a perforation. A perforation is a little tear in the lining of the bowel. This would require a short stay in hospital with antibiotics, or may require an operation to repair the hole. Bleeding: When polyps are removed there is a small risk of bleeding, approximately 1 in every 150 cases. Bleeding can occur up to 7-10 days after polyp removal. Bleeding often settles without treatment, but if it continues it may be necessary to return to hospital for re-assessment. You should also be aware that this examination is not perfect and even with a skilled Endoscopist some abnormalities may be missed. Around 90% are completed, but up to 10% are incomplete and may require an additional investigation (i.e. x-ray or scan) to be arranged. Be sure to tell us if you have any pain or persistent bleeding in the hours or days after your test. If you are worried about the risks please ask the doctor about them. page 5 of 20

Do I have to have an endoscopy or is there another type of procedure available which can examine the inside of my body? For some conditions, it may be possible to perform a barium enema or a CT scan. The disadvantages of these procedures are that a biopsy cannot be taken or a polyp removed. Colonoscopy is also the most accurate method of detecting serious bowel abnormalities. The consent form Before a doctor or healthcare professional examines or treats you, they will need to gain your consent. This will be required in writing. If you later change your mind, you are entitled to withdraw consent even after signing. A copy of the consent form will be offered to you. What should I know before deciding? The Endoscopist or health professional will ensure you know enough information about the procedure to enable you to decide about your treatment. They will write this information on the consent form as well as discussing choices of treatment with you. We encourage you to ask questions and inform us of any concerns that you may have. It may be helpful for you to write these down as a reminder. What are the key things to remember? The main thing to remember is that it is your decision. It's up to you to choose whether or not to consent to what is being proposed. Ask as many questions as you like and please express any concerns about medication, allergies or past medical history. page 6 of 20

Can I find out more about giving consent? For further information on consent you may wish to look at the NHS Choices website as follows: www.nhs.uk/conditions/consent-to-treatment Training at the hospital Sheffield Teaching Hospitals Trust is a teaching organisation and has a responsibility to ensure that students (both medical and nursing) receive a high standard of training. Occasionally there may be students or junior doctors to observe a procedure, or the Endoscopist may be a trainee under the supervision of an experienced Endoscopist. In each case you will be informed beforehand and it is your right to decline anything you are not comfortable with. This will not affect your treatment in any way. Preparing for the test If we are to see clear views of your bowel it must be completely empty of waste material. If it is not, certain areas will be difficult to see and the test may have to be repeated. You will be given detailed instructions about how to clear your bowel. Usually this will include using laxatives. Please note that different Endoscopists prefer for you to use different types of laxatives. If you are having a colonoscopy you should have received some laxative sachets to make into a drink. Full instructions on how to use these will be enclosed. If you are having a flexible sigmoidoscopy you may only need an enema. Enemas are usually carried out in the department. Sometimes however it is necessary to take sachets similar to the page 7 of 20

ones used for colonoscopy. Full instructions on how to use these will be enclosed. It is important that you follow any instructions carefully. You can help lessen the soreness around the back passage that the laxatives may cause by applying a barrier cream, for instance Sudacream, before taking the laxative. Medication You may continue to take your usual medication up to the day of the test but you must stop certain tablets at least 7 days before the test. These are: all tablets that contain iron medicines used for the treatment of diarrhoea If you are taking anti-blood clotting medicines such as Warfarin, Rivaroxaban, Apixaban, Dabigatran or Clopidogrel (Plavix) please contact the Endoscopy Suite as soon as possible. If you are diabetic, please refer to the 'Managing your diabetes' booklet which you received with your appointment letter. If you have any queries regarding your diabetes please contact the Endoscopy Suite. Please remember that if you are taking the oral contraceptive pill, you will need to take extra precautions until your next period. This is because the laxative used to prepare your bowel for the procedure will affect the absorption and effectiveness of the pill. The number to call is: Northern General Hospital: 0114 226 9174 / 0114 226 9730 Royal Hallamshire Hospital: 0114 271 2990 You may get an answer machine, if so please leave a message and contact number and someone will get back to you. page 8 of 20

Before your appointment Before you come to the Endoscopy Suite you should: Ensure you have completed your pre-assessment questionnaire and returned it to the Endoscopy Suite. Contact the Endoscopy Suite if you are suffering from a sore throat, cold or chest infection, as it may be necessary to postpone your test because of the risks from sedation. Bring with you any letters or cards you have received from the hospital. Bring any tablets you are currently taking. It is especially important to remember any asthma inhalers, angina sprays or diabetic medication. Follow all instructions included with this booklet. Arrive on time for your appointment. You should not bring valuables or large amounts of money into hospital, as we cannot accept responsibility for them. Do not drive yourself to or from hospital. Make sure someone is able to bring and collect you as you must have a responsible adult to accompany you home. How long will I spend in hospital? This will depend on your individual procedure and on whether or not you choose to be sedated for your test. If you choose sedation, please allow for a stay of anything from 2-4 hours. If you choose not to be sedated, then your stay will be much shorter. Please note that your appointment time is for your pre-procedure assessment and not the time of your examination. You may find your test is delayed. We do sometimes have to deal with unexpected emergency cases and this can prevent us seeing you as quickly as we would like. We apologise if such delays happen to you. If they do we will try to keep them to a minimum and make sure you know the reason for the delay. Please be patient. page 9 of 20

When you arrive at the Endoscopy Suite On arrival at the hospital, please go to the reception desk in the Endoscopy suite. Once checked in, you will be asked to take a seat in the waiting room. A nurse will call you in for pre-assessment. This involves checking your pulse and blood pressure, whether you have any allergies, discharge arrangements, etc. Please feel free to ask questions or voice any worries you may have about your test. The nurse will explain the options of sedation (injection) and entonox (gas and air). Both are available for you to have during the test. However some medical conditions may determine which is more suitable. The endoscopist will discuss this with you. Sedation This is a sedative injection which may make you sleepy. It is not like a general anaesthetic so you may still be aware of having the procedure. It does however sometimes have a short term 'amnesic effect' which means you may not remember having the procedure. You: will be less anxious may be sleepy may not remember the test at all will need to be monitored carefully will take longer to recover will not be able to drive home will have to have an adult with you to take you home We advise you to refrain from taking any sleeping tablets on the day of your procedure if you have had sedation. page 10 of 20

If you choose to have the injection you must have a relative or friend to accompany you home and who can also stay with you for 24 hours. Entonox Entonox is a gas made up of 50% oxygen and 50% nitrous oxide. This gas is colourless and odourless and acts as a painkiller. You breathe this in through a mouth piece. It is safe You are in control over the amount of entonox you need You generally recover more quickly There is generally no delay in going home It acts as a painkiller, not a sedation You cannot drive for 30 minutes After pre-assessment we will take you through to a changing area and ask you to put on a hospital gown, a dressing gown and disposable shorts. You may have to remove any jewellery or metal objects in case a special piece of equipment, called a diathermy, is used. All your other belongings will be put into a property bag, which will stay with you at all times. If you have false teeth and it is necessary for these to be removed, you will only need to remove them in the procedure room just before the examination begins. These will be placed in a denture pot and labelled and will stay with you at all times. page 11 of 20

What happens during the test? We will ask you to get on a couch and make sure you are lying comfortably, resting on your left side with your knees slightly bent. A nurse will stay with you throughout the procedure. If you are having sedation, a needle will be inserted in your arm or hand. This sedation will help you to feel relaxed and may mean you do not remember the test but it will not put you to sleep. If you have sedation we will also give you oxygen via tiny tubes into your nose. We will also monitor your pulse rate and your oxygen levels by attaching a small device to your finger. If you have entonox the nurse will give you instruction on how to use it correctly. When the tube has been gently inserted through the back passage, air will be passed through the tube into the large bowel to open it up and give us a good view of your bowel lining. This may give you a 'wind-like' pain but this does not usually last long. You may get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. You may also pass some wind. This is perfectly normal and nothing to be embarrassed about - remember the staff do understand what is causing it. Sometimes the doctor or nurse doing the test will need to take tiny samples of the bowel lining. It is also possible to remove polyps during a colonoscopy. Polyps are abnormal growths of tissue, rather like warts. If you have polyps removed, these will also be sent for analysis. It usually takes up to 30 minutes for the colon to be examined but can sometimes take a little longer. When the examination is finished the tube is removed quickly and easily. page 12 of 20

What happens after the test? If you had a test without sedation or with Entonox only you will be able to go home as soon as you are dressed and feel ready to leave. If you had sedation you will be taken into the Endoscopy recovery area where you will rest for about an hour. Whilst we endeavour to keep male and female separate in the recovery area, this is not always possible especially at peak times. However, the staff will ensure that your privacy is maintained at all times. Occasionally, we may transfer you to a ward for your recovery period. You may feel a little bloated with wind pains, these usually settle quickly once you have passed the wind and will not need any treatment. Once you are fully awake the needle used to give you the sedation will be removed. You will then be able to get up, get dressed, and have a drink and biscuits. The effects of the sedation can last for at least 24 hours and even though you will probably feel perfectly recovered your judgement can remain impaired during this time. It is essential that someone comes to pick you up. Once you get home, we recommend that you rest quietly for the remainder of the day and that someone stays with you. It is important that you do not: drive a car operate machinery or domestic appliances, as your reaction times may be slowed drink alcohol sign legally binding agreements page 13 of 20

When can I get back to my normal activities? You should be ready to get back to your normal activities by the next day. Getting your results The Endoscopist may be able to tell you the results of your tests straight away. However, if you had sedation you may not remember what has been said. To make sure you have had and understood your results, the recovery nurse will give them to you again when you are fully awake. If a biopsy has been taken or if polyps have been removed these have to go to the laboratory and the results from these tests may take several days. A copy of the procedure report will be sent to your GP/referring doctor. Further details of the examination and any necessary treatment should be discussed with your GP in 10 to 14 days or at your next outpatient appointment. What should I do if I have any problems when I get home? If you have any problems when you go home, or are feeling worse than you expected, please contact the Endoscopy Department on the telephone numbers given to you on discharge. Frequently asked questions and answers What if my Bowel Preparation hasn't worked after 3 hours of taking the laxative? Please be patient. We anticipate that the laxative will work within a few hours as outlined in the manufacturer's guidelines, but this can sometimes take a little longer depending on your age, diet, if you have diabetes and whether you suffer from constipation. If by the morning of your appointment you have had no result, please contact us for advice. page 14 of 20

Once it does start working please stay close to a toilet as sometimes no warning may be given. If my symptoms have stopped before the colonoscopy, should I still come for the test? Yes. It is important that you still come for the test. Your doctor has organised this test to ensure you have no problems in your large bowel. Although the symptoms may have gone, it's important to have a look to ensure all is clear. Will it hurt? You may feel some discomfort from the air that is pumped into the large bowel so that the endoscopist can view the lining adequately. Some patients find the air used to inflate slightly uncomfortable. It should not hurt. A mild sedative is available to you should you wish to have one. Can I drive home after the colonoscopy if I choose to have sedation? You will not be allowed to drive home and must arrange for someone to accompany you and drive you home. Medication given during the test will prohibit you from driving for 24 hours after the examination. Please do not plan to take public transport home. If you are unable to arrange transportation we can arrange a taxi to take you home, however you are responsible for the fare. You will need a responsible adult at home for 24 hours. Will I get any results on the day? Upon completion of the colonoscopy the findings will be discussed with you. We will be able to tell you any visual findings, however any samples will need to be sent to the laboratory for testing; this can take up to 3 weeks. A copy of the report will be sent to your referring doctor and your GP. page 15 of 20

What is the address for the Endoscopy Suite? Endoscopy Suite, Huntsman B floor Northern General Hospital, Herries Road, S5 7AU Endoscopy Suite, B floor Royal Hallamshire Hospital, Glossop Road, S10 2JS Can I park at the hospital? Yes. We have car parks at both hospitals; these are indicated on the enclosed maps. The rates are as follows*: Northern General Hospital Up to 4 hours = 2.40 Over 4 hours = 3.70 All the disabled parking bays around the Northern General Hospital are free of charge. Royal Hallamshire Hospital Up to 2 hours = 2.50 Up to 4 hours = 3.70 Over 4 hours = 8.40 Disabled parking bays in the multi-storey car park are charged at normal rate, however there are disabled parking bays on A and B Roads which are free of charge. *Car parking charges are correct at time of printing. Please ensure you check the rates before parking. Can I get public transport to the hospital? Yes. You may use public transport. See below for details of how to find out which bus routes serve the Endoscopy Suite you are visiting. Please remember if you have sedation you will not be able to travel home using public transport. page 16 of 20

01709 515151 (Traveline) www.travelsouthyorkshire.com Are there facilities for my relatives/friends to obtain refreshments while they are waiting for me? Yes. We have refreshments available at both hospitals. Northern General Hospital AMT Coffee Shop situated in the main entrance, C Floor Royal Hallamshire Hospital WRVS situated on B Road in the main entrance, B Floor page 17 of 20

Please use this space to make a note of any questions you may have about your test page 18 of 20

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