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COLONOSCOPY

WHAT IS A COLONOSCOPY?

This procedure involves a colonoscope – a long, thin flexible tube with a ‘video camera’ at the tip – being passed through the rectum (back passage) into the colon. It allows the doctor to inspect the large intestine and also perform specialised procedures such as biopsies and removal of polyps. WHY HAVE A COLONOSCOPY?

Colonoscopy can detect inflamed tissue, ulcers and abnormal growths. The procedure is used to look for polyps or early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the bowel and weight loss. In some individuals with a family history, this may also be an appropriate test to check for bowel cancer. Polyps are growths from the bowel wall which are more common in people older than 50 and can sometimes become cancerous if left untreated. When polyps are seen during a colonoscopy it is usual to remove them using a special wire loop that is inserted as part of the colonoscope. The heated wire “burns off” the polyp and seals the resulting wound at the same time. HOW ARE YOU PREPARED?

Prior to the colonoscopy you will need to collect the bowel preparation materials from your chemist. The evening before, or the morning of, the procedure you will need to take bowel preparation which completely cleanses the colon. Please make sure that you have fasted (no food or fluids) for a minimum of 6 hours prior to your procedure. Inadequate fasting increases the risk of complications and may cause your procedure to be delayed or rescheduled. The ONLY exception is that you can consume clear water only up to 3 hours prior to your procedure. You should cease iron tablets and drugs to stop diarrhoea five days before the procedure. It is also desirable that you are not taking Clopidogrel (Plavix), other blood thinners (e.g. warfarin) or anti-inflammatory medications (e.g. Nurofen). Aspirin can be continued. If you are taking Warfarin or Clopidogrel (or other blood thinners) or have a coronary stent and are using Clopidogrel, you will need to see your GP to discuss this further, and you may also need to us in the rooms (and/or your Cardiologist) before the date of your procedure, as special arrangements may be necessary with your medications. You should advise the nursing and medical staff if you are allergic or sensitive to any drug or other substance. WHAT DO WE DO?

You will be given a sedative through a vein in your arm before the procedure to make you more comfortable. The colonoscope is inserted through the back passage (rectum) into the large intestine to allow inspection of the whole large bowel. SAFETY AND RISKS?

Colonoscopy is usually simple and safe. Most surveys report complications in only 1 in 1000 examinations or less. These rare complications include bleeding and perforation of the bowel. Severe bleeding or perforation may require an operation. If polyps are found and removed (polypectomy), there is a higher risk of perforation or bleeding from the site where the polyp has been removed. Complications from the sedation are rare. Patients with severe heart or chest disease are at higher risk, and special precautions are taken to avoid complications. This includes administering oxygen during the procedure and monitoring oxygen levels in the blood and your pulse rate and blood pressure. The colonoscope is a reusable instrument, which cannot go through a heat sterilisation process. However, after each use it is thoroughly cleaned and then disinfected, using a high level disinfectant. The hospital cleans and disinfects the colonoscope

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100 Murdoch Drive

Murdoch , WA 6150

(08) 6389 06316133 0613

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according to the standards set by the Gastroenterological Society of Australia. The possibility of infection being introduced during the procedure cannot be completely ruled out, but seems extremely rare. Occasionally the laxative preparations can cause clinically significant changes in salt and water concentrations in some people. Death is a remote possibility with any interventional procedure. If you wish to have details of possible rare complications discussed before the procedure, you should inform your doctor. WHAT HAPPENS AFTERWARDS?

The sedative painkiller you are given before the procedure is very effective in reducing any discomfort. However, it may also affect your memory for some time afterwards. For this reason a relative or friend should come with you if possible. You must not drive or operate machinery or make major decisions for 12 hours after the test. You may feel some discomfort when the sedative wears off, and this is usually a result of air inflated into your colon during the procedure. Passing wind will help relieve the discomfort. If after the test you have any symptoms that cause you concern, you should contact the Hospital or your own Doctor (e.g. severe abdominal pain, bleeding from the back passage, fever). COLONOSCOPY INSTRUCTION SHEET (LAVAGE PREPARATION)

For patients with Kidney problems

Please follow the instructions carefully to ensure the bowel is perfectly clear for the procedure. If the bowel is not clean, the

procedure may have to be repeated.

Please do not drive yourself to the hospital, as you will not be able to drive yourself home. Arrange for someone to pick you

up.

• Diabetic patients: DO NOT take your medication on the day of the procedure, but bring it with you. • STOP taking blood thinning medications (e.g. Warfarin, Clopidogrel) or iron tablets 5-7 days before the test (unless you

have a coronary stent, in which case contact your GP or the rooms for further instructions). Aspirin may be continued. • Take your usual other medications (e.g. blood pressure medications) even on the day of the procedure.

The bowel preparation can be bought from a Pharmacy without a prescription. Suitable brands include Colonlytely, Glycoprep-C,

and Golytely. Follow the instructions in the pack. Obtain this preparation well before the test as sometimes stocks are low at the pharmacy.

TWO DAYS BEFORE THE PROCEDURE

Commence a low residue diet:

FOOD ALLOWED FOOD NOT ALLOWED

Any clear fluid Vegetables/fruit

Rice bubbles/corn flakes/Special K Butter/margarine/oil

Eggs Fish (battered, fried, baked)

Rice/spaghetti (white only) Meat

Chicken/turkey (no skin) NO MILK/MILK PRODUCTS

Grilled fish (only grilled) Wholemeal/Wholegrain products

White bread/crackers Peanut butter/Jam/Marmalades with skin, seeds or peel

Vegemite/honey/sugar/salt

THE DAY BEFORE THE TEST

Clear fluids only are to be taken. Examples of clear liquids are: clear soup, diluted fruit juice, cordials, clear jellies, cordials (not red

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Murdoch , WA 6150

(08) 6389 06316133 0613

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or dark cordials), soda or tonic water, black tea, black coffee, Bonox, Rehydration solutions, and water. DO NOT HAVE: milk or milk products, pulp, pips or seeds, stock cubes, or green, red or purple food colouring. Do NOT drink ONLY water, have a range

of di�erent clear �uids. NO milk products, NO solid food. Have another responsible adult with you at home the night before the test.

Please Note:

• The preparation will produce diarrhoea. This is important to clean the bowel. The bowel fluid should turn a clear, pale yellow with no solid material within it.

• If you develop troublesome abdominal/tummy/stomach pain or feel very unwell, stop taking the preparation drinks and contact the Hospital for assistance or advice. However, the drinks often cause some nausea.

FOR MORNING APPOINTMENTS

At 6pm on the day before the procedure begin drinking the bowel preparation fluid. 1 Litre at 6pm, 1 Litre at 7pm, and 1 Litre at 8pm. Diarrhoea will occur and the bowel discharge should become clear yellow. If it is not clear have a further 1 Litre at 10pm. On the morning of the colonoscopy you may have clear fluids up until 3 hours before your appointment. FOR AFTERNOON APPOINTMENTS

You may have clear fluids on the night before the test. Have nothing to eat on the morning of the test. At 6am begin drinking the bowel preparation fluid. 1 Litre at 6am, 1 Litre at 7am, and 1 Litre at 8am. Diarrhoea will occur and the bowel discharge should become clear yellow. If it is not clear have a further 1 Litre at 9am. You should continue to drink clear fluids and may do so up until 3 hours before your appointment. AT THE HOSPITAL:

Report to the Gastroenterology Department at the time advised. Bring your referral form, relevant X-rays and your pre-admission form if you have not already delivered these, and your Medical Insurance and Medicare details. You will be in the hospital for between 2 to 6 hours. It is unsafe to drive yourself home. You must not drive or operate

machinery or make major decisions for 12 hours after the test. The sedative painkiller you are given before the procedure is very effective in reducing any discomfort. However, it may also affect your memory for some time afterwards. Even when the sedative appears to have worn off, you may find you are unable to recall details of your discussion with your doctor. For this reason a relative or friend should come with you if possible. You may have some wind pain after the pain killers wear off. If you have any severe abdominal pain, bleeding from the back passage, fever, or other symptoms that cause you concern, you should contact the Hospital or your Medical Practitioner. In most instances health funds accept Coastal Gastroenterology accounts for direct no-gap billing. If not, you will be given an invoice for the doctor’s services. Payment will be your responsibility, but the majority of the cost will be reimbursed by Medicare and your private health fund. If paying on the day a receipt will be issued for you to claim from your health fund and Medicare. A separate account is issued by Hollywood Private Hospital for the Bed Fee. With some funds there is a $50 hospital gap (similar at all hospitals) which must be paid on the day. If biopsies are taken you will also receive an account from the Pathologist. For most procedures an Anaesthetist is also present, and a further account is raised by that doctor.