THE PROCEDURE EXPLAINED

COLONOSCOPY

Enclosed in this booklet:

Appointment Information and Pre-procedure instructions

Colonoscopy procedure explained

Colonoscopy Consent Form

YOU MUST READ THE INFORMATION CONTAINED IN THIS BOOKLET AS SOON AS

YOU RECEIVE IT AND BRING IT WITH YOU ON YOUR ARRIVAL

INTRODUCTION You have been advised by your hospital doctor to have an investigation known as a colonoscopy. If you are unable to keep your appointment, please notify the Endoscopy Unit as soon as possible. This will enable us to offer your appointment to someone else and they will be able to arrange another date and time for you. This booklet has been written to enable you to make an informed decision in relation to agreeing to the investigation and whether you wish to have Entonox (gas & air) or sedation to be used. This procedure requires your formal consent. At the back of the booklet is the consent form. The consent form is a legal document, therefore please read it carefully. Once you have read and understood all the information including the possibility of complications and you agree to undergo the investigation, please sign and date the consent form. There will be two copies of the consent form; the second copy is for you to keep for your records. Please sign and date both copies. If however there is anything you do not understand or wish to discuss further but still wish to attend, do not sign the form, but bring it with you and you can sign it after you have spoken to a health care professional.

IMPORTANT INFORMATION REGARDING YOUR APPOINTMENT

Please complete the Yellow “Confidential Endoscopy Questionnaire” sent to you with this booklet and bring this with you on the day of your appointment.

On arrival, please check-in at the Chichester Treatment Centre (CTC) reception desk (if your appointment is at St Richards Hospital) or at the Endoscopy reception desk, West Wing (if your appointment is at Worthing Hospital).

Before your procedure, you will be seen initially by an Endoscopy nurse who will do some routine checks ensuring you are adequately prepared for your procedure.

Please do not bring any valuables to the department.

We advise that you only bring one relative/friend with you on your visit as there is limited space in the department.

If you are a carer, please ensure you make arrangements for them to be cared for by someone else.

Children are not permitted into the Endoscopy Unit. If this causes any specific problems to you please contact us for advice.

Your procedure (colonoscopy) normally takes about 30 minutes to do.

You will be offered the choice to have a sedative injection into your vein to make you feel very drowsy and relaxed, or to have Entonox (gas and air), which you will breathe in and will make you feel relaxed.

Opting for Entonox means that you are awake during the procedure and therefore will be able to drive yourself home and continue as normal with your daily activities.

If you opt for sedation please ensure you have a responsible adult to escort you home and stay with you for at least 24 hours following your procedure. For safety reasons you are not allowed to drive, operate heavy machineries or do any cooking. Avoid signing any important documents for 24 hours as you may not recall doing so.

Western Sussex Hospitals NHS Foundation Trust is responsible for the training of healthcare professionals. This means students and trainees, supervised by qualified staff, may be involved in your care. If you do not want students to be present, please inform the Doctor or the nurse in charge.

COLONOSCOPY INFORMATION

TIME DELAYS

We endeavour to schedule appointment times that reflect patient requirements.

However, delays may occur with changes to individual treatment needs or if there

are any emergency cases on the day, as these take priority.

In light of this, please be aware and be prepared that you may be in the

department for up to 4 hours.

After reading the following information and before signing the consent form, you should be able to understand:

1. The reason/s for you having a colonoscopy; 2. What happens during colonoscopy; 3. How to prepare yourself for a colonoscopy; 4. What types of therapies are performed during colonoscopy; 5. Alternative therapies and/or procedures;

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 investigations.

If you had colonoscopy before, a follow-up inspection of previous disease may be required.

Assessing the clinical importance of an abnormality seen on an x-ray or a CT scan.

PREPARING FOR A COLONOSCOPY For the test to be successful and for the Endoscopist to have a clear view, your bowel MUST BE EMPTY. In order to achieve this, you will be required to follow a special diet and to take the laxative medications sent to you with this booklet. A full explanation of the bowel preparation can be found on the leaflet inside the box and a diet sheet is found at the end of this booklet with the specific times on when to take the bowel prep doses.

If you have Diabetes, you must phone the Endoscopy Unit prior to your appointment so we can give you specific advice regarding the management of your diabetes leading up to and during your procedure.

WHAT IS A COLONOSCOPY? A Colonoscopy is a visual examination of the inside lining of your large bowel (colon). This is done by inserting a thin and flexible tube (colonoscope) into your back passage and gently passing it around your large bowel. This allows the Endoscopist to see what might be causing the symptoms that you are experiencing. A video recording and/ or photographs may be taken and retained on your records.

If you are taking WARFARIN or ACENOCOUMADIN and have not been given instructions at your clinic appointment, pre-assessment or booking telephone call, please contact the Endoscopy Unit. You will be given instructions or be advised to contact the Anticoagulation nurse.

If you are taking other anti-platelets or anticoagulants (blood thinning) drugs such as APIXABAN, RIVAROXABAN, DABIGATRAN, EDOXABAN, CLOPIDOGREL, PRASURGEL, TICAGRELOR, and have not been advised, please contact the Endoscopy Unit for advice.

If you are taking IRON TABLETS you must STOP them 1 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 2 days prior to your appointment.

Your other routine medications can be taken as normal.

If you have a Pacemaker or Implantable Cardioverter Defibrillator (ICD) it is recommended that you had a device check within the last 6 months prior to your procedure, just in case we need to use diathermy. If you haven’t had a device check then please make arrangements with the pacemaker clinic on 01903 205111 ext 85860 (Worthing site) or 01243 788122 ext 33531 (Chichester site). Please ensure you bring in your device details on the day of the procedure. If diathermy was used during the procedure, then you will need to have your device checked afterwards, either the same day or at the earliest opportunity.

WHAT HAPPENS DURING COLONOSCOPY?

Prior to your procedure, the Endoscopist will speak to you to ensure you understand the procedure and discuss any outstanding concerns or questions you may have.

Depending on what you have decided, you could either use Entonox (gas and air) during your procedure or the Endoscopist can give you a sedative injection into a vein in your hand/arm. (An intravenous cannula will be left in your vein secured with a transparent dressing throughout your procedure and whilst you’re in recovery).

There will be two endoscopy staff present during your test: one will be looking after you throughout your procedure and the other staff will be assisting the Endoscopist.

A blood pressure cuff will be placed around your upper arm and you will have a device attached to your finger which will monitor your heart rate and the oxygen levels in your bloodstream.

The nurse looking after you will ask you to lie on your left side. You may also be given some oxygen via a nasal cannula which will be placed up your nostrils.

The endoscopist will gently pass the colonoscope (a thin flexible fibre-optic tube) into your back passage. Your large bowel will be gently inflated with air to expand it enabling the Endoscopist to have better view of the lining. You may feel some abdominal cramps due to the air being introduced. The air will be sucked out at the end of the test.

The colonoscope will be manoeuvred around the entire length of your large bowel. There are some bends that naturally occur in the bowel and negotiating these may be uncomfortable for a short period of time but both the sedation/analgesia and the Entonox will help minimise any discomfort.

Intravenous sedation The sedation and painkiller administered before your procedure will make you lightly drowsy and relaxed but not unconscious. You will be in a state called co-operative sedation. This means that, although drowsy, you will still hear what is said to you and therefore you will be able to follow simple instructions during the investigation. The sedative we use in endoscopy has an ‘amnesic effect’, which means that you may have no or little memory of the procedure once the effect of the sedative wears off.

PLEASE NOTE IF YOU’RE HAVING SEDATION, YOU MUST NOT DRIVE, DRINK ALCOHOL, OPERATE HEAVY MACHINERY, OR SIGN ANY LEGALLY BINDING DOCUMENTS FOR 24 HOURS FOLLOWING THE PROCEDURE AND YOU WILL NEED A RELATIVE/FRIEND TO TAKE YOU HOME AND TO LOOK AFTER YOU.

Entonox (gas and air) Entonox (gas and air) is an effective alternative to intravenous sedation. It is a gas consisting of nitrous oxide and oxygen mixture which you breathe through a small mouth piece during the procedure. Entonox will make you feel relaxed and it will help relieve any discomfort. The effect of Entonox wears off very quickly as soon as you stop breathing it in. You will feel back to normal within approximately 20 minutes after your procedure, and therefore you do not need to have anybody to take you home and look after you after the procedure.

OTHER THERAPIES OR PROCEDURES THAT MAY BE PERFORMED DURING COLONOSCOPY

A Biopsy (a small tissue sample from the lining) may be taken during the procedure to be sent to the laboratory for microscopic examination. You will not feel this being done.

Polypectomy: A polyp is a small growth in the lining of the bowel caused by an abnormal multiplication of cells. Some polyps are pedunculated (look like a grape) and are attached to the bowel wall by a stalk and some are flat. Polyps when found are generally removed or sampled by the endoscopist as they may grow and cause problems. The removal of a polyp is called polypectomy. A polyp may be removed just with a small biopsy forceps, or with a thin wire snare. Electrical diathermy (cauterization) may be applied to minimise the risk of bleeding. .You will not feel a polyp being removed

Marking: in some cases, a larger polyp is found which cannot be removed during sigmoidoscopy. In this case, the endoscopist may mark the site of the polyp by injecting some ink solution in a nearby spot. This is called marking or tattooing, and it is done so that the site can be identified easily at a next endoscopy procedure. You will not feel this being done

ALTERNATIVE TO COLONOSCOPY

Although you were advised by your Doctor to have this test, as they feel this is more appropriate and the best option to investigate your symptoms, there is another test available that can be done. (Please speak to your referring Doctor regarding this if necessary). CT colonography (virtual colonoscopy) is done in the Radiology Department. It has the disadvantage of not being able to take any tissue samples if an abnormality is found. If this is the case, a subsequent endoscopic examination may be required.

WHAT HAPPENS AFTER YOU’VE HAD COLONOSCOPY?

If you had Entonox only, the endoscopist will speak to you about the test findings, treatment plan and/or other recommendations before you leave.

You will be taken by an endoscopy nurse to the recovery area where you will be monitored for at least 15-20 minutes.

You should be able to continue as normal with your daily activities following the test. You may feel slightly bloated because of the air introduced during the test but this will pass.

Very rarely you may feel light headed, if so we encourage you to stay in the recovery area until you feel better.

If you had sedation, the endoscopy nurses will take you into the recovery area where you will be monitored for at least 30-40 minutes.

Once you have recovered from the sedative effect, the recovery nurse will read to you your endoscopy report stating the test findings, treatment plan and/or other recommendations by the Endoscopist.

You may not remember any of the information given to you because of the amnesic effect of the sedation so you may either nominate someone (i.e. your relative/friend) to be present when you are being spoken to. If you were referred by your GP to have this test, make an appointment to see them after one week for further advice and treatment.

You are reminded to ensure that if you have sedation you have a responsible adult to escort you and stay with you for at least 24 hours following your procedure. For safety reasons you are not allowed to drive, operate heavy machineries or do any cooking. Avoid signing any important documents for 24 hours as you may not recall doing so.

WHAT ARE THE RISKS AND POTENTIAL COMPLICATIONS? A Colonoscopy is classified as an invasive investigation and because of that it has the possibility of associated complications. These occur extremely infrequently; we would like to draw your attention to them and make an informed decision regarding your care.

VERY IMPORTANT. PLEASE ENSURE THE ABOVE MENTIONED IS IN PLACE

OTHERWISE YOUR TEST MAY BE CANCELLED AND REBOOKED UNTIL

ARRANGEMENTS FOR THIS HAVE BEEN MADE.

The doctor who has requested the test will have considered this very carefully before recommending that you have it and as with every medical procedure, the risk must be compared to the benefit of having the procedure carried out.

Perforation can occur in about 1 in 1000 examination. This is a small tear in the lining of the bowel. An operation is nearly always required to repair the hole. The risk of perforation is higher with polyp removal.

Pain. Colonoscopy is not normally a painful procedure, but in 1-5% of cases it can cause abdominal pain bad enough that the procedure has to be abandoned. In these cases, the pain is of short duration and usually stops as soon as the colonoscope is removed from the bowel. If the procedure is abandoned because of pain, the endoscopist will discuss alternative investigations with you.

Bleeding: bleeding may occur at the site of a biopsy or following polyp removal; the risk is approximately 1 in 100-200 examinations where this is performed. Typically minor in degree, such bleeding may either simply stop on its own or if it does not, can be controlled by cauterization, apply clips or injection treatment.

Adverse Reaction to sedative. The sedative can affect 1 in 2,500 people by reducing your breathing making it slow and shallow and may lower your blood pressure.

Incomplete Procedure. This may happen due to technical difficulties, or if your bowel is not clean enough for an accurate examination, if there are complications during the procedure or if you experience any discomfort. The endoscopist may recommend another colonoscopy or a different test.

Missed pathology. Although a colonoscopy is a very accurate way of identifying bowel problems, it is recognised that in a small number of cases (1-5%) a disease can be missed, even despite a thorough inspection. The endoscopist will perform the procedure to the best of their ability. On your part, the best thing you can do is ensure that you follow the bowel preparation instructions and empty your bowel so that the endoscopist can have as accurate an inspection as possible.

HOW TO PREPARE FOR COLONOSCOPY

YOU MUST FOLLOW ALL THE INSTRUCTIONS IN TAKING THE BOWEL PREPARATION CORRECTLY FOR IT TO WORK WELL AND ENSURE CLEAR VIEWS DURING YOUR PROCEDURE.

7 days before your examination If you take any medications containing iron (e.g. ferrous sulphate), please STOP taking them, but

CONTINUE all other medications and any laxative you usually take, unless otherwise advised by your GP or Consultant. Please avoid food containing obvious seeds/pips/nuts.

ALL OF THE ABOVE STATISTICS ARE NATIONAL FIGURES AND OURS ARE

SIGNIFICANTLY LOWER. IF THERE IS ANYTHING YOU DON’T UNDERSTAND OR ANY

WORRIES YOU MAY HAVE, PLEASE DISCUSS THIS WITH YOUR SPECIALIST DOCTOR

BEFORE YOUR EXAMINATION.

2 days before your examination If you take Loperamide (Imodium), Codeine or Cophenotrope (Lomotil), STOP taking them, but

CONTINUE all other medications.

Please follow a low residue diet: YOU CAN EAT: rice crispies/cornflakes/sugar puffs/porridge with milk; white bread; butter; honey; marmite; chicken; fish; potatoes; white rice; white pasta; yogurt; eggs; cheese PLEASE AVOID: wholemeal bread/pasta; all cereals containing bran; salads; tomatoes; fruits; any food containing fibre, nuts or seeds.

1 day before your examination Start taking the bowel preparation. As soon as you start taking the bowel preparation, YOU MUST NOT

EAT ANY SOLID FOOD NOR HAVE ANY DRINKS CONTAINING MILK.

Your bowel preparation sachets are mixed with water into an oral solution. The preparation acts as a laxative to stimulate and clear the bowel ready for the colonoscopy, in order to give the Endoscopist a clear view.

DRINK as much fluid as you can from the list of clear fluids below. Plenty of fluids will help to clear the bowel of its contents and improve the effect of the laxative.

CLEAR FLUIDS YOU CAN DRINK: Water; Squash; Coke, lemonade, tonic/soda water; black tea/coffee; clear soup/strained soup; Marmite/Bovril/Oxo-mixed into weak drinks with hot water. FLUIDS TO BE AVOIDED: Milk; all drinks containing milk, including hot chocolate; Fruit juices with pulp/pips/seeds, Tomato juice; Dark Red fluids, such as Blackcurrant Ribena.

TAKING THE BOWEL PREPARATION

If your appointment is in the MORNING: (You may have an early light breakfast before commencing your first dose) Take the 1st DOSE at 7:00 AM the DAY BEFORE of your procedure. Take the 2nd DOSE at 7:00 PM the DAY BEFORE of your procedure.

If your appointment is in the AFTERNOON: (You may have a light breakfast, light lunch and an early light dinner before commencing your first dose) Take the 1st DOSE at 7:00 PM the DAY BEFORE of your procedure. Take the 2nd DOSE at 7:00 AM ON THE DAY of your appointment.

Effects of the bowel preparations You should expect frequent bowel actions as soon as you start taking your bowel preparation. Some abdominal cramping is normal. You can use a barrier cream on your bottom such as Vaseline or zinc and castor oil for example, to ease any soreness. Please ensure you are near a toilet facility as soon as you start taking it.

Please read the information leaflet found inside the box of bowel preparation sent to

you with this booklet. It gives you the information on how to mix the solution for oral

use. Once you’ve read the leaflet, please refer to the specific times on WHEN to take

your bowel prep below:

It is important that you DO NOT eat any solid foods as soon as you start taking your

bowel preparation. You may drink clear fluids only up to 4 hours before your

appointment.

Useful Telephone Numbers:

FOR APPOINTMENTS, BOOKINGS OR CANCELLATIONS

St Richards Hospital site: Telephone: 01243 788122 ext. 35087, 35052, 35051 or 35089 Direct dial: 01243 831839 (with answering machine facility)

Worthing Hospital site: Telephone: 01903 205111 ext. 85674, 84020 or 841164 (Endoscopy reception) ext. 84354, 84165 or 84826 Direct dial: 01903 285259 (with answering machine facility)

FOR ADVICE OR ANY QUESTIONS REGARDING YOUR PROCEDURE OR MEDICATIONS

St Richards Hospital site: Telephone: 01243 788122 ext. 35049 or 35050 (with answering machine facility)

Worthing Hospital site: Telephone: 01903 205111 ext. 84109 (with answering machine facility)

Version: 1.2

Author: WSHT Endoscopy group

Date: Aug 2018

Next Review: Aug 2020

Opening times

Both endoscopy units are open from 0800-1900 (Mondays-Fridays). The endoscopy

bookings team are available from 0830-1630 (Mondays-Fridays). For out-of-hours

queries, please phone the direct dial numbers above respectively, leave a message and

someone will get back to you on the next working day.

Colonoscopy - Inspection of the large bowel (colon) with a flexible endoscope (with or without biopsy and

photography)

If you would like to ask further questions please DO NOT sign this form. You can obtain further information from your specialist

doctor prior to your test or from the endoscopist on the day of your appointment. Please bring this form with you.

Statement of patient (You have the right to change your mind at any time, including after you signed this form).

I have read and understood fully the information provided in this booklet including the benefits and any risks (bleeding,

perforation and reaction to sedation/anaesthetic)

I agree to the procedure described in this booklet and on the form. I also agree to any further therapies needed to be performed

during the procedure if deemed necessary.

I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person, however,

have appropriate experience. Where a trainee performs this examination, this will be undertaken under supervision by a fully

qualified practitioner.

I would like to have (please tick box): No sedation (Entonox) Sedation Patient’s signature………………………………………………………………………Date…………………………………………….

Name (PRINT)………………………………………………………………………………………………………………………………….. CONFIRMATION OF CONSENT (To be completed by a health professional on your arrival)

On behalf of the endoscopy team, I have confirmed that the patient understands what the procedure involves including the benefits and risks associated. I have confirmed that the patient has no further questions and wishes the procedure to go ahead.

Signed………………………………………………………………………………………..Date……………………………………………..

Name (PRINT)……………………………………………………………………………Job Title…………………………………………

CONSENT FOR A THIRD PARTY TO BE PRESENT IN THEATRE (You have the right to change your mind at any time,

including after you signed this form).

I consent for a third party to be present in the theatre during my procedure. All representatives will have the BTEC professional

theatre or hospital access qualification and have a current disclosure barring service certificate with the trust recorded. The

representative will have met you prior to your procedure and explained the reason for their attendance. They will have explained

their training in matters of confidentiality and patient safety, providing literature if required. All visits to theatre environment will

have been pre-booked with the unit manager. All representatives will display photographic identification, have signed into the trust

and will be chaperoned throughout their time within the theatre environment. You have the right to refuse.

I consent (Patient’s signature)………………………………………………………………………Date…………………………………………….

I do not consent (Patient’s signature)…………………………………………………………..Date…………………………………………...

PATIENT DETAILS (or affix patient labels) COLONOSCOPY CONSENT FORM

Patient agreement to Endoscopic investigation

or treatment

THIS COPY TO BE RETAINED IN PATIENT’S CASE NOTES, PLEASE SIGN PATIENT’S COPY ON NEXT PAGE

This page is left intentionally blank

Colonoscopy - Inspection of the large bowel (colon) with a flexible endoscope (with or without biopsy and photography).

If you would like to ask further questions please DO NOT sign this form. You can obtain further information from your specialist

doctor prior to your test or from the endoscopist on the day of your appointment. Please bring this form with you.

Statement of patient (You have the right to change your mind at any time, including after you signed this form.

I have read and understood fully the information provided in this booklet including the benefits and any risks (bleeding,

perforation and reaction to sedation/anaesthetic)

I agree to the procedure described in this booklet and on the form. I also agree to any further therapies needed to be performed

during the procedure if deemed necessary.

I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person, however,

have appropriate experience. Where a trainee performs this examination, this will be undertaken under supervision by a fully

qualified practitioner.

I would like to have (please tick box): No sedation (Entonox) Sedation Patient’s signature………………………………………………………………………Date…………………………………………….

Name (PRINT)………………………………………………………………………………………………………………………………….. CONFIRMATION OF CONSENT (To be completed by a health professional on your arrival) On behalf of the endoscopy team, I have confirmed that the patient understands what the procedure involves including the benefits and risks associated. I have confirmed that the patient has no further questions and wishes the procedure to go ahead.

Signed………………………………………………………………………………………..Date……………………………………………..

Name (PRINT)……………………………………………………………………………Job Title…………………………………………

CONSENT FOR A THIRD PARTY TO BE PRESENT IN THEATRE (You have the right to change your mind at any time,

including after you signed this form).

I consent for a third party to be present in the theatre during my procedure. All representatives will have the BTEC professional

theatre or hospital access qualification and have a current disclosure barring service certificate with the trust recorded. The

representative will have met you prior to your procedure and explained the reason for their attendance. They will have explained

their training in matters of confidentiality and patient safety, providing literature if required. All visits to theatre environment will

have been pre-booked with the unit manager. All representatives will display photographic identification, have signed into the trust

and will be chaperoned throughout their time within the theatre environment. You have the right to refuse.

I consent (Patient’s signature)………………………………………………………………………Date…………………………………………….

I do not consent (Patient’s signature)…………………………………………………………..Date…………………………………………...

PATIENT DETAILS (or affix patient labels) COLONOSCOPY CONSENT FORM

Patient agreement to Endoscopic investigation

or treatment

THIS IS THE PATIENT’S COPY, PLEASE DETACH AND KEEP IT FOR YOUR RECORDS