Armidale General Surgery. Patient Information regarding Colonoscopy

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Valentine Ray
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1 Armidale General Surgery Patient Information regarding Colonoscopy Colonoscopy is an examination of the inner lining of the large bowel (colon and rectum) using a flexible telescopic tube (about the diameter of your finger), which is passed through the anus (back passage). Air/carbon dioxide is blown into the bowel to allow the colonoscope to be steered around the bends to reach the right-hand side. It is possible to look directly at the bowel lining (seen on a TV monitor), and to take biopsies (samples) as well as remove polyps (small benign growths). During the procedure, you will lie on your left side, and you will be kept relaxed, sleepy and free of pain with medications given through an intravenous needle. A mask will supply extra oxygen. The procedure takes approximately 15 minutes (but may occasionally take longer), after which you will spend some time being monitored in the recovery room, before returning to your room. Why has my doctor referred me for a colonoscopy? Large bowel (colon) cancer is one of the possible concerns. It is a common killer, representing the second most common cause of cancer-related death. Most people with early colon cancer feel perfectly well, or have relatively minor symptoms. Early colon cancer can be detected by colonoscopy before it has spread outside the colon - at this stage it may be curable. More importantly, pre-cancerous polyps (benign growths) may be detected and removed during a colonoscopy, which prevents the development of colon cancer. Experts believe that colon cancer deaths may be preventable with regular colonoscopy for those at risk. Do I really need this test if I have no symptoms? Colon cancer may be developing with few or no symptoms. Pre-cancerous changes can be seen with a colonoscopy and removed, and so prevent the development of cancer in that area. If you have a family history of colon cancer or polyps, you may have a higher risk of developing the same condition, and a colonoscopy will allow this to be detected. Is there any alternative to having a colonoscopy? Other investigations, such as specialised x-rays (e.g. barium enema and CT colonography), can be carried out. However, these are not as accurate as colonoscopy, and do not allow biopsies to be taken, and polyps cannot be removed. If you choose not to have a colonoscopy, your doctor/specialist may not be able to make a diagnosis, and there is a possibility that an abnormality in the large bowel will develop and worsen. Faecal testing for blood (e.g. Rotary BowelScan test) is not accurate enough to be a substitute.

2 What do I do about my usual medications? You should be able to continue to take your usual medications, but there are some which may need to be stopped. Please discuss the following with your doctor: Aspirin (including Solprin, Astrix, Cartia)* Arthritis medications Blood thinners/anticoagulants, including Clopidogrel (Iscover, Plavix), rivaroxaban (Xarelto) and Warfarin (Coumadin)* Diabetes medications (tablets and insulin) Iron tablets Herbal remedies *NOTE: NO NOT STOP ASPIRIN/BLOOD THINNERS UNLESS ADVISED TO DO SO Please inform the doctor about the following health problems: Drug allergies, heart valve replacement or pacemaker, and artificial joints Preparation for colonoscopy The inside of the large bowel must be clean, to ensure the examination is as accurate and complete as possible. The preparation begins with a change to your diet two days before the procedure, and this is followed by a bowel cleansing mixture (e.g. Picolax or Picoprep), taken by mouth (please follow the instructions on the information sheet you receive from the surgeon s staff). Helpful hints: chill the mixed preparation solution, drink with straw to the back of the throat to avoid taste, and moist anal cleansing wipes (e.g. Anusol Medicated Wipes or similar generic products) can make the later stages of the preparation more comfortable. NOTE: YOU MUST DRINK 3-4 LITRES CLEAR FLUIDS ON THE DAY OF PREPARATION What happens if the bowel preparation doesn t seem to be working? The effect of the preparation solution varies from person to person, and may not be as dramatic as you might have heard or expected. You should expect to pass watery bowel actions after the second glass of preparation solution; if this does not occur, please contact the doctor or specialist (during office hours), or the hospital (after-hours) for further advice. Sedation You will have a small needle placed in a vein in one of your arms, and a short-acting light anaesthetic (IV sedation) will be given, as well as a pain-relieving drug. You will continue to breathe for yourself, with an oxygen mask, but you may not remember much about what happens during the procedure.

3 Fasting It is very important for safe sedation that you have absolutely nothing by mouth for at least 2 hours prior to your procedure. You should be taking clear fluids only in the 24 hours before the procedure. Risks of colonoscopy While colonoscopy provides the very important health benefits of early cancer detection and cancer prevention, there are potential risks of having the procedure performed, even when it is properly performed by an expert who is using proper technique with appropriate caution and care. Fortunately, for most patients these risks are far outweighed by the benefits. Doing nothing and taking your chances with colon cancer is itself risky, and more people would be harmed by simply hoping for the best, and avoiding cancer screening measures, rather than undergoing colonoscopy by an experienced endoscopist at a facility providing this procedure on a routine basis in a safe and effective fashion. It is important for you to understand that this is the right procedure for you before continuing. Your general practitioner is one of your best resources for helping you with the decision to undergo colonoscopy. If your GP is 50 years of age or older, he or she may already have had a colonoscopy, and could advise you from their personal experience in addition to standard medical advice. Serious complications from colonoscopy are quite uncommon. The more common and important risks include the following: The possibility of not being able to fully examine the large bowel, due to disease or scar tissue from previous surgery, or poor cleansing effect from the preparation The risk of not seeing (missing) an existing abnormality, such as polyps or cancer The risk of bleeding, particularly after removing polyps (1 per 1000 when a polyp has been removed). This may be delayed by up to 7-10 days. It is rare for a blood transfusion to be required The risk of a perforation (a puncture or tear in the bowel wall), which may require admission to hospital and sometimes surgery (1-3 per 1000) Post-polypectomy coagulation syndrome (abdominal pain and fever after removing a polyp) The risk of diverticulitis Heart or lung problems as a result of the sedation drugs (e.g. heart irregularity, respiratory depression) Other medication effects: allergic reaction, injection site reactions, nausea, vomiting, hypotension (low blood pressure) Colonoscopy performed by an experienced endoscopist is the most accurate means of detecting abnormalities such as colon cancer or colon polyps, but no test is 100% accurate.

4 Rare complications: splenic rupture, acute appendicitis, intra-abdominal haemorrhage, small bowel obstruction, infection (extremely rare), death (5 per 84,000) Preparation-related: electrolyte disturbances, fluid volume changes, vomiting (rarely oesophageal tears, pulmonary aspiration) In most cases, the risks of a serious complication of colonoscopy are easily outweighed by the benefits of cancer prevention and early cancer detection for cure. While events such as perforations are uncommon, they do occur occasionally during a properly and carefully performed colonoscopy. When complications occur, early diagnosis is important for the best outcome. If you are having any unexpected symptoms after an examination, such as bleeding, increasing abdominal pain or fever, it is important to contact the doctor or the hospital. Perforations and similar serious injuries may require surgery. While taking a previously healthy patient for an operation because of a colonoscopy complication is always a very difficult matter, doctors and family members of people who have died from colon cancer know that the risk of a very uncommon and treatable problem is much easier to bear than the risk of missing an opportunity to prevent a relatively common and often fatal disease. Haemorrhoids - can these be treated at the same time? Bleeding from the back passage is often a result of haemorrhoids. If this (or other haemorrhoid symptoms) is a major problem for you, please inform your doctor/specialist, who can make a specific request for haemorrhoids to be examined (they do not show up well with the colonoscopy and require a specialised short device called a proctoscope). Troublesome haemorrhoids can be treated (with internal rubber bands or injections) immediately after the colonoscopy, if this is appropriate. How will I feel after the colonoscopy? It is common to experience abdominal bloating from air trapped within the bowel, with mild pain and discomfort for one or two days. You should be able to eat and drink normally. There may be some initial drowsiness or problems with memory within the first 24 hours following the procedure. DO NOT DRIVE or make any important decisions during this time. Make sure that there is an adult person who can accompany you when you leave the hospital and go home. There may be a small tender lump or bruising where the needle was placed in the vein for the sedation. This should settle within a few days, but may last several weeks. When will my bowels function normally again? This is quite variable, but usually within 1-3 days What happens to the results? On the day of the procedure, you will be given a single page printed report explaining whether any significant abnormality has been found, and whether biopsies have been taken. This will also notify whether you require a further appointment. A separate full report of the colonoscopy will be sent directly to your referring doctor within several days. The results of any biopsies (including any polyps removed) will also be sent directly to your doctor.

5 Do I need any further tests? As indicated above, you will have written advice about whether an appointment is required either with your GP or the specialist. Your general practitioner may wish to see you again after the colonoscopy, especially if there are ongoing symptoms or other problems to be dealt with. Please check with your doctor regarding this. What happens when I check in at the Hospital? Please go to the front counter, from where you will be directed to your room. A nurse will see you to complete paperwork and check your blood pressure, temperature, etc. You will then be assessed by the anaesthetist who will confirm that you are medically fit for the colonoscopy to proceed as planned. Are there any costs involved in having a colonoscopy? For patients with private health insurance, the cost is not fully covered by the health fund, with a gap depending on the level of cover. Please check this with your health fund. There will be separate accounts from the specialist and the anaesthetist. The actual fee for the procedure depends on whether polyps are removed, and so the gap is variable. Please contact your doctor or the hospital if any of the following occur after your colonoscopy: Generally feel ill with or without headache, chills or muscle aches. High temperature/fever. Bright red bleeding from your back passage - more than half a cup. Have feelings of dizziness, shortness of breath or feel faint. Start to have severe abdominal pains or begin vomiting. Increasing discomfort/irritation in your back passage Further information This written information about colonoscopy is meant to help your preparation for the procedure, and does not take the place of advice from the referring doctor/specialist or the surgeon. Please discuss any questions or concerns you have with your general practitioner. You will also have the opportunity of asking the specialist to answer your concerns before the procedure is performed.

Colonoscopy Explained

Colonoscopy Explained Your doctor has recommended that you have a medical procedure called a colonoscopy to evaluate or treat your condition. This brochure will help you understand how a colonoscopy can