Colonoscopy is a procedure to examine the lining of the colon (large intestine) with an instrument called an endoscope (or colonoscope). Usually the whole colon is examined (to the caecum) and sometimes also the end of the small intestine (terminal ileum). The aim of colonoscopy is to assess the colon for any diseases such as colitis (inflammation), Crohn’s disease, diverticulosis, polyps and tumours. Biopsies are often taken from the colon at the time of colonoscopy and polyps may be removed.

WHAT ARE POLYPS AND WILL THEY BE REMOVED?

Polyps are growths in the colon that are usually benign. If it is safe to do so they are usually removed at colonoscopy because they can, with time, enlarge and become cancerous. Removal of polyps will prevent their progression to colon cancer. When polyps are removed they are usually sent for examination by a pathologist. If the polyp is very large then your Gastroenterologist may decide not to remove it at the time because of excessive risk.  If this is the case then your Gastroenterologist will discuss it with you after the procedure and make arrangements for polyp removal.

HOW DO I PREPARE?

For a successful procedure it is important that your Gastroenterologist can see the lining of your bowel clearly.  Bowel preparation takes place on the day before colonoscopy. This is explained on a separate sheet. (link to page) It is important to keep well hydrated (drink lots of fluid) while having the bowel preparation. You must stop all fluids 4 hours before your admission to the hospital.

SHOULD I TAKE MY USUAL MEDICATIONS?

Some medications should be stopped up to a week before your procedure. Aspirin, Persantin, Asasantin and Clopidogrel (Iscover, Plavix or equivalent) will usually be stopped a week prior to the procedure and your Gastroenterologist may ask you to stay off these medications for a week afterwards if polyps are removed. However, in some patients your Gastroenterologist may decide to do the procedure on these medications, particularly if you have significant heart disease or recent insertion of coronary stents. Blood thinning (‘anti-coagulant’) drugs such as Warfarin, Xarelto and Pradaxa greatly increases the risk of bleeding and this needs to be discussed with your Gastroenterologist before the procedure. They will usually need to be stopped and you may need to have injections with Clexane (an injected anti-coagulant) around the time of the procedure.
Diabetics will need special consideration and this needs to be discussed with your Gastroenterologist before colonoscopy.  Most oral diabetic medications will be stopped on the morning of the procedure and insulin doses will be adjusted in the 24 hours before the procedure.  Iron tablets should be stopped a week before the procedure. Anti-inflammatory drugs should be stopped 48 hours before the procedure.
All other important medications can be taken normally.

WHAT HAPPENS ON THE DAY?

When you arrive at the hospital the nursing staff will greet you and get you prepared for the procedure.  The anaesthetist will meet you and once you are in the procedure room you will have an intravenous cannula placed and be given a sedative.  The procedure is done with you asleep but it is not a general anaesthetic. You should recover quickly after the procedure.  Patients rarely have any memory of the procedure.
Once you have been sedated your Gastroenterologist will perform the colonoscopy.  This usually takes approximately 30 minutes. Your Gastroenterologist will gently inflate the bowel with gas during the procedure.  Most of this gas will be removed by the end of the procedure but you may notice bloating and pass some residual gas after the procedure.

ARE THERE ANY RISKS?

Colonoscopy is generally a low-risk procedure. However, it does carry a small risk of complications. One of the risks is perforation (tearing of the bowel). This can be caused by the instrument or at the time of polypectomy (polyp removal). Fortunately, it is a rare complication but it is serious and would require admission to hospital and often surgery, should it occur.

Bleeding can occur, particularly after polyp removal. Bleeding is more likely to occur if you have been on Aspirin or other blood thinning drugs. Bleeding usually stops spontaneously but may require intervention (eg surgery).
Intravenous sedation is generally safe and well tolerated but there is a small risk of allergic reaction to the drugs or aspiration (pneumonia from inhaling gastric contents while sedated).  Low blood pressure and oxygen levels can occur but you will be closely monitored during the procedure and this can usually be rapidly corrected.

The bowel preparation carries a risk of dehydration which can be associated with fainting and electrolyte disturbances. This is much less likely to happen if a good fluid intake is maintained while taking the bowel preparation. The bowel preparation is explained on a separate sheet.

No test is perfect. Colonoscopy is considered the most accurate way of assessing the colon but a lesion can be missed. The likelihood of missing something is greater if the bowel is not adequately cleaned out.

WHAT HAPPENS AFTER THE PROCEDURE?

After the procedure you will be taken to the recovery room.  You may have bloating and abdominal cramping or discomfort but this usually settles quickly. Your Gastroenterologist will speak to you after the procedure to explain the findings but you may not recall all of the conversation.  You will be given a sheet with a summary of the findings to take home.  Your Gastroenterologist will send a written report to your GP and let you know whether or not they need to see you again.  If you need a repeat colonoscopy your Gastroenterologist will tell you when this should be. If biopsies have been taken or polyps have been removed your Gastroenterologist will usually write to you or talk to you a few days after the procedure.

You must not drive, return to work, drink alcohol, operate machinery, sign legal documents or use public transport unaccompanied until the following day. You should be escorted home by an adult and have someone with you at home until the following day.

Overall, colonoscopy is a low-risk procedure and should go without any major problems. If you have questions before the procedure then please phone Northern Gastroenterology on 9439 7575.  If you have significant pain or bleeding the night after the procedure you can contact the hospital. In an emergency call 000.

Further information is available on the Gastroenterological Society of Australia website on the ‘consumer information’ page at www.gesa.org.au.

 

Good bowel preparation is important to allow adequate viewing of the colon during colonoscopy. This allows accurate identification of any abnormalities including polyps and the safe removal of any polyps that are found.

In general, bowel preparation involves three steps. Firstly you will go onto a low-residue diet, usually starting 2 days before the procedure. Secondly you will start a liquid-only (‘clear-fluid’) diet usually the day before the procedure. Thirdly you will take the prescribed bowel preparation which usually comes in 2 or 3 separate doses. Bowel preparation will usually cause watery diarrhoea starting soon after the first dose.
Bowel preparation can cause dehydration and disturbance of the balance of salts in the body. It is important to take the bowel preparation in the way it is prescribed and drink plenty of fluid to avoid dehydration.

The information about bowel preparation on this website is general advice only. There are a number of different bowel preparations available. The choice of appropriate bowel preparation and the procedure for modifying your diet and taking the bowel preparation depends on factors including the time of your procedure, your overall health and the presence of any other medical conditions.

A personalised plan will be generated for your bowel preparation during the consultation prior to colonoscopy. This will include the type of bowel preparation used, when it is to be taken, dietary modifications in the days prior to colonoscopy and any changes to your usual medications. People with diabetes or kidney disease need particular care with bowel preparation and this should be discussed during your consultation.

If you have unanswered questions about the procedure please phone Northern Gastroenterology on 9439 7575.  Further information is available from the Gastroenterological Society of Australia on their ‘consumer information’ page at www.gesa.org.au.

 

Flexible sigmoidoscopy is a procedure for examining the last part of the colon (the sigmoid colon and rectum) with an endoscope or colonoscope. Flexible sigmoidoscopy is similar to colonoscopy but only allows examination of the left side of the colon. Colonoscopy, on the other hand, allows examination of both the left and right side of the colon and often the last part of the small bowel (ileum).
Flexible sigmoidoscopy is performed when a full examination of the colon is not required. It is a less invasive and quicker procedure and usually does not require an oral bowel preparation.

 

Are there any risks?

Flexible sigmoidoscopy is a simple and safe procedure. It is usually very well tolerated with a minimum of discomfort. Although very safe complications including pain, bleeding, tearing (perforation) of the bowel and reaction to the sedative (if used) can rarely occur. Because flexible sigmoidoscopy only examines the left side of the bowel, any problems further up the bowel will be missed.

 

How do I prepare?

Usually patients will be given an enema shortly before the procedure to empty out the last part of the colon. A small tube will be inserted into the passage and some liquid will be inserted into the rectum. You will be asked to hold the liquid in the bowel while lying on your side for 5 or 10 minutes and then use the toilet to empty the lower part of the bowel. If you wish to have sedation for the procedure you will need to be fasted (nothing to eat or drink) for at least 4 hours before the procedure.

 

Can I take my usual medications?

Most medications can be continued for flexible sigmoidoscopy. Medications that increase the risk of bleeding (such as Aspirin, Clopidogrel and Warfarin) may be stopped up to a week before the procedure if it is anticipated that biopsies need to be taken or polyps removed. This will be discussed when the procedure is booked.

If you have diabetes then a plan for you diabetic medications and insulin should be agreed when the procedure is booked. Some blood pressure medications may need to be ceased before the procedure.

 

What will happen during the procedure?

Flexible sigmoidoscopy can be performed under sedation but is usually well tolerated with the patient fully awake. For this reason the procedure is quicker, the recovery is quicker and the risks of a complication are smaller.

 

What happens after the procedure?

If you have not had any sedation then you should feel back to normal soon after the procedure. Some gas will be inserted into the bowel during the procedure and you may have some bloating and cramping and pass some residual gas after the procedure.

If you do have sedation then you will need to stay until you have recovered sufficiently from the sedatives (usually an hour or so). You must not drive, return to work, drink alcohol, operate machinery, sign legal documents or use public transport unaccompanied until the following day. You should be escorted home by an adult and have someone with you at home until the following day.

The findings will be discussed in person with the patient, along with a written report and a full report sent to your GP. A follow up with either your Gastroenterologist or your GP will be advised. If biopsies are taken your Gastroenterologist may give you a call when the results are available.

If you have unanswered questions about the procedure please phone Northern Gastroenterology on 9439 7575.  Further information is available from the Gastroenterological Society of Australia on their ‘consumer information’ page at www.gesa.org.au.

What is polypectomy?

Polypectomy is the procedure for removing polyps from the digestive tract. Normally polypectomy is performed for polyps in the colon during colonoscopy but polyps can form in other parts of the digestive tract including stomach and small bowel and sometimes require removal from these sites as well. Polypectomy is an important part of colonoscopy. Looking for polyps and removing them is one of the most common reasons for performing colonoscopy.

 

How is polypectomy performed?

Polypectomy is performed with specialised equipment that allows your Gastroenterologist to safely remove the polyp from the lining of your bowel. This is usually performed with a loop of wire called a ‘snare’. Sometimes a small amount of electrical current is administered during polypectomy to assist the cutting and reduce the risk of bleeding after the procedure.

 

Are all polyps removed?

When polyps are detected during colonoscopy it is often possible to determine whether they are cancerous or pose a risk of becoming cancerous. However, the most accurate way to determine if a polyp poses a risk is to remove it and look at it under a microscope. For this reason, polyps are usually removed at the time of colonoscopy where it is safe to do so. This eliminates any risk of the polyp becoming cancerous in the future and also allows your doctor to determine how regularly you should be checked for polyps in the future.

 

Are there any risks?

Removing polyps is generally safe and a routine part of colonoscopy. There is a small risk of bleeding after polyp removal although usually the bleeding is minor and will settle without any particular treatment. People who take medications that increase the risk of bleeding are at higher risk of bleeding and may need to avoid taking these medications for up to a week after the removal of polyps. There is a very small risk of tearing of the bowel (perforation) during removal of polyps. The risk may be increased during removal of very large polyps and under some circumstances large polyps may be left so the risks of removal and the alternatives (surgery) can be fully discussed.

If you have unanswered questions about the procedure please phone Northern Gastroenterology on 9439 7575.  Further information is available from the Gastroenterological Society of Australia on their ‘consumer information’ page at www.gesa.org.au.

What is oesophageal dilatation?

Oesophageal dilatation is a procedure for stretching the oesophagus (gullet) in people with a narrowing that is causing difficulty swallowing. It is performed at the time of gastroscopy. A couple of techniques can be used including with a tapered ‘bougie’ or with a high pressure balloon.

 

Why is oesophageal dilatation performed?

Oesophageal dilatation is performed when there is a narrowing in the oesophagus that is causing difficulty with swallowing. It allows the narrowing to be stretched so that food can pass more easily. Narrowing may occur in the oesophagus as a result of chronic gastro-oeosphageal reflux, from congenital or developmental abnormalities, from inflammatory conditions such as eosinophilic oesophagitis or due to a malignant condition.

 

Are there any risks?

Oesophageal dilatation is generally safe but does carry a small risk of complications in addition to the risk of gastroscopy itself. The risks include bleeding, aspiration and perforation of the oesophagus. If bleeding occurs it usually settles without any treatment but may require observation in hospital. If a tear through the wall of the oesophagus occurs (perforation) then you will need to be observed in hospital and may need antibiotics. Sometimes surgery may be required to repair a tear in the oesophagus.

 

What happens after the procedure?

The recovery after oesophageal dilatation is similar to after gastroscopy itself. You may have a sore throat and some bloating due to retained gas immediately after the procedure. You will be observed in recovery for a few hours and will usually be able to start drinking 2-4 hours after the procedure. Depending on the type of dilatation your Gastroenterologist will tell you after the procedure when you can start eating normally. You may need additional reflux treatment for a few weeks after the procedure to promote healing after the dilatation. Sometimes repeated dilatation is required to achieve a durable response.

If you have unanswered questions about the procedure please phone Northern Gastroenterology on 9439 7575.  Further information is available from the Gastroenterological Society of Australia on their ‘consumer information’ page at www.gesa.org.au.