It is an examination of your large bowel or the colon.It is performed using a colonoscope (a flexible tube, with a small camera at one end) which is passed carefully through your back passage (anus), and air is inflated into the bowel.The colonoscope is then advanced around the large bowel enabling the endoscopist to look directly at its lining.

Although there are alternatives I feel this is the test which will provide the best information. One alternative is a CT colonography which is a special form of CT scan to look at the bowel. examination. However it may not be as informative as a colonoscopy and has the added disadvantage that tissue samples cannot be taken. If you want further information, please do not hesitate to discuss with me.

A colonoscopy carries a small risk of complications, the main risks are:

• Perforation or tear of the lining of the bowel wall (1 in every 1000). Though uncommon; an operation is usually required to repair the hole. The risk of perforation is higher with polyp removal.
• Bleeding may occur at the biopsy site or polyp removal (1 in every 100-200). This may stop on its own but may require further treatment and an operation may be required. Bleeding can occur up to 14 days after polyp removal but this is rare.
• A reaction to drugs used during the test may require you to stay in hospital.
• An abnormality may be missed due to poor bowel preparation or for technical reasons; however this is rare and tends to be with small polyps.

An outline for preparing oneself for the procedure for colonoscopy:

• If you are a Diabetic or if you are taking any blood thinning medication such as Aspirin, Clopidogrel and Prasugrel or Warfarin, Apixiban, Dabigatran or Rivoroxiban please contact the preassessment unit at the Nuffield hospital for further information.
• To give the endoscopist a clear view of your bowel you should stop iron preparations and bulking agents (bran, Fybogel, Regulan) for one week before the test.
• All other medication should be taken as normal.
• If you have a stoma and use a one piece bag you may want to contact your nurse to arrange for a two piece drainable bag to be used during the bowel preparation.

• It is extremely important that the bowel is clean during your test so you must drink as much clear fluid as possible.
• Please follow the instructions carefully and take the enclosed bowel preparation as prescribed by the manufacturer.
• Be prepared for frequent bowel actions whilst taking the laxatives and make arrangements to be near toilet facilities.
• Aim to drink at least one full tumbler of clear liquid per hour to avoid becoming dehydrated.

• Please continue to drink clear fluids up to two hours before your appointment time.
• Please leave any valuables at home

• Before the procedure you will be seen by a qualified nurse and the endoscopist and you will have the opportunity to discuss any problems or worries.
• You will be asked to sign a consent form indicating that you understand the nature and risks of the procedure. The consent form is a legal document, therefore please read it carefully.

The sedative injection makes you feel relaxed and less anxious. It is not a general anaesthetic and you will not be unconscious.

• Please arrange for a relative or friend to collect you directly from the ward to take you home after your colonoscopy. Please liaise with the ward staff to arrange collection time.
• You will not be fit to go home by public transport.
• Once home you should rest quietly for the remainder of the day.
• Please ensure a responsible adult remains with you until the next morning as the after effects of the injection make you sleepy or forgetful for 24 hours after the test.
• You may experience some abdominal discomfort and bloating during the test, the nurses will support you during the colonoscopy.

• Before the colonoscopy you will be asked to change into a hospital gown and you will be taken to main theatres.
• A clip will be lightly attached to your finger to check your pulse rate and level of oxygen and your blood pressure may also be monitored.
• You will be asked to lie on your left side and if you are having sedation and oxygen will be administered into your nose and you will be given an injection to make you relaxed.
• When the colonoscope is inserted into your bottom, air is gently passed into the bowel. This opens up the bowel so the endoscopist can see where they are going.
• At first you may feel that you want to go to the toilet. You may feel a little embarrassed that you will pass a motion. Do not worry! It is the air that causes this feeling.
• Throughout the test the endoscopist will put air into your bowel to provide a clear view. This may result in some mild discomfort but the air is sucked out at the end of the test.
• Small tissue samples (biopsies) can be taken through the colonoscope, which is painless.
• If a polyp, a small growth on the wall of the bowel is found, then it may be removed. A polyp is a protrusion from the lining of the bowel. Polyps when found are generally removed or sampled by the endoscopist as they may grow and later cause problems.
• The colonoscopy will take 20 to 40 minutes.

Sedation:

• You will be allowed to rest quietly in the recovery area where a qualified nurse will observe you until the main effects of the injection have worn off.
• You may feel a little bloated but this will settle quickly.
• Please arrange for a relative or friend to collect you directly from the ward to take you home after your colonoscopy. Please liaise with the ward staff to arrange collection time.
• You will not be fit to go home by public transport.
• Once home you should rest quietly for the remainder of the day.
• Please ensure a responsible adult remains with you until the next morning as the after effects of the injection make you sleepy or forgetful for 24 hours after the test.

For 24 Hours Please Avoid:

• Go to work
• Drive a vehicle
• Operate machinery (including household appliances)
• Drink alcohol/take sleeping tablets/recreational drugs
• Sign any legal documents
• Have a bath unsupervised
• Be left alone to care for children

You may experience some abdominal discomfort immediately following the procedure. This is usually mild and will soon pass with the help of warm drinks, walking around or taking peppermint water or sweets. Following bowel preparation normal bowel function should return over 2-3 days. You may experience some slight soreness where the flexible tube has been however this will wear off in a day or so. If you have had any biopsies taken or a polyp removed you may notice a small amount of bleeding from your back passage over the next few days. This is normal.

It is rare to experience any of the following, but if you do within 48 hours of your procedure, please contact the hospital. If you have problems after 48 hours please contact your GP.

• Severe abdominal pain/vomiting
• A high temperature
• Passing large amount of fresh blood/clots

• Sedation can make you forgetful, but a nurse, in the presence of your accompanying relative or friend, will discuss the results of the test with you.
• If you have had biopsies taken you will receive the results at your out patient appointment or by letter.
• A full report will be sent to your doctor.
• Before you are discharged you should be given clear details concerning follow-up arrangements.