LOWER GI PROCEDURE

COLONOSCOPY

A colonoscopy procedure is performed using a narrow, flexible, telescopic camera called a colonoscope. Colonoscopy allows the doctor to look inside the large bowel (colon and rectum).
A colonoscope can help find out what is causing symptoms such as persistent diarrhoea or change in bowel habit, bleeding from your rectum and anaemia. It's also used to check for certain bowel conditions such as inflammation (for example, ulcerative colitis or Crohn's disease), early signs of bowel cancer and polyps (adenoma).
Sometimes, a colonoscopy is used to confirm the results of other tests, such as the faecal occult blood (FOB) test, which is used in routine screening and looks for hidden blood in your faeces.

How long do I have to be hospitalized?

Colonoscopy is usually done in a hospital as an out-patient or day case. However you will be asked to prepare for the procedure. You will usually be asked to stop eating solid food the day before the test, drink plenty of clear fluids in the 24 hours before your test and take a strong laxative to clear your bowel so that your doctor can see the bowel wall clearly.
If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your doctor tells you not to. Your doctor may ask you stop taking certain medicines such as aspirin, which increase the risk of bleeding.
At the hospital your nurse may check your heart rate, blood pressure, take a blood sample and test your urine.
Colonoscopy is usually done under sedation to make sure you're relaxed and comfortable during the procedure. If you have a sedative, you won't remember much about the test.

The Procedure

The procedure usually takes 30 to 60 minutes to complete.
If you're having sedation, this is usually given through a small plastic tube (cannula) in a vein on the back of your hand. You should start to feel relaxed and drowsy almost immediately. While you're sedated, your doctor will monitor the amount of oxygen in your blood through a sensor on your finger and will give you extra oxygen through a mask.
With you lying on your left side, your doctor will gently insert the colonoscope into your rectum. Lubricating jelly will be used to make this as easy as possible. Air is pumped through the colonoscope and into your bowel to make it expand and your bowel wall easier to see. When this happens, you may briefly feel discomfort and you may pass some wind.
The camera lens at the end of the colonoscope sends images from the inside of your colon to a monitor. Your doctor will look at these images to examine your bowel. During the procedure, you may be asked to change your position - for example turning from your side on to your back. This helps your doctor to examine different areas of the colon more easily.
If necessary, your doctor will take a biopsy (a small sample of tissue) and/or remove small growths of tissue called polyps. This is done using special instruments passed inside the colonoscope, and is quick and painless, although you may feel a slight pinch. The samples will be sent to a laboratory for testing to determine the type of cells and if they are benign or malignant (cancerous).
When the test is finished the colonoscope is taken out quickly and easily, sucking out the air that has been pumped in. The colonoscopy won't hurt but it may be a bit uncomfortable.

What to expect afterwards

You will need to rest until the effects of the sedative have passed. You will usually be able to go home when you feel ready, although you may need to stay in a bit longer if a polyp has been removed. You will need to arrange for someone to drive you home.

Results

If you have a biopsy or polyps removed, your results will be ready several days later and will usually be sent to the doctor who recommended your test. At the hospital, your doctor may discuss other findings from the colonoscopy with you before you leave, or you may be given a date for a follow-up appointment.

Recuperation

After having a colonoscopy you may feel bloated and have slight discomfort due to trapped wind, feel sleepy as a result of the sedative and slight bleeding from your back passage if you have had a biopsy or polyp removed.

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SIGMOIDOSCOPY

A sigmoidoscopy is a procedure used to look inside the rectum (back passage) and lower part of the bowel using a narrow, flexible, tube-like telescopic camera called a sigmoidoscope. During the procedure, your doctor may take one or more biopsies (samples of tissue) for examination in a laboratory. If necessary, it's possible to remove polyps and treat haemorrhoids during the procedure.

How long do I have to be hospitalized?

Flexible sigmoidoscopy is routinely done in the out-patient department and you don't usually need an anaesthetic or sedation. You will probably be in hospital for between one and two hours. However you will be asked to prepare for the procedure.
If you normally take iron tablets, codeine phosphate or medicines that bulk out your faeces, such as ispaghula husk, you will probably be asked to stop taking them for up to two weeks before the procedure. If you normally take other medicines, such as tablets for high blood pressure or diabetes, continue to take these as usual unless your doctor specifically tells you not to. If you're unsure about any medicine you're taking, ask your doctor.
For your doctor to be able to see your bowel clearly, your bowel needs to be completely empty. To help empty your bowel you may be given a strong laxative to take, or you may be given an enema (a fluid which you inject into your back passage) to use before you come into hospital. You will be given instructions on how and when to do this. You can eat and drink normally until you have the enema and after that you should drink clear fluids only. If you have difficulty giving yourself an enema at home it can be given just before the procedure.

The Procedure

A sigmoidoscopy usually takes between 10 and 15 minutes. It may feel uncomfortable, but shouldn't be painful. Occasionally, you may be given a sedative before the procedure. This relieves anxiety and helps you to relax. It is given as an injection into a vein in your hand or arm. However, usually you won't need a sedative for this procedure.
While you're resting on your side, your doctor will gently examine your back passage with a gloved finger and then carefully insert the sigmoidoscope into your rectum. Lubricating jelly will be used to make this as easy as possible.
Air is then usually pumped through the sigmoidoscope into your lower bowel to make it expand and to make the bowel wall easier to see. This can cause stomach cramps. It is normal if you get an urge to go to the toilet or pass wind.
A camera lens at the end of the sigmoidoscope sends pictures from the inside of your bowel to a monitor. Your doctor will look at these images. If necessary, your doctor will take a biopsy and/or remove any polyps you have. This is done using special instruments passed inside the sigmoidoscope and shouldn't cause you any pain.

What to expect afterwards

If you haven't had a sedative you will be able to go home when you feel ready. If you have had a sedative you may need to stay a little longer and you will have your blood pressure and pulse taken to monitor your recovery.

Results

If you have a biopsy your results will be ready several days later and will usually be sent to the doctor who recommended your test. At the hospital, your doctor may discuss other findings from the sigmoidscopy with you before you leave, or you may be given a date for a follow-up appointment.

Recuperation

After having a sigmoidscopy you may have some mild pain and discomfort. You may also have a swollen abdomen. This usually gets better after a few hours and can ease when you pass wind. If you have had a biopsy or had polyps removed you may have a small amount of bleeding. This usually stops on its own. Most people feel able to resume normal activities on the following day.

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