Flexible Sigmoidoscopy and Gastroscopy

This leaflet has been written by staff working in the Endoscopy Unit at Chelsea and Westminster Hospital and West Middlesex Hospital.

We hope you find it useful. If, after you have read it, you have any questions or concerns, please contact or visit us:

Chelsea and Westminster

2^nd Floor, Lift Bank B

020 3315 3056/5223

If you would like to change your appointment time or date, please contact the Endoscopy Unit booking team on 0203 315 4141/5984 or email us Chelwest.cwdiagnosticcentre.admin@nhs.net.

West Middlesex Hospital

Ground floor of the Main Hospital Building in the East Wing

020 8321 2585/5191

If you would like to change your appointment time or date, please contact the Endoscopy Unit booking team: chelwest.endoscopy.westmid@nhs.net

Your appointment time in Endoscopy is approximate because some procedures may take longer than expected and emergency procedures need to take priority. Please expect to be in the department for several hours – having pre-procedure checks, the procedure and for recovery after the procedure.

What is a flexible sigmoidoscopy?

A flexible sigmoidoscopy is a test in which a long flexible telescope called an endoscope is passed into the anus (back passage) allowing the Endoscopist to look directly at the lining of the last part of the large bowel.

What is a Gastroscopy?

A gastroscopy, also known as an endoscopy or OGD is a test in which a long flexible telescope called an endoscope is passed through the mouth allowing the endoscopist to look directly at the lining of the oesophagus (gullet), stomach and duodenum (small bowel).

For both procedures, sometimes a biopsy - a sample of tissue – is taken for analysis (testing) in the laboratory. The tissue is removed through the endoscope using tiny forceps.

There is a considerable variation in the way people react to this procedure and the sedation. General anaesthesia is not required. The procedure is safe but may be unpleasant and, at times, uncomfortable.

If you chose to have sedation, we aim to use enough sedative to relax you. We do not send you to sleep but we will do our best to make you as comfortable as possible. Some people will not remember all of the procedure after having the sedative, this is normal and nothing to worry about.

What should I do before I come in?

7 days before procedure

Please stop taking iron tablets (including vitamin tablets that contain iron), Omeprazole (Losec), Lansoprazole (Zoton), Esomeprazole (Nexium) and bulking agents (Fybogel or Regulan) one week before the test.

4 days before procedure

Stop taking any constipating agents (loperamide, codeine phosphate etc) but continue any other medications and laxatives until your appointment.

Unless advised otherwise, if you are taking any of the following medicines, please inform the pre-assessment nurse or a member of the Endoscopy team for further instructions:

Warfarin, rivaroxaban, apixaban, dabigatran, edoxaban
Clopidogrel, prasugrel, ticagrelor, dipyridamole
Any other medication used to thin the blood (anti-coagulant)

When to use the Enema

You need to have an enema before the test, as the bowel needs to be empty. Enemas are safe to use at home. Sometimes you will be sent an enema to conveniently use at home. If you have been sent an enema please administer it to yourself at home one - two hours before your appointment time.

How to use the Enema at home

Rest the enema bottle in warm water (NOT hot water) so the fluid doesn’t feel too cold when it goes in. Remove the orange cap, lie on your left side with your knees drawn up to your chest. Insert the nozzle gently into your back passage. Squeeze the bottle until nearly all the liquid has been emptied, then remove the nozzle from your back passage and continue lying down.

This should not be painful; if you feel any resistance or pain, do not continue. Try to hold the liquid in for as long as possible, 10minutes is ideal but do not worry if you cannot manage this. Stay close to a toilet as you may open your bowels more than once. Some people do experience mild stomach cramps and some may feel dizzy.

Then you should make your way to the hospital / Endoscopy unit. Please ensure you leave enough time to travel to the hospital after you have been to the toilet.

If you have no response to the Enema – do not worry. Come into hospital as normal and we can always give another Enema if necessary.

Note: If you feel that you cannot give the enema yourself then please inform the Endoscopy unit.

COLLECT YOUR BOWEL PREP MEDICINE

Please collect your bowel prep medication on the time and date booked for you. If you would like to change the collection appointment, please call the numbers on your letter. If you do not collect your preparation, your procedure will be cancelled and you may be discharged back to your GP.

On the day of the procedure

Continue drinking clear fluids until two hours before the procedure.

What are the benefits and risks?

The benefit is that this procedure will help us to investigate your symptoms and may help us to treat you.

Gastroscopy - There is an extremely small risk of bleeding or a tear in the lining of the gut (perforation 1 in 9,000), which may require urgent treatment, blood transfusion or an operation. Gastroscopies also involve a slight risk of damage to crowned teeth or dental bridgework.

Flexible sigmoidoscopy – This carries an extremely small risk of bleeding or a tear in the lining of the bowel (perforation 1 in 2500), which may require urgent treatment, blood transfusion or an operation.

What options are available for the procedure?

Throat spray: If you chose this, you will be fully awake during the examination. The Endoscopist and Nurses will talk you through it. A local anaesthetic spray will numb the back of the throat, helping the endoscope to go down.

Sedation via a needle If you chose this we will give you a sedative via a needle in your arm. This is not a general anaesthetic but will make you relaxed and may make you feel sleepy. If you have sedation you will need to rest on a trolley here for at least an hour afterwards until the effects of the sedation have worn off.

Please note with sedation, even if you feel wide awake your reactions may still be affected. You may find it difficult to concentrate and you may forget things that you have been told after the procedure. The nurses will give you written discharge information. This includes the advice that for 24 hours after sedation you should not drive, ride a bicycle, operate machinery, take sedatives or drink alcohol, or sign legal documents.

If you have sedation, your escort must collect you from the unit, take you home and be with you for the next 24 hours. We cannot escort you home. If you do not have an escort, you may choose to have Entonox Only.

Entonox (gas and air) If you chose this you will be given Entonox to breathe in as needed during the procedure. The gas takes immediate effect and helps relieve discomfort but does not make you feel sleepy. If you chose this option you do not need an escort to take you home after.

What will happen when I come in?

On admission to the unit a nurse will ask you several questions about your health, current medication (please bring an up to date list with you), take your blood pressure and pulse, and ask you to get changed into a gown and dignity short which are specially designed to maintain patient modesty before, during and after a colonoscopy procedure.

Please leave any valuables at home, as we cannot be responsible for any valuables lost whilst you are in the unit. You do not need to bring anyone with you to your appointment, unless they are acting on your behalf (e.g. interpreting for you). Your escort/relative will only be needed when you are discharged if you have sedation.

Prior to the test you will be seen by the Endoscopist. This is an opportunity to discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.

What will happen during the procedure?

In the procedure room you will lie on a trolley (narrow bed) on your left side. A nurse and the endoscopist will stay with you throughout the tests.

During the test you may be given oxygen through little prongs that fit just inside your nostrils. Your blood pressure, pulse and oxygen levels will also be monitored.

Gastroscopy

You will be asked to bite on a small plastic mouthpiece to help keep your mouth open. This will also help to protect your teeth during the test. Dentures have to be removed if they are loose.When the endoscope is passed through your mouth it is likely to be uncomfortable. It may make you feel sick or you may retch. The endoscope will not interfere with your breathing. During the test, air is passed down the endoscope into your stomach to get a clear view. This may make you burp. The air is sucked out at the end of the test. If you get a lot of saliva in your mouth, the nurse will clear it using suction (the sort of tube that is used when you go to the dentist).

Flexible sigmoidoscopy

The doctor will perform the flexible sigmoidoscopy by passing the endoscope into your bottom. During the test air is passed down the endoscope into your bowel to expand it, so the doctor has a clear view of the lining of your bowel. This may give you some wind like pains and may also make you need to pass wind.

Although this can be embarrassing, remember the staff do understand what is causing it and the air is sucked out at the end of the test. You may also get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening. This sensation is normally due to the air we have pumped in.

Both procedures are usually completed between 30–60 minutes. If you need treatment given through the endoscope, this may take longer. If this applies to you it will be discussed when your appointment is made.

FAQs

Q: Will I get the results of my test on the same day?

A: Before you go home you will be given the results of the test. It will also say whether you need an appointment with a consultant or with your GP. Your GP will receive a copy of the report of the examination from the hospital. If biopsies were taken these results take longer and will be sent to your consultant and GP.

What happens to my medication?

We will talk to you before you go home about any changes/additions to your medications.

What can I expect when I go home?

You may experience bloating and stomach discomfort for a few hours after the test. This is because of the air that is used to expand and inflate your bowel during the test. These symptoms are often relieved by passing the wind.

If you have had a polyp removed or a biopsy, you may experience a little bleeding from your back passage.

Some patients have told us that they experience discharge from their back passage or an urgent need to open their bowels after the procedure. You may therefore like to bring a change of underwear and some incontinence pads with you to your appointment.

If the pain continues or are passing large amount of blood, or are passing large amount of blood, or you have concerns or questions, please contact the Endoscopy Unit:

Chelsea and Westminster:

8am–6pm on 020 3315 3056/5223.

Outside of these times please call St. Mary Abbot ward on 020 3315 8602 / 8603 or go to your nearest Accident and Emergency and remember to take your Endoscopy report with you.

West Middlesex:

8am–6pm on 020 8321 2585/5191.

Outside of these times please call 020 8560 2121 or go to your nearest Accident and Emergency and remember to take your Endoscopy report with you.

Contributors

Ciara Callan