Download Same Day Flexible Sigmoidoscopy Barium Enema Service

Same Day Flexible Sigmoidoscopy
and
Barium Enema Service
Patient Information
Important – Please read now
Ninewells Hospital
Telephone: 01382 632750
Perth Royal Infirmary
Telephone: 01738 473825
Stracathro Hospital
Telephone: 01356 665012
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Please read this booklet and complete the questionnaire and consent form in the
middle of this booklet before you arrive.
Introduction
Your doctor has referred you to the Tayside Colorectal Service to further investigate your
bowel symptoms.
Arrangements have been made for you to have a Flexible Sigmoidoscopy and Barium
Enema which will be performed on the same day.
This booklet aims to give you enough information:

To give properly informed consent for the procedures

To help prepare you for the procedures

To guide you through the procedures

To make appropriate arrangements afterwards

To answer frequently asked questions
Your appointment has been arranged at:
Ninewells Hospital
Perth Royal Infirmary
Stracathro Hospital
For
Date
Time
Flexible
Sigmoidoscopy in
Endoscopy Unit
then proceed to
Barium Enema in
Radiology (X-ray)
Department
Ladies
If you are or think you may be pregnant please inform the Colorectal Office as soon as
possible. (The contact numbers are on the front of this leaflet).
When and where?
Your appointment is given above. If you wish to change the appointment, please
telephone the number on your appointment letter (an answerphone is available out of
hours).
If you fail to attend and do not make contact within 5 days of the appointment your request
card may be returned to the doctor who asked for the test. This means that you will not be
given another appointment.
As a patient, you deserve privacy and to be treated with dignity and respect in a way which
takes account of your physical, communication and cultural needs.
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Treating all our patients in privacy and with dignity is our priority, to ensure your
experience is the best it can be. Our Endoscopy Unit provides treatment to both male and
female patients as part of an outpatient service.
We are working to the principle of providing separate (single sex) accommodation, where
possible, for patients during their journey through our endoscopy service. We are also
committed to providing separate areas for patients waiting to have their procedure from
those patients who are recovering from a procedure. Where we are not able to provide
care in a single sex area we will:
 use privacy screens
 provide single sex toilet facilities
 ask you to take your bowel preparation at home, if appropriate.
If you are uncomfortable with being treated in a mixed sex environment then please
discuss this with a member of staff prior to your appointment. We will, where practical, take
your needs and preferences into account
If you have a pacemaker or ICD (Implantable Cardioverter Defibrillator) please
contact the department where you are having your test for further advice.
How long does the flexible sigmoidoscopy and barium enema take?
You should attend at the appointed time. This is to allow time for the admission and
assessment process, so you may not have the flexible sigmoidoscopy immediately. You
will be in the hospital for up to 4 hours in order for both tests to be carried out. You should
bring your own dressing gown and slippers. You are also welcome to bring your own
reading or listening materials (for example books, magazines, ipods).
If you need Patient Transport, please telephone 0300 123 1236 to arrange this.
What is a Flexible Sigmoidoscopy?
A flexible sigmoidoscopy allows direct inspection of the lower part of your bowel (rectum
and sigmoid).
A slim, flexible tube with a bright light at the end (a colonoscope) is passed through your
back passage into the rectum, and guided gradually around the bowel. Instruments can
be passed through the scope to allow samples to be taken. The appearance of your bowel
may be recorded on a photograph or video film for future reference.
How do I prepare for flexible sigmoidoscopy?
If you are pregnant of think you may be pregnant, contact us on the number on the front of
this leaflet.
If you have:

diabetes

take Clopidogrel

take Warfarin

have Addison’s disease
please see the specific instructions on the next pages.
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What if I have diabetes?
Do you have insulin dependant diabetes, mellitus or tablet controlled diabetes?
Unfortunately due to the length of time that you would be required not to eat or drink, your
tests will have to be carried out on different days.
Please telephone the Unit as soon as possible to allow us to re-schedule your
barium enema appointment.
However, you should still attend for your flexible sigmoidoscopy appointment as stated in
the enclosed letter.
Important information for people who have diabetes (read prior to a procedure):
Preparation prior to procedures such as bowel preparation medicine, the type of food and
drink allowed, and fasting for a procedure can potentially cause your blood sugar levels to
be low. The guidelines below will help you reduce the risk of problems.
If you have diabetes treated with tablets:

Ask for an early morning appointment for your procedure – before 10 am.

If you take tablets Gliclazide, Glipizide, Glimerpiride or Glibenclamide for diabetes, the
dose can be reduced by 50% (by half) during the day of bowel preparation treatment.

On the morning of your procedure, do not take your tablets for diabetes.

Bring your diabetes tablets with you to your appointment.

You can take your diabetes tablets as prescribed with food following the procedure.
If you have diabetes treated with Insulin:

Ask for an early morning appointment for your procedure – before 10 am.

The dose of your mealtime insulin can be reduced by 30 – 50% (one third to one half)
during the day of bowel preparation treatment.

If you normally take insulin before each main meal and long acting insulin once daily,
continue to take your long acting insulin as usual daily (Lantus, Levemir, Insulatard,
Humulin I).

On the morning of your procedure, do not take your ‘mealtime’ breakfast insulin.

Bring your insulin with you to your appointment.

You can take your insulin as prescribed with food following the procedure.

If you are re-starting your insulin late in the morning or before lunchtime, then it is
advisable to take half of your normal breakfast insulin dose at this late time.
If you have any doubt about managing or adjusting your diabetes medicine before your
procedure, please contact the Diabetes Healthcare professional or the Diabetes Specialist
Nurse on the telephone contact number below:
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Diabetes Specialist Nurse contact details:
Monday – Friday, 9 am – 5 pm
Ninewells Hospital
Telephone: 01382 632293
Perth Royal Infirmary
Telephone: 01738 473476
Further details:
http://taysidedn.dundee.ac.uk/HandBook/PreparationsPriorProcedures4.aspx
Remember: A change in your normal diabetes medication and food routine may affect
your blood sugar levels, so it is advisable to have someone accompany you to and from
hospital (you are not advised to drive yourself).
What if I take Clopidogrel/Plavix, Warfarin or Aspirin?

If you are on Clopidogrel/Plavix or Aspirin, continue to take these.

Do not stop your Warfarin tablets. Continue on your present regime but 7 days before
your appointment arrange to have your Warfarin level checked at your Warfarin Clinic
or GP surgery.

This is to make sure it is at the correct level. If it is not, you will be asked to adjust
your dose prior to your appointment. Your GP will organise this with you.

Please bring your INR record book with you to your appointment.
If you have any concerns about this appointment, please contact us.
What if I take or Rivaroxaban (Xarelto) or Dabigatran (Pradax)?
These new blood thinning tablets should betaken as normal.
What if I have Addison’s disease?
If you have Addison’s disease please let us know so that other arrangements can be made
for you.
How and why do I take the bowel preparation?
It is essential that your bowel is completely empty on the day of the test, so that the
endoscopist can get a complete view unhampered by faeces.
Preparations for this need to start well beforehand, so it is important that you follow the
instructions for your diet and take all of the bowel preparation otherwise the examination
may need to be repeated.
7 days before the appointment

Stop taking any iron supplements or medicines that contain iron.

Stop or reduce, if possible, painkillers containing codeine or dihydrocodeine.
Paracetamol can be used as an alternative.

Stop anti-diarrhoea medication (for example, Loperamide, Codeine Phosphate,
Imodium, Lomotil).

Stop eating seeded breads
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The day before the appointment
As per our department recommendations (which are slightly different from the
manufacturers instructions), you should remain at home, take the enclosed Picolax or
CitraFleet purgative and take a clear fluid diet, as follows:
Start the clear fluid diet after breakfast
1. At 8am take the first sachet of Picolax or CitraFleet.
2. Between 2pm and 4pm take the second sachet of Picolax or CitraFleet.
Using Picolax or CitraFleet
1. Add the contents of the sachet to a cup of cold water.
2. Stir for 2 – 3 minutes before drinking. If it becomes hot, wait until it is cool enough to
drink.
3. Expect frequent loose or liquid bowel movements to start within 2 hours.
You may suffer nausea, colic, anal pain or headache during the day. If you suffer severe
persistent abdominal pain or feel faint you should contact your GP.
Example of a clear fluid diet during bowel preparation

Water (it is advisable to drink plenty of water, at least 8 glasses per day)

Black tea/coffee

Lemonade/Cola

Lucozade

Strained Soup – consommé, Chicken noodle, vegetable, Broth (strain to remove
noodles all solid food and vegetables out)

Oxo/Bovril

Jelly (only orange, lime or lemon)
Avoid fluids with artificial colours or sweeteners especially red or blackcurrant juices
and tomato soup.
Continue to take lots of clear fluid (water, clear squash or pop) until your bowel
movements have ceased, drinking as much as you need to satisfy your thirst.
It is advisable to drink at least one glass of water every hour during the preparation period.
If you have a morning appointment, only drink water after 12 midnight. You may drink
water up until 2 hours before your appointment. You may eat and drink normally after the
procedure.
What happens on the day of my appointment?

Continue to take clear fluids only, to satisfy your thirst until 2 hours before your
appointment time.

Take your usual medicines with water at the usual time (except diabetic medicines).
Bring any insulin and/or diabetes tablets with you.
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
Complete the questionnaire and consent form enclosed with this leaflet before you
arrive, unless you need further information, or wish to discuss any issues, before you
sign it.

Bring your appointment letter, this booklet (with a list of your medications) and the
health questionnaire with you.

Do not wear nail varnish or false nails as this will interfere with the monitor we use.

Do not bring valuables or large quantities of money into hospital, as we cannot accept
responsibility for them.
What happens when you arrive at the Unit?

On arrival please report to the reception desk.

You will be shown to an admission room where a nurse will check your details and
confirm transport and aftercare arrangements with you.

A nurse will discuss the procedure with you in detail. If you have any questions please
ask; if you are anxious please let us know.

The nurse will confirm that you have understood the information you have been sent,
have signed your consent form and that you agree to proceed with the test.

You will be asked to undress and put on a hospital gown.

Please bring your own dressing gown and slippers.

You may keep any spectacles on until immediately before the procedure. After you
have spoken to the endoscopist these will be removed and kept in your trolley.
What happens during the procedure?
You will be taken to the examination room. Here you will meet the endoscopist and other
staff who will remain with you during the test. You will be told if students are present, and
if you prefer you can ask them to leave.
The endoscopist may ask you about your symptoms and treatment, and you can discuss
with him or her any questions you have about your condition and about the procedure
itself.
A small monitor will be placed on your finger to measure your pulse and breathing.
You will be asked to lie on your left side, with your legs bent so your knees are up towards
your chest.
The endoscopist will examine your back passage gently with a gloved finger. The scope
will then be passed through the anus into the rectum, and the rectum inflated with air
(passed through the scope) to allow a good view.
The instrument is then passed gradually around the rest of the colon, inflating each section
with air to give a view.
You may be asked to roll onto your tummy, your back or your right side to help the scope
pass around the many bends or loops in the bowel.
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Biopsies: Small samples of tissues (biopsies) may need to be taken using forceps
passed down the endoscope.
Once the examination is complete, the endoscopist will gradually withdraw the instrument,
inspecting the bowel wall and sucking out as much air as possible.
Throughout the test a nurse will be sitting next to you, checking your pulse and breathing.
During the test you will probably be vaguely aware of bloating and a desire to move your
bowels or pass wind. Do not feel inhibited from doing either: no stool is present, and this
feeling is simply due to the presence of the scope and the clean air pumped down the
scope. It is better to relax rather than try to contain yourself. You may feel a “pushing”
sensation inside, as the endoscopist presses round a corner. The nurse may press on
your abdomen to guide the scope round a corner. The nurse will be monitoring your
response. You will not feel biopsies being taken, or polyps removed.
Sometimes, even with careful preparation, the bowel may contain too much faeces to
allow a good view, and the flexible sigmoidoscopy will need to be repeated on another
occasion.
When the test is completed you will be taken to a recovery room. Your pulse and blood
pressure may be checked if required.
You will feel bloated for several hours, and may pass much wind or a little blood.
You are entitled to withdraw consent at any time, including during a procedure. Please
inform the nurse who is looking after you if you wish the procedure to stop.
What happens after the procedure?
The endoscopy staff will explain the results to you and tell you if any biopsies have been
taken or if any further tests are necessary. He or she may also recommend treatment to
be given by your GP and further measures with which you can help yourself.
You will be told whether further follow up will be with your GP or at the hospital.
Your GP will be sent a report containing the results of your flexible sigmoidoscopy and any
suggestions about treatment, but we would advise you to contact your GP to confirm that
the results have arrived before making an appointment.
You will be invited to take a seat in our waiting area whilst waiting your barium enema
appointment. You will be given an envelope with the results of your flexible sigmoidoscopy
to take to the Radiology (X-ray) department.
Remember to restart your iron tablets tomorrow.
What are the risks/complications of flexible sigmoidoscopy?
Flexible sigmoidoscopy is a very safe procedure. However, as it is an invasive procedure
it carries risks/complications.
The major risks/complications:
 Perforation (risk approximately 1 for every 2,000 examinations) or tear of the lining of
the bowel.
Page 8 of 13
An operation is nearly always required to repair the hole. The risk of perforation is
higher with polyp removal (1 in 1,000).
Discharge Advice
Bloating and colic are common for about 12 hours after the flexible sigmoidoscopy.
If you experience:

Severe abdominal pain

Pass large amounts of blood

A high temperature

Experience vomiting

Swelling or redness of an injection site
then you should contact your GP, or NHS 24.
BariumeEnema

You will be directed to the Clinical Radiology (X-ray) Department

On arrival at the Clinical Radiology (X-ray) Department please report to the reception
area. There are toilets nearby.
What happens before the barium enema?
You will be shown to an examination room. You will be asked to change into an x-ray
gown and remove any jewellery. Any valuables should be taken into the examination
room with you because there is no secure storage available.
Who will be present during the barium enema?
A small team of people including a radiographer or radiologist, nurse and a helper will
carry out the examination.
What happens during the barium enema?

The examination will be explained to you at the beginning.

A nurse, health care assistant, radiographer or radiologist will put a small lubricated
tube into your back passage (rectum).

This tube will be used to put the barium liquid and air into the bowel. This may be
uncomfortable but is not usually painful.

You will be asked to lie in different positions. Help will be given if you need it. This
allows the various parts of the bowel to be seen more easily.

You may need an injection in your arm to relax your bowel. This will be discussed with
you during the examination. You should not drive for 30 minutes after the injection, as
there could be some temporary blurring of vision.

X-rays will be taken during the examination.
You should expect to be in the department for about 1 hour.
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What happens after the barium enema?
As you have been without food for several hours, you may wish to bring a snack with you
to eat and drink after the test is over (as there is no facility within the X-ray Department to
provide this for you).
You are advised to drink plenty of fluids over the next
24 hours. Stools will be pale in colour for a few days after the examination.
Sometimes even with careful preparation the bowel may contain too much faeces to allow
a good view, and the tests will need to be repeated on another occasion.
You were referred for your test by your:
GP/Colorectal Pathway
Consultant
You will receive the results of your test by letter from the:
Colorectal Pathway
Consultant
The results of your biopsy will be sent to the person
who requested your test
You have been discharged from this service
You require an outpatient appointment
This will be at the Gastroenterology Clinic.
This will be on
……………………………………………………………...
An outpatient appointment will be sent to you
A copy of your report and results will also be sent to
your GP
Completed by nurse ………………………………………………………………………………
Page 10 of 13
Research
Ninewells Hospital Endoscopy Department is involved in clinical research for the diagnosis
and treatment of various gastroenterological conditions. Our research may speak with you
during your appointment.
Confidentiality
Data on certain flexible sigmoidoscopies is collected as part of local or national audit,
quality assurance or research programmes.
All such data is anonymised before collection, so that patients cannot be identified by
anyone other than staff involved in their care. Please let the Unit staff know if you do not
wish data from your examination to be included.
Comments
We would welcome any comments about this information leaflet.
Remember to bring this booklet with you!
Further information:
If you have any questions or concerns, call the Endoscopy Unit/ward where you are to
have your procedure between 8.30am or 5pm.
Ninewells Hospital
Telephone: 01382 632750
Perth Royal Infirmary
Telephone: 01738 473825
Stracathro Hospital
Telephone: 01356 665029
NHS24
Telephone: 111
Developed by Endoscopy staff and has been reviewed by other staff and patients
Revised: 04/2015 Review: 04/2017 LN0034
Page 11 of 13
NHS Tayside Consent Form
Name of procedure(s): Flexible Sigmoidoscopy
Inspection of the lower gastrointestinal tract with a flexible endoscope (with or without
biopsy and photography/video)
Biopsy specimens will be retained.
_____________________________________________________________________________________
Statement of patient
You have the right to change your mind at any time, including after you have signed this
form.
I have read and understood the information in the attached booklet including the benefits
and any risks.
I agree to the procedure described in this booklet and on the form.
I understand:
 That any procedure in addition to those described above will only be carried out if it
is necessary to save my life or to prevent serious harm to my health.
 That you cannot give me a guarantee that a particular person will perform the
procedure. The person will however, have appropriate experience.
 Information, including digital information (video and/or photographic material) may
be stored as part of the patients medical records and may be stored on computer
databases.
The University of Dundee is very active in medical research: donations of excess body
tissues and agreement to the use of images are a valuable resource for researchers and
clinical scientists.
Please tick () the appropriate box if you agree to:

Excess body tissue not 
required for diagnosis
or future treatment
being used for medical
research
Digital images (for example – such as described above)
being used for research, education and teaching in
presentations (for example – conferences or websites) and
in publications. Whenever relevant, such images will be
anonymised to protect patient privacy.
(If consent is withdrawn at a later date, it may not be possible to withdraw images that are
already in the public domain.)
NB: Medical staff – you must complete the appropriate clinical photography forms.
Have you ever been notified that you are at increased risk of CJD or vCJD for public
health purposes?
(Please tick)
Yes 
No 
Patient Signature: ………………………………………………….. Date: ……………………
Name (print in capitals):…………………………………………………………………………
Page 12 of 13
If you would like to ask further questions please do not sign the form now. Bring it with you
and you can sign it after you have talked to the healthcare professional.
Please remember to bring this booklet and form with you when
attending for your appointment.
Confirmation of consent
(To be completed by a health professional when the patient is admitted for the procedure).
I have confirmed that the patient/parent understands what the procedure involves including
the benefits and any risks.
I have confirmed that the patient/parent has no further questions and wishes the procedure
to go ahead.
Signed: …………………………………………………….. Date: ……………………………
Name (print in capitals): …………………………………………………………………………
Job title: ……………………………………………………………………………………………
dditional discussions with patient
Endoscopist signature: ………………………………… Date: ………………………………
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