What is endoscopy?

Endoscopes are long, thin, flexible tubes with video cameras and a light at their tip which can be passed by the gastroenterologist through the mouth into the upper gastrointestinal tract (upper endoscopy or gastroscopy), or through the anus into the colon (colonoscopy). The image of the intestinal tract is relayed to a video monitor and is carefully examined by the gastroenterologist. Fine instruments can also be passed through the endoscope and biopsies taken or polyps removed. The procedures are performed while under sedation which is administered by an anaesthetist.

During upper endoscopy, the gastroenterologist examines your oesophagus, stomach and duodenum (the first part of the small intestine), and can detect abnormalities such as inflammation, ulcers or tumours in these regions, and also with the help of biopsies diagnose conditions such as Helicobacter infection, Coeliac disease, Barrett’s oesophagus or cancer.

During colonoscopy, the gastroenterologist examines your rectum and colon and often the end of the small intestine. This enables detection of conditions such as diverticular disease or haemorrhoids, biopsy of any abnormalities and also removal of polyps which have the potential to become cancerous.

Who will do the procedure?

An upper endoscopy or colonoscopy with GIE is always done by one of our doctors.  All of the doctors at GIE are gastroenterologists, a specialist doctor who is trained in the evaluation and management of problems of the digestive tract.

What are the benefits of colonoscopy?

Colonoscopy is more accurate than an x-ray exam of the colon to detect polyps or early cancer. With colonoscopy, it is now possible to detect and remove most polyps without abdominal surgery. Removing polyps is an important step in the prevention of colon cancer.

What are the risks of colonoscopy?

Colonoscopy is a very safe procedure with complications occurring in less than 1% of patients. These risks include bleeding, a tear in the intestine, risks of anesthesia and failure to detect a polyp.

How do I prepare for colonoscopy? Will I need to miss work?

A registered nurse will give you instructions at your preparation appointment at least 3-4 days before your procedure. Read these instructions carefully ahead of time. You will need to follow a special diet for a few days before the procedure. You usually start your bowel preparation (often called the bowel prep) the day before the actual test so you may need to change your plans for the preparation day. You will need to stay close to a bathroom as soon as you start the bowel preparation. If any of the instructions are not clear or you do not understand them, call the GIE office and go over them step by step with the staff.

Many people consider the bowel prep the worst part of these tests. Preparation is a critically important part of the procedure. In order for the doctor to see the inside of your rectum and colon clearly, your bowels need to be as cleaned out as possible.

Because colonoscopy is usually done with drugs that make you sleepy, you will miss work the day of the procedure. You might want to schedule the test the day after a scheduled day off, so you can be at home the day before without taking an extra day off.

What can I expect during the colonoscopy?

Colonoscopy is usually well tolerated with minimal discomfort. There is often a feeling of pressure, bloating, or cramping at times during the procedure, which is related to the air that is put in the colon during the exam. The doctor, an anaesthetist, gives you intravenous sedation to help you relax and tolerate any discomfort during the procedure. While you are in a comfortable position on your side or on your back, the colonoscope is advanced through the large intestine. As the colonoscope is withdrawn, the lining is carefully examined. The procedure usually takes about 20 minutes to perform. You will be at the hospital facility for approximately 2-3 hours.

What are polyps and how are they removed?

Polyps are common but abnormal growths from the lining of the colon which vary in size from a tiny dot to several centimetres. The majority of polyps are benign (not malignant or cancerous), but it can be difficult to discern whether a polyp is benign or cancerous by its outer appearance alone. Therefore, polyps are generally removed a soon as they are detected during the colonoscopy and analysed microscopically. Removal of colonic polyps is an important means of preventing colon cancer as the majority of cancers develop from polyps.

Tiny polyps may be completely destroyed by biopsy. Larger polyps are removed by a technique called snare polypectomy, in which a wire loop is passed through the colonoscope and the polyps are cut from the intestinal wall by means of a small electrical current.

How will I feel afterward? Will I need someone to drive me home?

Most people feel okay after a colonoscopy. You may feel a bit drowsy from the drugs (anesthesia). You will be monitored in the recovery room and the major effects wear off rapidly. You may feel some cramping or bloating because of the air that was introduced into the bowel during the procedure. This should disappear quickly with the passage of gas. Side effects from the anaesthesia such as nausea and vomiting are uncommon. It is illegal for you to drive on the day of the procedure. Because of the medicines given for the procedure, you will need someone to escort you home and stay with you for 12 hours following. You must not drive a vehicle, operate machinery or sign important documents. You must be careful with simple household tasks for 12 hours following the procedure as your coordination may be impaired for sometime.

Other considerations following colonoscopy:

  • Diet — generally, you will be able to eat normally after the colonoscopy. If your doctor recommends diet modifications, you will be instructed regarding this. If you feel nauseous or are having persistent pain, you should inform the recovery room nurse or call your doctor. If you feel the onset of nausea when you start to eat, it is best to stop eating; usually the nausea will pass and you will be able to resume eating several hours later. Sometimes this nausea or upset stomach is due to the medications given during the colonoscopy.
  • Results/Biopsy Results — you will be handed a typed report following your procedure and a report will be sent to the referring doctor. It will take approximately 2-3 days to receive the results of any biopsy. Please follow up with your referring doctor at this time.
  • Activity — you should not drive a vehicle or perform strenuous activities on the afternoon or evening following colonoscopy. Unless you have had a polypectomy, you should be able to resume all normal activities the day after your colonoscopy. If you have any doubts about resuming an activity, call your doctor.
  • Medications — you should resume your usual medications on the evening following your colonoscopy. It is especially important that you resume taking your cardiac and blood pressure medications. For other blood thinners your physician will give you specific instructions.
  • Air Travel – If you have had polyps removed, you must not undertake domestic air travel for 48 hours, and international or remote travel for two (2) weeks after your procedure.

Things to watch out for:

Colonoscopy is generally a very safe and well tolerated procedure. However, in rare circumstances, complications can occur. If you develop any of the symptoms below, call your doctor.

  • Abdominal pain — a small amount of abdominal discomfort following the test is normal. However, if you have persistent abdominal pain, or find that your abdominal discomfort is getting worse either the day of the test or several days thereafter, it is important that you contact your doctor.
  • Bleeding — a small amount of rectal bleeding after the colonoscopy is normal. However, if your rectal bleeding is severe (more than one half cup), contact your doctor.

When will normal bowel function return?

This depends on your underlying bowel habit and your diet after the procedure.  Most patients return to normal bowel function within 1-3 days.

I think I have hemorrhoids.  Can they be treated at the time of my colonoscopy?

Haemorrhoids are engorged veins that may extend from the junction of the rectum and interior anus through the anal canal to the external anus.  Hemorrhoids are common.  While they frequently cause symptoms of minor bleeding, pressure discomfort, itching and protrusion of tissue during or following a bowel movement, they may cause no symptoms at all.  Minor haemorrhoidal symptoms may improve with a concerted effort to take in additional dietary fibre.  Haemorrhoids are not removed during open access procedures with GIE.

When do I need to have another procedure?

Your doctor will let you know when another colonoscopy should be planned, based on your findings, your family history, and other factors which may be important in your case.  The quality of bowel cleansing and the size, shape, number and microscopic characteristics of any polyps found factor into our recommendations, which in most cases follow these guidelines. Your details will be entered into our recall register and both you and your referring doctor will be notified at the time that a repeat procedure is required.

When should I begin bowel cancer screening?

In patients who have no symptoms or family history of bowel cancer, the National Bowel Cancer Screening Program would be suitable for you. Please discuss this with your GP. For patients with a family history of bowel cancer and/or patients experiencing symptoms such as rectal bleeding, a persistent change in bowel habit or abdominal pain please speak with your doctor as soon as possible.

Information for Patients (click here for brochure)