A state-of-the-art Joint Advisory Group (JAG) accredited Endoscopy Unit comprising six endoscopy rooms and a GI Physiology Service. It delivers the full range of diagnostic and therapeutic procedures which include OesophagoGastroDuodenoscopy (OGD), Colonoscopy, Flexible Sigmoidoscopy, Trans-nasal Endoscopy, Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS), Endoscopic Mucosal Resection (EMR), Double-Balloon Enteroscopy (DBE), Endoscopic Submucosal Dissection (ESD), Peroral Endoscopic Myotomy (POEM), Trans-nasal Endoscopy (TNE), Cytosponge, Bowel Cancer Screening Programme, Percutaneous Endoscopic Gastrostomy (PEG), Gastrointestinal Physiology and a Bronchoscopy service. We are also providers of specialised training and education for medical and nursing staff.

Message from our Unit Manager, Mrs V Jomon: 
"Our dedicated, fully trained team of multi-diverse specialist nurses and health care workers work together with our Endoscopists to provide you with the best standards of care during your time with us.”

Getting Here

Royal Stoke Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG

Please note, car parking charges apply. There is a shuttle bus service running between Royal Stoke and County Hospital. Please call 01782 824232 to arrange a place on the bus.

Contact information

For more information about the team or advice on how to obtain your screening kit, contact:

Bowel Cancer Screening Centre Office: 01782 676643 (answer machine) or 01782 676642 (screening nurses) or 01782 676641 (Lead Nurse​).

Email: bcsp@uhnm.nhs.uk

Screening Hub Free telephone helpline: 0800 707 60 60

The Bowel Cancer Screening Centre is open Monday to Friday between 8.00am and 4.30pm.

For further information: www.bowelcancer.uk, www.cancerresearchuk.org

About the condition

Symptoms

• Blood in the poo
• Going to the toilet more often
• A change in your normal bowel habit
• Lost weight and you don't know why
• Lump in the tummy

After the treatment

Most patients receive a normal result, but about two percent receive a positive or abnormal result. Patients with a positive result will be invited to see a specialist nurse and may be referred for a colonoscopy, an examination of the lining of the large bowel (colon) using a tiny camera on the end of a flexible tube.

• About 5 in 10 people who have a colonoscopy will have a normal result.
• 4 in 10 people who have a colonoscopy will be found to have a 'polyp'.
• About 1 in 10 people who have a colonoscopy will have cancer detected.

Clinics

Nurse-led clinics are run at Royal Stoke University Hospital and County Hospital. Full details and clinic times are sent to patients with their invitation. Colonoscopy investigations take place in the endoscopy unit at the Royal Stoke University Hospital and County Hospital. 

Bowel cancer screening team

The bowel cancer screening team are working hard to increase awareness and eventually improve outcomes for patients with bowel cancer in Stoke on Trent and Staffordshire.

The NHS Bowel Cancer Screening Programme (BCSP) offers screening every two years to all men and women. Its aim is to identify people who appear healthy but are at an increased risk of developing bowel cancer. Over the next four years or so the screening programme is 'Age Expanding'; it will include people aged 50 – 58 and our screening centre has now commenced with screening for 56-year-olds. Anyone above the age of 74 can opt into the programme by telephoning the free phone hub on 0800 707 60 60. From April 2022 58-year-olds will be invited. People aged 60-74 will continue to be invited when they are due to be screened.

Age Expansion is very exciting for the screening programmes across England.

The team are regularly out in the local area speaking to the public about the importance of bowel cancer screening and explaining the importance of early detection and diagnosis. Bowel cancer affects around 42,000 people in the UK every year and is the second most common cause of cancer death, with 1 in 20 people developing bowel cancer during their lifetime. Each year around 16,000 people die from bowel cancer. The work that the team are carrying out is aimed at improving the diagnosis and eventual prognosis for patients with bowel cancer.

The service has received excellent feedback from patients and highlights the importance of patient engagement to help improve and develop the programme.​

UHNM's team has 14 members. The team will continue to carry out health promotion activities in 2022.

The wider team

Dr Sandip Sen, Consultant Gastroenterologist: BCS Clinical Director and Accredited Screening Colonoscopist

Dr Srisha Hebbar, Consultant Gastroenterologist: Accredited Screening Colonoscopist

Dr Sarveson Rajkumar, Consultant Gastroenterologist: Accredited Screening Colonoscopist

Dr Arun Kurup, Consultant Gastroenterologist: Accredited Screening Colonoscopist

Dr Rajeev Desai, Consultant Gastroenterologist: Accredited Screening Colonoscopist

Prince Thomas, Endoscopist: Accredited Screening Nurse

Dr Daniel Brett, Lead Pathologist

Dr Ingrid Britton, Lead Radiologist

Carol Beeston, Service Lead Specialist Screening Nurse

Rachel Owen, Screening Nurse, Deputy Service Lead Specialist Screening Nurse

Gloria Garlick, Screening Nurse

Adrian Black, Screening Nurse

Deborah Maccioni, Screening Nurse

Edna Beaty, Screening Nurse

Carol Wheatley, Screening Nurse

Amanda Baggaley, Screening Nurse

Wendy Walchester, Screening Nurse

Angela Power, Bowel Cancer Screening Programme Manager

Karen Davies, Lead Administrator

Louise Booth, Co-ordinator

Kathleen Pointon, Administrator

​

Further information and support

The Macmillan Cancer Support and Information Centre

At the centre, staff will:

• Listen to how cancer is affecting your life
• Provide a wide range of free booklets and other written information
• Put you in touch with other sources of support such as local counselling services, benefits advisers and support groups
  
  

The address is: 

The Macmillan Cancer Support and Information Centre
University Hospitals of North Midlands
Ground Floor
Main Building
Newcastle Road
Stoke on Trent
ST4 6QG

Contact: 01782 676333 or e-mail: macmillancentre@uhnm.nhs.uk

Opening hours are Monday to Friday between 9.00am and 5.00pm

Please note, we are not related to the local Douglas Macmillan Hospice, despite the word Macmillan being in both our names. If you are making a special journey, please ring to make an appointment so you are not kept waiting.​

University Hospital North Midlands (UHNM) Endoscopy Unit is a Joint Advisory Group (JAG) accredited training centre which sits within UHNM as a teaching hospital.   The JAG encompasses national best practice standards for endoscopy.  Hospitals have to go through a rigorous assessment process to become an accredited Trust, and are then subject to annual compliance reviews.  Only those hospitals that are awarded this accolade are able to apply to become a training centre.  More information on JAG can be found here https://www.thejag.org.uk

Advisory Group (JAG) accredited training centre which sits within UHNM as a teaching hospital.   The JAG encompasses national best practice standards for endoscopy.  Hospitals have to go through a rigorous assessment process to become an accredited Trust, and are then subject to annual compliance reviews.  Only those hospitals that are awarded this accolade are able to apply to become a training centre.  More information on JAG can be found here https://www.thejag.org.uk

Through our national training programmes we run courses that:

• Allow medical and nursing professionals training in the specialism of endoscopy, to gain learning opportunities from our knowledgeable, accredited trainers here at UHNM. Our trainers have undertaken JAG endorsed training courses themselves, to enable them to train others.
• Assess these professionals against the national standards to allow them to be signed off for independent practice (as a qualified Endoscopist in their area of training).
• Train the future generations of Endoscopist
• Train and assess qualified Endoscopy colleagues to become trainers themselves and thus contribute to train Endoscopists in their own hospitals.
• Share good practice between medical professionals to provide a better quality of care for not only our patients, but patients from around the country.

We offer the following JAG accredited courses from our County and Royal Stoke Endoscopy units:

• Basic Skills in Upper Gastrointestinal  (UGI) Endoscopy
• Basic Skills in Colonoscopy
• ERCP Skills Training
• Basic Skills in EUS
• ERCP Sharing Good Practice
• Training the ERCP Trainer (TERCPT)
• Training the Colonoscopy Trainer (TCT)

We are now affiliated with Midlands Endoscopy Training Academy (META) to deliver its ERCP and EUS course agenda, which will include dedicated courses for nurses, and we are looking to deliver a Train the EUS Trainer course in the future.    We are also proud to host our international ERCP EUS Symposium from Royal Stoke Hospital.

If you are a trainee and would like further information on any of our courses please follow the link below, or email our Training Centre Manager: Emily.Meakin@uhnm.nhs.uk
https://www.jets.nhs.uk/RoyalStoke

Follow us:

Twitter: @UHNMEndoscopyTC

Linkedin: UHNM Endoscopy Training Centre

Bronchoscopy procedures are performed five days-a-week across both the Royal Stoke and County Hospital sites. 

Royal Stoke site, Stoke on Trent

Monday (AM), Tuesday (AM), Wednesday (PM), Thursday (AM), Friday (AM).

County Hospital site, Stafford

Tuesday (AM), Wednesday (PM)

The bronchoscopy department comprises a dedicated team including Bronchoscopists, Nurses, Healthcare Assistants and reception and appointment clerks, who all work together to give you a good experience in our department.   

Bronchoscopy procedures performed at UHNM include:

Diagnostic flexible bronchoscopy

This helps us to visualise the breathing passages of the lungs (called 'airways'). It is done to see inside the airways of your lungs, or to get samples of mucus or tissue from the lungs.

Endoscopic inspection vocal cords to investigate dysfunctional breathing

We inspect the movement of the voice box (vocal cords) in relation to breathing.

EBUS (Endobronchial Ultrasound) and transbronchial needle aspiration

This procedure allows us to visualise the breathing tubes (similar to a bronchoscopy) and take sampling from enlarged glands (lymph glands) within the chest. This is done by using the aid of an ultrasound scan which is present at the end of a telescope and taking samples from the glands which lie outside the normal breathing tubes (bronchi).

Autofluoresence bronchoscopy and narrow band imaging​

This helps us to visualise early abnormalities on the surface of the lung airways.​​

Bronchoscopy/EBUS under propofol sedation

This is the same as procedures for a bronchoscopy and EBUS but it is done with deeper sedation​.

Rigid bronchoscopy under general anaesthesia

This is carried out in combination with a flexible bronchoscopy for diagnostic and therapeutic purposes, which include central airway obstruction management, argon plasma coagulation, stenting and balloon dilation.

Endoscopic management of emphysema​

In addition to these procedures, the unit performs:

• Local anaesthetic thoracoscopy (LAT)
• Visualisation of the inner lining of the chest cavity and sampling of abnormal lesions
• Tunnelled chest tube to drain fluid collection in the chest at home

The service at Royal Stoke has been running for five years, with the Local Anaesthetic Thoracoscopy (LAT) service introduced two years ago. It is one of the largest services of its kind in the UK and the service will shortly be expanding to include a radial ultrasound mini-probe and cryobiopsy service. 

The service is also accessed by surrounding hospitals investigating and treating patients from Walsall, Telford and Shrewsbury.

The Respiratory Consultant team comprises:

Dr M Haris
Dr S Khan
Dr N Maddekar
Dr S Bikmalla
Dr I Hussain
Dr E Idris
Dr M Iqbal
Dr M Ganaie
Dr K Asa'ari (interventional bronchoscopy and pleural fellow)​

Colon video capsule Endoscopy

What is a colon capsule?
This is where a special capsule containing a small camera, is swallowed allowing images of the bowel to be recorded as it travels through the gut.

Why do I need to prepare for this procedure?

Your bowel needs to be empty for the procedure so that the Doctor or Specialist Nurse can see the lining of your bowel. 

To achieve this you will need to alter your diet for a few days before the procedure and take specific bowel preparations before the procedure.

The changes are explained in this leaflet.

What is bowel prep?

You have been supplied with an oral preparation which is a bowel cleansing agent (also referred to as “bowel prep”). This is called Moviprep®.

The purpose of this medication is to clear out your bowels and ensure safety and effectiveness of the planned procedure. 

You may also require a recent blood test to check your kidney function. 

What are the risks of Moviprep® ?

The person prescribing the Moviprep® will have assessed your risk and identified that the medication is appropriate for you.

The risks include:

• Developing dehydration.
• Low blood pressure 
• Kidney problems. 
• Taking Moviprep® 

The following will apply when taking the bowel 
preparation:

• The Moviprep® will cause diarrhoea and urgency so you will need to stay close to toilet facilities after you have taken it. 
• If after taking both doses (all 4 sachets) of the Moviprep® you have not had your bowels open within 7-8 hours of the last 
  dose, please seek medical advice as soon as possible.
• Make sure that you drink plenty of water up to 2 hours before your procedure as the bowel prep can cause dehydration. 
• Do not drink dark coloured liquids or milk. (refer to dietary information).
• If you experience symptoms of dizziness or light headiness (particularly on standing up), thirst or reduction in passing urine, then you may be dehydrated and should seek medical attention.

All bowel cleansing agents cause diarrhoea so if regular medication is required, it should be taken more than 1 hour or at least 1 hour after taking the Moviprep®. 

Do not take any other medication at the same time as you are taking the bowel prep,

Moviprep® and other medication. 

Please tell the Nursing Staff as soon as possible on the number at the end of the leaflet if you:

Take any medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as Warfarin, Rivaroxaban, Dalteparfin or Clopidogrel). If you only take low dose 75mg aspirin, you do not need to call.

Have diabetes (contact your Nurse Specialist).

Have an allergy to Moviprep® or its ingredients.

Please let us know if you are taking any regular medicines at your pre-assessment appointment (including anything you buy yourself over the counter or any herbal or homeopathic medicines).

The diarrhea caused by the bowel preparation can make the oral contraceptive pill less effective. You should continue to take your contraceptive pill as normal but extra precautions (such as condoms) must be used for 7 days after completing the bowel prep.

Refer to the manufacturer’s instructions when taking the Moviprep® for a list of ingredients and allergies.

There may be medicines which you are asked to stop taking and these include:

• Heart/Blood pressure tablets e.g. Lisinopril, Ramipril, Perindopril, Captopril, Losartan, Candesartan, Irbesartan, Valsaratan;
• Diuretics (Water tablets) e.g. Furosemide, Bendroflumthiazide, Spironolactone, Amiloride, Co-Amilfruse, Bumtanide, Metolazone, Indapamide, Eplerenone;
• Anti-inflammatory drugs, such as Ibuprofen, Naproxen.
• Tolvaptan: Used for progressive Autosomal Dominant Polycystic Kidney disease or conditions causing low sodium.

Your medication will have been discussed and advice given during your clinic or pre-assessment appointment.

Dietary Management – Low Residue Diet

Three to five days before your procedure you should start to eat a low residue (fibre) diet. This reduces the stool (poo) residue in the bowel.

The main sources of fibre in the diet are cereal products, vegetables, seeds and fruits, so these foods need to be reduced..

It is important to have regular meals and a varied diet which includes foods such as meat, poultry, fish, eggs and dairy products (milk, cheese, yoghurt)

It is important to drink plenty of fluid and at least 8-10 cups of water or squash per day (avoid red/purple coloured squash). This helps to flush the bowel contents out and will improve the effect of the bowel preparation. It will also prevent you from becoming dehydrated.

A vegan diet sheet is available from the Endoscopy Department if required. Please contact the number at the end of this page.

Suggested meals you can eat that are low residue

BREAKFAST
Cornflakes / Rice cereals
White bread toasted / egg 
- (little butter)

(DO NOT EAT WHOLEGRAIN CERALS e.g. Weetabix,

LUNCH
Chicken soup with white bread/ 
Chicken or Ham sandwich/ Egg on white toast.

EVENING MEAL

White bread with ham /cheese (little butter) or boiled potatoes 
(without skins) cauliflower, turnip

Small amount of chicken/white fish.

White rice/pasta

Food Choices you can eat    

White bread or toast,  pastry, plain naan bread and chapatti,     crumpets. (made with white flour).

Cornflakes and rice breakfast cereals, but no bran, Marmite.

Soya or tofu, white rice, white pasta, and noodles, plain couscous

Do not eat lentils or pulses.

Cheese, cottage cheese

Biscuits made with white flour e.g. rich tea, shortbreads, plain cream crackers, arrowroot, plain scones.

Well cooked, lean (low fat) beef, lamb, ham, veal or pork, textured vegetable protein, Quorn®

Poultry, White Fish, Shellfish.

Eggs boiled or poached.

Dessert Choices you can eat

Sponge pudding and custard.
Mousses, plain or set yoghurts, cream.
Lemon Curd, Honey.
Bananas, canned pears, melon, stewed apple (Maximum of 2 portions per day)

Do not eat any seeds, pips, skins or piths

Orange, lime, lemon Jelly. DO NOT EAT RED/PURPLE JELLIES

ONLY the below fluids are allowed the day before your test.

Flavoured water/ Lemonade/ light coloured Squash, black tea/ black coffee, Oxo/ Bovril or other meat/veg extract cubes/clear strained soup e.g. consommé.

Boiled sweets and Jellies are allowed.

Flavoured water/ Lemonade/ light coloured Squash, black tea/ black coffee, Oxo/ Bovril or other meat/veg extract cubes/clear strained soup e.g. consommé.

Boiled sweets and Jellies are allowed.

Potatoes boiled or mashed without skins, sweet potatoes without skins boiled or mashed. Well cooked vegetables, turnip, squashes, carrots.

MOVIPREP INSTRUCTIONS

Five Days before the Test    

Stop taking Iron tablets.

Three Days before the Test    

Stop taking medications such ascodeine and loperamide and stool bulking agents such as fybogel, as these can reduce the effectiveness of the preparation.

If you suffer from constipation speak to your pharmacist or take your usual  laxatives before you need to start drinking the  Moviprep (do not exceed your maximum dose).

Three Days before the test    

You should eat a low residue (low   fibre) diet. This reduces the stool    residue in the bowel. 

The day before your test  

NO more solid food after breakfast

You can continue to have clear fluid, clear soup, soft drinks or black tea or coffee (NO MILK)

At 6.00pm the evening before your test 

Take both litres of Moviprep following the instructions below

The Morning of your test (up to 2 hours before your test).    

You can take essential medicines (as agreed during your clinic/pre-assessment appointment) with a sip of water.

STEP 1

Empty the contents of 1 sachet A and 1 sachet B in to a 1 litre Jug of water.

STEP 2

Stir until the solution is clear

STEP 3

Drink 1 glassful 250ml (¼ litre or

½ pint) of Moviprep every 15 minutes until you have drunk it all.

You can eat any combination of the following:

Adult Moviprep instructions for a morning appointment

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Moviprep

1. At 6pm empty the contents of ONE sachet A and ONE sachet B in to a jug and add 1 litre (1¾ pints) of cold water and stir until dissolved. (if desired, cordial can be added to taste).
2. Drink 250ml (½ pint) of Moviprep mixture every 15-30 minutes until you have drunk it all (usually over about 1-2 hours - no need to rush).
3. It is important to drink an additional 500ml (1 pint) of water or fluid of your choice (No Milk).
4. Make up your second litre of Moviprep as above and continue to drink, followed by 500ml water or fluid of your choice (No Milk).
5. Allow 2 hours after taking the second litre for the Moviprep to work.
6. Go to bed when you stop going to the toilet (e.g. 11.00pm or 12.00 Midnight).

Points to Remember

You will experience watery bowel movements so stay close to a toilet.

If you have not had your bowels open after taking the solution please seek medical advice.

If your health has deteriorated since seeing the

doctor or specialist nurse in clinic, please call the consultants who referred you for this test or your GP.

On the day of your test

IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST.

After your test, you will be advised when to return to your usual diet and medication.

The procedure
When you arrive at your appointment, the Nurse will ensure you are correctly prepared and have followed all of the instructions.

The Nurse will connect a sensor belt around your abdomen and attach a recorder in a bag which is placed over your shoulder.

You will be given a capsule to swallow with a glass of water.

The Nurse will go through the instructions with you about what you will need to do when you get home as you will be required to take some further bowel preparation. These are called ‘Boosters’.

The Boosters will be included in the bag of medicines with the Moviprep® you have been given to take home.

An alarm will sound on the machine throughout the day indicating your next part of the procedure.

Please follow the advice sheet and if you have any concerns or need support, contact the Video  Capsule Office on 01785 230508.

Your procedure is complete when the capsule is excreted (passed into the toilet). You will not feel any pain when the capsule passes and the capsule can be safely flushed down the toilet.

Please make sure that you or a relative/friend return the recorder and belt to the Endoscopy Department the following day.

Points to Remember
You will experience watery bowel movements so stay close to a toilet. 

If you have not had your bowels open after taking the solution please seek medical advice.

On the day of your test

IT IS IMPORTANT YOU stop drinking 2 hours before the test.

After your test, you will be advised when to return to your usual diet and medication.

Tips:
Some patients report drinking the bowel prep from a sports bottle or with a straw can help take it easier.

If you wish add some orange or lemon squash in with the prep to make it taste better.

Have some normal squash or Lucozade along side the prep to drink.

 Don’t rush it—this can make you feel sick.

The results

The images will be downloaded on to the recording device ready to be looked at. 

Once a report has been completed, it will be sent back to your referring doctor to act on. 

Additional information

The belt will be placed on top of one layer of clothing so please do not wear synthetic materials such as football tops, as this can interfere with the transmission of the pictures. 

You can put a jumper or top, if you are able, over the belt if you wish. 

If you are happy to, there is no medical reason why you are unable to drive yourself to and from the hospital. 

Please make a note of any questions you need to ask using the notes page opposite.

Patency capsule

Introduction 
This leaflet provides you with information for the Patency Capsule. It is not meant to replace the discussion between you and your Doctor or 
Healthcare Professional but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you. 

What is a Patency Capsule?
The Patency Capsule is a small pill that is swallowed by the patient at a pre-test before having a Capsule Endoscopy. This indicates whether passage through the bowel is clear for further investigations with the 
Video Capsule.

Why do I need to have a Patency Capsule?
The Patency Capsule will identify any blockages in the bowel that may prevent the Video Capsule from safely passing through the bowel.

How does the Patency Capsule work?
The Patency Capsule which you swallow, consists of dissolvable components surrounding a tiny radio frequency identification (RFID) tag that can be detected by X-ray, CT or a Patency Scanner. 

How long does the test take? 
The Patency Capsule starts to dissolve about 30 hours after it has been swallowed. 

You will given an appointment time to return to the Hospital the following day to have a scan to check if you have passed the Patency Capsule. 

If the Patency Capsule is not detected, this means that it has been excreted whole and therefore it is safe to continue with the Video Capsule.

It is common for patients to retain the capsule for more than 30 hours, in which case the Patency Capsule will dissolve and pass naturally through your intestine.

Before the procedure

You will be contacted by a Specialist Nurse who will ask you questions about your medical history and will explain the procedure and answer any questions you may have. 

How do I prepare for the Patency Capsule?

You will be asked to sign a consent form.

You will need to swallow the Patency Capsule with 
a glass of water. 

 You can eat as normal immediately after you have swallowed the Patency Capsule up until midnight before your appointment. 

After midnight, do not eat or drink anything at all. 

If you take any medication, take it after swallowing the Patency Capsule. 

Are there any risks? 

There is only a risk of aspiration (breathing the capsule into your lungs), but this is extremely rare.

What if I pass the Capsule before I return?

If you pass the capsule before returning for your appointment, please call the Capsule Office on the number below and let the Nurses know, as you may not need to attend in person . 

If you suffer with any severe abdominal pain, nausea or vomiting that is unusual for you whilst undergoing the procedure, please contact your Nurse or Doctor or go to your nearest A&E if appropriate.

What happens at the appointment?

Using a hand held scanner, the Nurse will check if the Patency Capsule is still inside you.

If the scanner locates it, you will need a CT scan to identify its location.

If it has passed into your large bowel, it will then be safe to proceed with the Video Capsule.

If it has not passed through successfully, it will not be safe to continue.

If you are aged 12-55 and could be pregnant, you will be asked to do a pregnancy test in our department before a CT scan is carried out.

Contact Details
Video Capsule Specialist Nurse
01785 230508

Small bowel endoscopy

What is a Capsule Endoscopy?

This is where a special capsule containing a small camera, is swallowed allowing images of the small bowel to be recorded as it travels through the gut.

The capsule is about the size of a penny. 

Why do I need a Capsule Endoscopy?

The small bowel connects your stomach to the large bowel and is difficult to examine properly by conventional methods.

Why do I need to prepare for this procedure?

Your bowel needs to be empty for the procedure so that the Doctor or Specialist Nurse can see the lining of your bowel. 

To achieve this you will need to take specific bowel preparations before the procedure, which is explained in this leaflet.

What is bowel prep?

You have been supplied with an oral preparation which is a bowel cleansing agent (also referred to as “bowel prep”). This is called Moviprep®.

If you change your mind at any point, you are entitled to withdraw your consent. You are encouraged to ask questions to help make your decision.

The purpose of this medication is to clear out your bowels and ensure safety and effectiveness of the planned procedure. 

You may also require a recent blood test to check your kidney function.

What are the risks of Moviprep® ?

The person prescribing the Moviprep® will have assessed your risk and identified that the medication is appropriate for you 

The risks include:
- Developing dehydration.
- Low blood pressure .
- Kidney problems. 

Should I still come for the test if my symptoms stop?

It is important that you still come for the appointment, even if your symptoms stop, so that the Doctor can investigate what has been causing your problems and rule out certain conditions.

Taking Moviprep® 

The following will apply when taking the bowel preparation:

The Moviprep® will cause diarrhoea and urgency so you will need to stay close to toilet facilities after you have taken it. 

If after taking one dose (1A + 1B sachets), of the Moviprep® you have not had your bowels open within 7-8 hours of taking the sachets, please seek medical advice as soon as possible.

• Do not drink dark coloured liquids or milk. 
  (refer to dietary information).
• If you experience symptoms of dizziness or light headiness (particularly on standing up), thirst or reduction in passing urine, then you may be dehydrated and should seek medical attention. 
• All bowel cleansing agents cause diarrhoea so if regular medication is required, it should be taken more than 1 hour or at least 1 hour after taking the Moviprep®. 
• Do not take any other medication at the same time as you are taking the bowel prep,

Moviprep® and other medication. 

• Please tell the Nursing Staff as soon as possible on the number at the end of the leaflet if you:
• Take any medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as Warfarin, Rivaroxaban, Dalteparfin or Clopidogrel). If you only take low dose 75mg aspirin, you do not need to call.
• Have diabetes (contact your Nurse Specialist).
• Have an allergy to Moviprep® or its ingredients.
• Please let us know if you are taking any regular medicines at your pre-assessment appointment (including anything you buy yourself over the counter or any herbal or homeopathic medicines).

The diarrhea caused by the bowel preparation can make the oral contraceptive pill less effective. You should continue to take your contraceptive pill as normal but extra precautions (such as condoms) must be used for 7 days after completing the bowel prep.

Refer to the manufacturer’s instructions when taking the Moviprep® for a list of ingredients and allergies. There may be medicines which you are asked to stop taking and these include:

• Heart/Blood pressure tablets e.g. Lisinopril, Ramipril, Perindopril, Captopril, Losartan, Candesartan, Irbesartan, Valsaratan;
• Diuretics (Water tablets) e.g. Furosemide, Bendroflumthiazide, Spironolactone, Amiloride, Co-Amilfruse, Bumtanide, Metolazone, Indapamide, Eplerenone;
• Anti-inflammatory drugs, such as Ibuprofen, Naproxen.
• Tolvaptan: Used for progressive Autosomal Dominant Polycystic Kidney disease or conditions causing low sodium.

Your medication will have been discussed and advice given during your clinic or pre-assessment appointment.

Adult instructions

7 Days before the Test

Stop taking Iron tablets.

3 to 5 Days before the test

You should eat a low residue (low fibre) diet. This reduces the 
stool residue in the bowel.

3 Days before the test

Stop taking medications such as codeine and loperamide and stool 
bulking agents such as fybogel, as these can reduce the effectiveness of the preparation. 

If you suffer from constipation speak to your pharmacist or take 
your usual laxatives before you need to start drinking the Moviprep® (do not exceed your maximum dose).

The day before the test
NO solid food after 10.00 am
You can continue to have fluid, clear soup, soft drinks or black tea 
or coffee (NO MILK)

At 6.00pm the evening before your test
Take 1 litre of Moviprep®

How to take Moviprep® 

1. Between 12.00 noon and 2pm the day before your test, prepare your Moviprep® in advance by emptying the contents of ONE sachet A and ONE sachet B in to a jug and add 1 litre (1¾ pints) of cold water and stir until dissolved. (if desired, cordial can be added to taste). 

2. Once mixed, the solution should be kept covered and stored in the fridge until needed. It is easier to take if the mixture is chilled.

3. At 6pm the evening before your procedure, drink 250ml (½ pint) of Moviprep mixture every 15-30 minutes until you have drunk it all (usually over about 1-2 hours - no need to rush). It is then important to 
drink, at least, an additional 500ml 1 pint) of water or fluid of your choice. (No Milk).

4. You are advised to continue to drink plenty of clear liquids up until Midnight. Any essential medications can be taken with a small glass of water up until 2 hours before your appointment. 

You will experience watery bowel movements so stay close to a toilet. If you have not had your bowels open after taking the solution please seek medical advice

STEP 1
Empty the contents of 1 sachet A and 1 sachet 
B in to a 1 litre Jug of water.

STEP 2

Stir until the solution is clear

STEP 3
Drink 1 glassful 250ml (¼ litre or ½ pint) of Moviprep 
every 15 minutes until you have drunk it all. There is no need to rush.

The procedure

When you arrive at your appointment, the Nurse will ensure you are correctly prepared and have followed all of the instructions and you will be asked to sign and complete a Consent Form.

• The Nurse will connect a sensor belt around your abdomen and attach a recorder in a bag which is placed over your shoulder.
• You will be given a capsule to swallow with a glass of water.
• The Nurse will check that the capsule has passed into your stomach by looking at a real time view screen on the data recorder.
• You will be then asked to go for a walk for 30 minutes.
• When you return, the Nurse will check the progress of the capsule and if the capsule has entered the small bowel successfully, you will be free to return home.
• You will be shown how to remove the equipment before you return home so that you can remove it before you go to bed. 

What happens when I return home?

You can have clear fluids 2 hours after you swallowed the capsule.

You will be able to eat a light lunch 4 hours after swallowing the capsule unless the Nurse tells you otherwise.

The capsule will move naturally through your digestive system whilst you continue with your normal activities.

Remember do not sleep wearing the equipment as this can slow down the capsule transit.

If you notice the capsule pass before you go to bed, you can remove the equipment as the procedure is complete.

Please make sure that you or a relative/friend return the recorder and belt to the Endoscopy Department the following day.

What are the risks?

A small bowel capsule endoscopy does have its risks but major and serious complications are rare. 

These risks will be discussed with you before you sign the consent form. These include:

• The capsule may be inhaled into the lungs.
• The capsule might get stuck in your small bowel. If 
  this occurs, then it may be necessary to remove the capsule.
• The capsule may need to be repeated with extra bowel preparation if the images taken are of poor quality and we are not able to see the small bowel clearly.
• The capsule may remain in your stomach for too long and not all of the small bowel lining may be visible before the battery runs out. To help reduce this risk, the Nurse will check the capsule has left your stomach and entered the small bowel before you leave the department.

The results

The images will be downloaded on to the recording device ready to be looked at. 

Once a report has been completed, it will be sent back to your referring Doctor to act on. This can take up to 4-6 weeks.

Additional information

The belt will be placed on top of one layer of clothing so please do not wear synthetic materials such as football tops, as this can interfere with the transmission of the pictures. 

You can put a jumper or top, if you are able, over the belt if you wish. 
If you are happy to, there is no medical reason why you are unable to drive yourself to and from the hospital. 

County Hospital:  Monday – Friday, 8am – 6pm, closed Bank Holidays

Royal Stoke:  Monday – Saturday, 8am – 6pm, closed Bank Holidays

We very often receive lovely comments from our patients following their care at UHNM.

Here is just a snapshot of the type of feedback we get. We hope that reading it will help to bolster your confidence in the knowledge and skill of our amazing team: 

“Kept informed and at ease throughout the procedure”

“Everybody was kind and looked after me extremely well”

“The department is very efficient and friendly”

“Staff very kind and compassionate despite being very busy. Everything was explained at each step clearly”

“Everything during endoscopy was very good, very good support throughout”

“I was made to feel very comfortable; staff very friendly explained everything in detail”

“Really well, all staff were really pleasant polite and made my visit very comfortable, could not have asked for a better service”

 “The whole team were excellent I arrived extremely stressed. From entering the surroundings everyone was very supportive through the entire procedure. Even held my hand. Thank you to everyone”

NHS Choices

You can share your experience of our services on NHS Choices. NHS Choices is a national website similar to the trip advisor you see on holiday and hotel websites.

Visit the NHS Choices website and type in which hospital you visited.

Your comments can also help us to improve things for future patients.

Colonoscopy

Introduction 

Your Specialist has recommended that you have a colonoscopy to investigate your symptoms.   

You will be asked to attend either Royal Stoke Hospital Endoscopy Unit or County Hospital Endoscopy Unit. 

Your appointment 

Please check your appointment letter before attending to make sure you attend the correct site.   

If you request sedation, your procedure will be cancelled if you do not have an escort arranged to take you home. The escort will also need to stay with you for 12 hours once you return home.   

As you will need to see the admission Nurse first, the time you are given to attend is not the time of your colonoscopy. 

The time is approximate due to different procedures taking different time periods.  

Emergency procedures will take priority. 

Endoscopy appointments are in high demand so if you are unable to attend your appointment, please contact the Endoscopy Unit as soon as possible: Tel: 01782 676010

Expect to be in the unit for approximately 3 hours. 

If you call to cancel your appointment, you will need to provide: 

Your full name. 

Date of birth.  

Date of your procedure.  

Contact telephone number. 

You are advised to discuss with your doctor the implications of not having this procedure. 

What is a colonoscopy? 

A colonoscopy is a test which allows the Doctor/Nurse Specialist (Endoscopist) to look directly at the lining of your large bowel (colon).  

A long flexible telescope (colonoscope), about the thickness of your index finger, with a bright light at its tip is carefully passed through the bottom (anus) to the caecum and the end of your small intestine. 

A digital video camera on the colonoscope transmits pictures of the inside of your colon to a monitor.  This enables the Endoscopist to be able to look for any abnormalities.  

A biopsy (small piece of tissue) may be taken using tiny biopsy forceps.  This does not cause any pain. 

If polyps (projections of tissue, rather like mushrooms) are found, in most cases these can be removed, or a biopsy taken to be sent for further tests. 

Sometimes polyps are not removed, and you may need a further test this will be discussed with you before you go home.
 
 

What are the benefits and risks? 

The procedure helps to investigate symptoms and be able to treat them.   

A colonoscopy does have its risks but major and serious complications are rare.   These risks will be discussed with you before you sign the consent form.  

Bleeding can happen specifically after taking a biopsy or after removing a polyp however, this should stop quickly within a few days. 

A significant bleed is an infrequent occurrence however, this risk increases to 1 in 200 for large polyp removal. If a significant bleed were to happen, further treatment may be required such as a blood transfusion. It is advisable not to travel overseas for 2 weeks following removal of polyps because bleeding can be delayed in some cases.  

Very rarely a perforation (tear in the bowel). The risk of a perforation is less than 1 in 1000. If a significant perforation were to happen, further treatment may be required such as surgery or a stay in hospital. 

Reaction to medication for example, sedation and painkillers. 

Missed pathology. This is where a diagnosis is not seen. 

Every effort is made to reduce these risks if you have any concerns, please speak to Endoscopist or a member of the Endoscopy team. 

What preparation will I need for my colonoscopy? 

Your bowel must be completely empty of waste material (faeces) for the Endoscopist to have a clear view.   

The procedure may have to be repeated at a later date if your bowel is not empty. 

Preparation instructions 

Five Days before your colonoscopy :

It is important that you follow the dietary and medication instructions provided in the information leaflet:  ‘Taking Moviprep/Picolax/Plenvu Oral Bowel Cleansing Agents Safely and Effectively for Colonoscopy/Flexible Sigmoidoscopy’. 

Day of colonoscopy:

Please stop drinking clear fluids TWO HOURS before your appointment at the hospital. 

What should I bring on the day? 

If you are diabetic, please bring your insulin or tablets.  

Your prescription medication. 

Your reading glasses so that you can read the consent form. 

You are welcome to bring your own dressing gown and slippers. 

Contact details of your escort/relative collecting you. 

When you arrive 

If need someone to support you through-out your stay with any care needs, please call the unit to arrange. 

Please report to the Endoscopy Reception.  You will be greeted by a Nurse and then: 

You will be asked several questions about your health and current medication.   

Your blood pressure and pulse will be taken. 

You may be asked to sign a consent form. 

You will be taken to a private single sex area. 

You will be asked to undress and change in to a theatre gown or if you have brought them, your own dressing gown and slippers.  

A cannula (small needle) will be inserted so intravenous medication can be given. 

Please talk to us about any worries or concerns that you may have.

What about my medication? 

If you are taking any blood thinning medication for example, Warfarin, Clopidogrel, Apixaban, Rivaroxaban, please contact the Endoscopy Unit Tel: 01782 676010. 

There is no need to stop low dose aspirin, for example, 75mg/day.  

If you are diabetic, please contact your Diabetic Nurse Specialist for advice. 

If you take Iron tablets, please stop them 5 days before the test. 

If you have a stoma, please contact your Specialist Nurse for advice. 

If you have any other concerns about your medication, please seek advice from your GP. 

Your colonoscopy procedure 

The procedure will take place in the Endoscopy theatre. 

You will be kept as comfortable as possible. 

You will need to lie on your left side. 

A Nurse will stay with you throughout the procedure. 

Each stage of the procedure will be explained to you as it happens. 

Your oxygen levels and pulse will be monitored as well as your level of comfort.  

You may be given oxygen during the test, through little prongs that fit just inside your nostrils. 

Sedation and painkiller options 

‘Gas and air’ (Entonox), is a mild sedative and painkiller. This method will help you to feel more comfortable and relaxed and wears off in half an hour. 

Moderate sedative (Midazolam) and strong painkiller (Fentanyl). This method will help you to relax but it is not a general anesthetic. This is given through a small needle placed in a vein on the back of your hand. This can affect your breathing so you will be monitored during the procedure and given oxygen. 

Deep Sedation (Propofol) is only available in exceptional circumstances and requires an anesthetist to be present. This will have been discussed with you by the Consultant or nurse before your procedure. 

During your procedure  

The Endoscopist will carefully pass the colonoscope through your bottom (anus) into your rectum and on into your colon.  

Some abdominal cramping and pressure is felt from the air which is introduced into your colon which is normal and will pass quickly.   

You may get the sensation of wanting to go to the toilet, but as the bowel is empty, there is no danger of this happening.  

You may feel you need to pass wind and, although this may be embarrassing, remember the staff do understand what is causing it.  

If you need to change position during the procedure, a Nurse will help you. 

The Nurse may need to press on your abdomen for a few moments during the procedure to help the colonoscope around awkward bends in your bowel. You will be warned before any pressure is applied. 

The Endoscopist may take tissue samples (biopsies), photographs or a video of your bowel, even if it all looks normal.  

At the end of the examination, the colonoscope is removed quickly and easily.  

The procedure usually takes between 10 and 45 minutes. 

After your procedure 

You may feel bloated because air remains in your bowel.  This will settle as you pass wind. 

Your blood pressure and pulse will be monitored. 

If you have been given intravenous sedation you will need to rest in the recovery area until you are fully awake (usually one hour).  

If you have used gas and air (Entonox), you should be able to leave after 30 minutes as the sedative effects wear off quickly. 

Going home  

If you have received intravenous sedation: 

This impairs your reflexes and judgment so it is important that a responsible adult escorts you home and stays at home with you for 12 hours.  Please note that your procedure will be cancelled if you do not have an escort to collect you and take you home.  We cannot escort you home. 

For 24 hours after the procedure you must not: 

Drive. 

Operate machinery. 

Drink alcohol. 

Sign legal documents. 

If you have received Entonox (gas and air): 

It wears off within 30 minutes and you should be able to drive home. 

You do not require an escort home. 

You will be given any written information that you need when you leave the hospital.  

Your medication after the procedure 

We will talk to you about your medication after the procedure and before you go home in case changes to your medication are needed.  

When will I know the results? 

You will be told about the results when you are ready to be discharged and provided with a copy of the colonoscopy report.  A copy will also be sent to your GP or whoever referred you. 

It is suggested that when you receive your results, you have your escort or relative with you in case you forget any information due to the sedation you have received.    

Concerns or questions 

For further advice please contact the Endoscopy Unit between 8am and 5pm Monday to Friday:  

Endoscopy Unit Tel: 01782 676010. 

Please leave your contact number, full name, date of birth and date of your procedure as this is a voicemail facility.  We will return your call as soon as possible. 

Sources of information and support 

For further information (including videos of what to expect during your appointment), please visit our website:  

www.uhnm.nhs.uk/our-services/endoscopy/  

Free Bus Service 

There is a free shuttle bus service between Royal Stoke and County sites. 

Members of the public who wish to use this service are required to                  pre-book their journey in advance: 

Shuttle Bus booking line Tel:     01782 824232 

How to find us: 

County Hospital  

(formerly Stafford Hospital),  

Weston Road,  

Stafford, ST16 3SA.  

Tel: 01785 257731 

Endoscopy Unit is on the ground floor.  

Royal Stoke Hospital,  

Newcastle Road,  

Stoke-on-Trent,  

ST4 6QG.  

Tel: 01782 715444 

Please note car parking charges may apply. 

Endoscopy appointments are in high demand so if you are unable to attend your appointment, please contact the Endoscopy Unit as soon as possible. Tel: 01782 676010

Expect to be in the unit for approximately 3 hours. 

If you call to cancel your appointment, you will need to provide: 

Your full name. 

Date of birth.  

Date of your procedure.  

Contact telephone number. 

You are advised to discuss with your doctor the implications of not having this procedure. 

What is a Flexible Sigmoidoscopy?

What is a Gastroscopy?

A gastroscopy (or simple endoscopy) is a test which allows the Endoscopist to look directly at the lining of the oesophagus (gullet), the stomach, and the first part of the small intestine (duodenum). In order to do this, a thin flexible tube called a gastroscope that transmits live video images to a TV monitor is passed through your mouth into your stomach.

Why am I having a Gastroscopy?

Your doctor wants to find out if there is a reason for the symptoms you are having so that they can suggest treatment. The Endoscopist will get a clear internal view and find the cause of your symptoms. Importantly, this is the only test that allows biopsies to be taken for analysis.

What is a Flexible Sigmoidoscopy?

A flexible sigmoidoscopy is a test which allows the Endoscopist to look directly at the lining of the left side of the large bowel (colon). This is done using an endoscope which has a thin flexible tube that transmits live video images to a TV monitor. This is passed into your anus (back passage) and around your bowel. The test allows the Endoscopist to painlessly take tiny pieces of tissue (biopsies) for analysis to assess the lining of the bowel.
If a polyp (an overgrowth of tissue) is found this can often be removed painlessly during the procedure and again sent for analysis.

Why am I having a Flexible Sigmoidoscopy?

Your doctor wants to find out if there is a reason for the symptoms you are having so that they can suggest treatment. The Endoscopist will get a clear internal view and find the cause of your symptoms. Importantly, this is the only test that allows biopsies or polyps to be taken for analysis.

Are there any alternatives to the test?

Yes, a barium swallow, barium meal or a Computed tomographic colonography (virtual colonoscopy) which will show larger abnormalities of the mucosa (lining) however biopsies cannot be taken and polyps cannot be removed.

Are there any risks to the test?

The procedure is considered safe. Complications are rare but possible:

• If a biopsy is taken or a polyp removed it can lead to bleeding or a perforation (tear) of the bowel. Bleeding usually settles on its own. A perforation often requires surgery but the risk of this complication is small. The overall complication rate including perforation and bleeding is estimated to be less than 1 in 1000 cases.
• Complications of sedation.
• Damage to teeth, crowns or bridges.
• Aspiration.
• You are likely to feel bloated and have some abdominal discomfort after the test.
• You may also have a mild sore throat.

Before admission

Do not eat or drink anything for 2 hours before the test. Please bring a list of your medication with you and your dressing gown and slippers.

What should I expect?

• On arrival, report to the Reception desk in Endoscopy Unit. Your details will be checked and you will be asked to take a seat.
• A nurse will collect you and take a brief medical history from you, including a discussion of your current medication, discharge arrangements and the test itself.

Please inform the nurse of any allergies. Please ask questions if you have any.

• You may be asked to wait a short while until you have the test.
• A Nurse or Endoscopist will ask you to sign the consent form making sure you understand the test.
• You will be asked to change into a theatre gown and remove your underwear.
• You will be given an enema, which is inserted into the back passage. The large bowel, which normally contains faeces, must be clean to ensure safe, clear views. You will have a private room with its own toilet facilities.
• The ward is a single sex area.

Is the procedure painful?

The procedure can be uncomfortable so you will be offered Entonox which is a short acting pain relief in the form of gas you breathe in. This does not remain in your system so you would not need any special aftercare requirements if you choose this option or you will be offered a sedative and a painkilling injection which is given through a plastic tube (cannula) inserted into the back of your hand or arm. This will make you more
comfortable but it does not put you to sleep, however you may forget the procedure afterwards, and there are special aftercare requirements for 24 hours after the procedure. During the gastroscopy you may experience some retching as the tube touches the back of your throat. You may feel bloated and burp because air is put into your stomach to ensure good views. The test usually lasts between five and fifteen minutes. These feelings are not pleasant but do not last long.

There are two ways you can have the Gastroscopy:

1. You can have local anaesthetic spray to the back of the throat which numbs the area and makes it easier to the pass the tube. It also reduces retching.
2. You can have a mild sedative which will help you feel more relaxed about the test. It does not put you to sleep.

If you do not wish to have any of these options, please inform the nurse.

During the test

• You will be taken into the procedure room. In the room will be the Endoscopist and two nurses who will stay with you during the test
• You will normally be given Entonox or a sedative injection unless you have requested otherwise.
• You will be made comfortable on your left side with your knees bent
• A pad will be placed under your chin and one under your bottom.
• A plastic mouth guard will be placed gently in your mouth.
• The endoscope will be passed across the top of your tongue to the back of your throat. Try to breathe steadily and remain calm.
• It will then be passed down the gullet, into the stomach and the small intestine.

You may feel bloated as air is used to inflate your stomach to get good views.

• Biopsies can be taken and this is painless.
• Photographs may be taken of normal and abnormal mucosa.
• If you get a lot of saliva in your mouth, the nurse will clear it using a suction tube.
• The endoscope is removed slowly taking some air out at the same time.
• The mouth guard will be removed and a tissue provided to wipe your mouth.
• The trolley you are lying on will be turned around.
• The Endoscopist will lubricate your back passage with a gloved finger and lubricating jelly.
• They will then pass the instrument into your back passage and manoeuvre it carefully around the bowel
• Biopsies can be taken or polyps removed.
• Photographs may be taken of normal and abnormal mucosa
• You may be asked to change positions and the nurses will help you do this
• The nurse may press on your abdomen to assist the manoeuvring of the
instrument
• The endoscope is removed slowly to ensure good views
• You will be covered and made comfortable
• You will be taken out to the ward area to recover.

When can I go home?

If you have had Entonox and/or throat spray then you would be allowed to leave the department when the effects have worn off normally no longer than 30 minutes. If you had a sedative then you will need to rest in the department for as long as necessary.

We will only discharge you when you are safe to go home and you feel happy to do so.

If you have had sedation: FOR 24 HRS YOU MUST NOT:

• Drive
• Operate machinery
• Drink alcohol
• Sign legal documents

How will I feel afterwards?

• Your throat may feel sore but will settle without treatment.
• You may feel bloated because air remains in your bowel; it will settle as you pass wind
• If you have been sedated, you may feel tired and lethargic for the next 24 hrs so you should rest
• You should be able to eat and drink as normal

When will I know the results?

When you are fully awake, you will be told about the test and anything that has been done. We prefer a family member or friend to be present as you may forget what you have been told because of the medication you have had. If you object to a family member being present, please inform the nurses. You will be given a discharge leaflet which includes aftercare, useful telephone numbers and information about your test. The hospital Consultant responsible for your procedure will receive any biopsy results and will write to you or see you in Out- patients. A copy of the report will also be sent to your GP.

The consent form

You will find a Consent form​ with this information. This gives the Endoscopist a formal indication that you are agreeing to undergo the procedure as described. You keep a portion of the form as your record. Please read the consent form and bring it with you to the appointment.

What if I decide not to have the test?

If you read this information and decided not to go ahead with the test, please ring the department, using the telephone number on your appointment letter, to let us know. You should also discuss your decision with your GP or hospital Consultant.

What is a Gastroscopy?

A gastroscopy (or simple endoscopy) is a test which allows the Endoscopist to look directly at the lining of the oesophagus (gullet), the stomach, and the first part of the small intestine (duodenum). In order to do this, a thin flexible tube called a gastroscope that transmits live video images to a TV monitor is passed through your mouth into your stomach.

Why am I having a Gastroscopy?

Your doctor wants to find out if there is a reason for the symptoms you are having so that he can suggest treatment. The Endoscopist will get a clear internal view and find the cause of your symptoms. Importantly, this is the only test that allows biopsies to be taken for analysis.

What is a Colonoscopy?

A colonoscopy is a test which allows the Endoscopist to look directly at the lining of the large bowel (colon). This is done using an endoscope which has a thin flexible tube that transmits live video images to a TV monitor. This is passed into your anus (back passage) and around your bowel.
The test allows the Endoscopist to painlessly take tiny pieces of tissue (biopsies) for analysis to assess the lining of the bowel.

If a polyp (an overgrowth of tissue) is found this can often be removed painlessly during the procedure and again sent for analysis.

Why am I having a Colonoscopy?

Your doctor wants to find out if there is a reason for the symptoms you are having so that he can suggest treatment. The Endoscopist will get a clear internal view and find the cause of your symptoms. Importantly, this is the only test that allows biopsies or polyps to be taken for analysis.

Are there any alternatives to the test?

Yes, a barium swallow, barium meal or a Computed tomographic colonography (virtual colonoscopy) which will show larger abnormalities of the mucosa (lining) however biopsies cannot be taken and polyps cannot be removed.

Are there any risks to the test?

The procedure is considered safe. Complications are rare but possible:

• If a biopsy is taken or a polyp removed it can lead to bleeding or a perforation (tear) of the bowel. Bleeding usually settles on its own. A perforation often requires surgery but the risk of this complication is small. The overall complication rate including perforation and bleeding is estimated to be less than 1 in 1000 cases.
• Complications of sedation.
• Damage to teeth, crowns or bridges.
• Aspiration.
• You are likely to feel bloated and have some abdominal discomfort after the test.
• You may also have a mild sore throat.

Before admission

Bowel preparation is included with this letter together with specific diet instructions for you to follow. It is essential that you follow these instructions exactly as the bowel needs to be clear for the test to be successful. Do not drink anything for 2 hours before the test. Please bring a list of your medication with you and your dressing gown and slippers.

What should I expect?

• On arrival, report to the Reception desk in Endoscopy Unit. Your details will be checked and you will be asked to take a seat.
• A nurse will collect you and take a brief medical history from you, including a discussion of your current medication, discharge arrangements and the test itself. Please inform the nurse of any allergies. Please ask questions if you have any.
• You may be asked to wait a short while until you have the test.
• A Nurse or Endoscopist will ask you to sign the consent form making sure you understand the test.
• You will be asked to change into a theatre gown with your dressing gown and slippers on. Please remove your underwear.
• The ward is a single sex area.

Is the procedure painful?

The procedure can be uncomfortable so you will be offered Entonox which is a short acting pain relief in the form of gas you breathe in. This does not remain in your system so you would not need any special aftercare requirements if you choose this option or you will be offered a sedative and a painkilling injection which is given through a plastic tube (cannula) inserted into the back of your hand or arm. This will make you more
comfortable but it does not put you to sleep, however you may forget the procedure afterwards, and there are special aftercare requirements for 24 hours after the procedure. The colonoscopy makes you feel bloated and as if you need to go to the toilet. These sensations settle after the tests. During the gastroscopy you may experience some retching as the tube touches the back of your throat. You may feel bloated and burp because air is put into your stomach to ensure good views. The test usually lasts between five and fifteen minutes. These feelings are not pleasant but do not last long.

There are two ways you can have the Gastroscopy:

1. You can have local anaesthetic spray to the back of the throat which numbs the area and makes it easier to the pass the tube. It also reduces retching.
2. You can have a mild sedative which will help you feel more relaxed about the test.

It does not put you to sleep. If you do not wish to have any of these options, please inform the nurse.

During the test

• You will be taken into the procedure room. In the room will be the Endoscopist and two nurses who will stay with you during the test
• You will normally be given Entonox or a sedative injection unless you have requested otherwise.
• You will be made comfortable on your left side with your knees bent
• A pad will be placed under your chin and one under your bottom.
• A plastic mouth guard will be placed gently in your mouth.
• The endoscope will be passed across the top of your tongue to the back of your throat. Try to breathe steadily and remain calm.
• It will then be passed down the gullet, into the stomach and the small intestine.You may feel bloated as air is used to inflate your stomach to get good views.
• Biopsies can be taken and this is painless.
• Photographs may be taken of normal and abnormal mucosa.
• If you get a lot of saliva in your mouth, the nurse will clear it using a suction tube.
• The endoscope is removed slowly taking some air out at the same time.
• The mouth guard will be removed and a tissue provided to wipe your mouth.
• The trolley you are lying on will be turned around.
• The Endoscopist will lubricate your back passage with a gloved finger and lubricating jelly.
• They will then pass the instrument into your back passage and manoeuvre it carefully around the bowel
• Biopsies can be taken or polyps removed.
• Photographs may be taken of normal and abnormal mucosa
• You may be asked to change positions and the nurses will help you do this
• The nurse may press on your abdomen to assist the manoeuvring of the
instrument
• The endoscope is removed slowly to ensure good views
• You will be covered and made comfortable
• You will be taken out to the ward area to recover.

When can I go home?

If you have had Entonox and/or throat spray then you would be allowed to leave the department when the effects have worn off normally no longer than 30 minutes. If you had a sedative then you will need to rest in the department for as long as necessary. We will only discharge you when you are safe to go home and you feel happy to do so.

If you have had sedation:FOR 24 HRS YOU MUST NOT:

• Drive
• Operate machinery
• Drink alcohol
• Sign legal documents

How will I feel afterwards?

• Your throat may feel sore but will settle without treatment.
• You may feel bloated because air remains in your bowel; it will settle as you pass wind
• If you have been sedated, you may feel tired and lethargic for the next 24 hrs so you should rest
• You should be able to eat and drink as normal

When will I know the results?

When you are fully awake, you will be told about the test and anything that has been done. We prefer a family member or friend to be present as you may forget what you have been told because of the medication you have had. If you object to a family member being present, please inform the nurses. You will be given a discharge leaflet which includes aftercare, useful telephone numbers and information about your test. The hospital Consultant responsible for your procedure will receive any biopsy results
and will write to you or see you in Out- patients. A copy of the report will also be sent to your GP.

The consent form

You will find a Consent form​​ with this information. This gives the Endoscopist a formal indication that you are agreeing to undergo the procedure as described. You keep a portion of the form as your record.
Please read the consent form and bring it with you to the appointment.

What if I decide not to have the test?

If you read this letter and decide not to have the test, then please ring the department to tell us and you should also discuss your decision with your GP or hospital Consultant.

ERCP Procedure Information

Giving my consent (permission):

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a Consent form​​​​​​​​​. This states that you agree to have the treatment and you understand what it involves. Please read the Consent Form and bring it with you to your appointment.

What if I decide not to have the test?

If you read this information and decided not to go ahead with the test, please ring the department, using the telephone number on your appointment letter, to let us know. You should also discuss your decision with your GP or hospital Consultant.

Gastroscopy

How to find us

Introduction

Your specialist has recommended that you have a gastroscopy to investigate your symptoms. 

You will be asked to attend either Royal Stoke Hospital Endoscopy Unit or County Hospital Endoscopy Unit.

Your appointment

• Please check your appointment letter before attending to make sure you attend the correct site.
• Your procedure will be cancelled if you request sedation, and do not have a suitable escort to collect you and take you home. The escort will also need to stay with you for 12 hours once you return home.
• As you will need to see the Nurse first, the time you are given to attend is not the time of your gastroscopy.
• The time is approximate due to different procedures taking different time periods.
• Emergency procedures will take priority.
• Expect to be in the unit for up to 3 hours approximately.

If you call to cancel your appointment, you will need to provide:

• Your full name.
• Date of birth.
• Date of your procedure.
• Contact telephone number.

You are advised to discuss with your Doctor the implications of not having this procedure.

What is a gastroscopy?

A gastroscopy (or simple endoscopy) is a test which allows the Doctor/Nurse Specialist (Endoscopist) to look directly at the lining of the oesophagus (gullet), the stomach and the first part of the small intestine (duodenum).

• A thin flexible tube called a gastroscope is passed through your mouth. The digital camera it contains transmits pictures to a monitor.
• A biopsy (small piece of tissue) may be taken using tiny biopsy forceps. This does not cause any pain.
• A gastroscopy takes approximately 5 minutes.

What are the benefits and risks to a gastroscopy?

The procedure helps to investigate symptoms and be able to treat them. 

Procedures do have their risks but major and serious complications are rare.

These will be discussed with you and any risks identified before you sign the consent form.

These can include: 

• You may have a mild sore throat.
• Aspiration. This is where fluid/food residue could go into your lungs.
• Bleeding can happen. Slight spotting of blood on the toilet paper or small drops in the toilet bowl should be expected however, this should stop quickly within a few days.
• A perforation (tear in the small bowel). The risk of perforation is less than 1 in 1000.  If a significant bleed or perforation were to happen, further treatment may be required such as a blood transfusion or surgery.
• Reaction to medication for example, sedation and painkillers.
• Damage to teeth, crowns or bridges.
• Missed pathology. This is where a diagnosed was not noticed.

Preparation instructions

Day of your procedure

Unless you are told otherwise, no food for SIX HOURS prior to your appointment.  Please stop drinking clear fluids TWO HOURS before your appointment at the hospital.

What should I bring on the day?

If you are diabetic please bring:

• your insulin or tablets.
• Your prescription medication.
• Your reading glasses so that you can read the consent form.

When you arrive

Only one escort/relative will be able to accompany you due to limited space.  If you need someone to support you, please call the unit to arrange.

Please report to the Endoscopy Reception. You will be greeted by a Nurse and then:

• You will be asked several questions about your health and current medication.
• Your blood pressure and pulse will be taken.
• You may be asked to sign a consent form.
• A cannula (small needle) will be inserted so intravenous medication can be given.
• Please talk to us about any worries or concerns that you may have.

What about my medication?

• If you are taking any blood thinning medication for example, Warfarin, Clopidogrel, Apixiban, Rivaroxaban,etc., please contact the Endoscopy Unit Tel: 01782 676010 or 01782 675713.
• There is no need to stop low dose aspirin, for example, 75mg/day.
• If you are diabetic, please contact the Diabetic Nurse Specialist for advice Tel: 01782 679770 or 01782 715444.
• If you have any other concerns about your medication, please seek advice from your GP.

Your gastroscopy procedure

The procedure will take place in the Endoscopy theatre.

• You will be kept as comfortable as possible.
• You will need to lie on your left side.
• A Nurse will stay with you throughout the procedure.
• Each stage of the procedure will be explained to you as it happens.
• Your oxygen levels and pulse will be monitored as well as your level of comfort.
• You may be given oxygen during the test, through little prongs that fit just inside your nostrils.

Procedure options for gastroscopy

• Local anesthetic spray. This is sprayed to the back of your throat which numbs the area and makes it easier to pass the tube. This also reduces retching.

And/ Or

• Sedative. This method will help you to relax but it is not a general anaesthetic. This is given through a small needle placed in a vein on the back of your hand or arm.

During your procedure

• Your throat will be sprayed with local anesthetic which numbs the back of your throat. The sedation will then be administered if you request it.
• A plastic mouth guard will be placed gently in your mouth.
• The endoscope will be passed across the top of your tongue to the back of your throat.
• It will then be passed down the gullet, into the stomach and the small intestine. It is normal if you feel bloating during this.
• Biopsies can be taken which is painless.
• If you get saliva in your mouth, the nurse will clear this using a suction tube.
• The endoscope is removed slowly taking some air out.
• The mouth guard will be removed. A tissue will be provided to wipe your mouth.

After your procedure

• You may feel bloated because air remains in your bowel. This will settle as you pass wind.
• Your blood pressure and pulse will be monitored.
• If you have been given intravenous sedation you will need to rest in the recovery area until you are fully awake (usually one hour).
• If you have had throat spray without sedation, you can be discharged once you feel ready.

Going home

If you have received intravenous sedation:

This impairs your reflexes and judgment so it is important that a responsible adult escorts you home and stays with you for 12 hours.  Please note that your procedure will be cancelled if you do not have an escort.  We cannot escort you home.

For 24 hours after the procedure you must not:

• Drive.
• Operate machinery.
• Drink alcohol.
• Sign legal documents.
• Breast feed.

You will be given any written information that you need when you leave the hospital.

Your medication after the procedure

We will talk to you about your medication after the procedure and before you go home in case changes to your medication are needed.

When will I know the results?

You will be told about the results when you are ready to be discharged and provided with a copy of the report.  A copy will also be sent to your GP or whoever referred you.

It is suggested that when you receive your results, you have your escort or relative with you in case you forget any information due to the sedation you have received.    

Concerns or questions

For further advice please contact the Endoscopy Unit between 8am and 5pm Monday to Friday:

Endoscopy Unit Tel: 01782 676010 or 01782 675713.

Please leave your contact number, full name, date of birth and date of your procedure as this is a voicemail facility.  We will return your call as soon as possible.

Sources of information and support

Free Bus Service

There is a free shuttle bus service between Royal Stoke and County sites.

Members of the public who wish to use this service are required to pre-book their journey in advance:

Shuttle Bus booking line Tel: 01782 824232

How to find us

County Hospital

Weston Road

Stafford

ST16 3SA

Tel: 01782 715444

Endoscopy Unit is on the ground floor

Royal Stoke Hospital

Newcastle Road

Stoke-on-Trent

ST4 6QG

Tel: 01782 715444

Endoscopy Unit is on lower ground floor 1.

Please note car parking charges will apply

Taking Moviprep oral bowel cleansing agents safely and effectively for colonoscopy/flexible sigmoidoscopy

What is a colonoscopy/flexible sigmoidoscopy?

This is where a soft, flexible tube with a camera at the end is passed through your back passage (anus) and up inside your bowel by a specially trained doctor or nurse.

You should have received the procedure leaflet with your appointment letter which explains the procedure in more detail. If you have not received a copy of this, please ask us for one.

Why do I need to prepare for this procedure?

Your bowel needs to be empty for the procedure so that the doctor or specialist nurse can see the lining of your bowel.

To achieve this you will need to alter your diet and take specific preparations for a few days before the procedure.

The changes are explained in this leaflet.

What is bowel prep?

You have been supplied with an oral preparation which is a bowel cleansing agent (sometimes called “bowel prep”).

The purpose of this is to clear out your bowels and ensure safety and effectiveness of the planned endoscopic procedure.

There is a risk of developing dehydration, low blood pressure or kidney problems with this medication.

Frequently Asked Questions (FAQs)

Q: How long does the procedure take?

A: A colonoscopy usually takes between 10 and 45 minutes. A flexible-sigmoidoscopy takes between

10 and 20 minutes. You may be in the department for approximately 3 hours.

Q: Does it hurt?

A: Sometimes patients find the test painful, gas and air (Entonox) or sedation is available to use for pain relief if needed.

Q: Can I take my tablets as normal?

A: Yes unless you have been instructed otherwise see page 4, 5, 8 & 12. If your tablets need to be taken at the same time you are drinking the Moviprep please

take them at least one hour before or at least one hour after drinking Moviprep. Please see separate patient procedure information that will be sent with your appointment letter for more advice e.g. Diabetics,

those on antiplatelets and anticoagulants.

Q: Will I be asleep for this procedure?

A:  No. Gas and air (Entonox) or sedation is available (if your circumstances permit).

You will be awake throughout the procedure.

Points to Remember

You will experience watery bowel movements so stay close to a toilet.

If you have not had your bowels open after taking the solution please seek medical advice.

If your health has deteriorated since seeing the doctor or specialist nurse in clinic, please call the

consultants who referred you for this test or your GP.

On the day of your test

IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS BEFORE THE TEST.

After your test, you will be advised when to return to your usual diet and medication.

The person prescribing the oral bowel cleansing agent will have assessed your risk and identified the most appropriate medication for you.

You may also require a recent blood test to check your kidney function.

The following conditions apply in all cases:

• The bowel prep will cause diarrhoea and urgency so you will need to stay close to toilet facilities.
• If after taking your bowel preparation you have not had your bowels open within 7-8 hours after taking the last sachet of Moviprep, please seek medical advice as soon as possible.
• Make sure that you drink plenty of water up

to 2 hours before your test as the bowel prep can cause dehydration.

• Do not drink dark coloured juices or milk.
• If you experience symptoms of dizziness or light headedness (particularly on standing up), thirst or reduction in passing urine, then you may be dehydrated and should seek medical attention.

All bowel cleansing agents cause diarrhoea so if regular medication is required, it should be taken either one hour or more before taking the cleansing agent. Or, it should be taken 1 hour or more after taking the cleansing agent.

Please tell the nursing staff as soon as possible on the number at the end of the leaflet if you:

• Take any medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as warfarin, rivaroxaban, dalteparin or clopidogrel).

• Have diabetes (contact your nurse specialist).
• Have an allergy to Moviprep or its ingredients.

If you only take low dose 75mg aspirin, you do not need to call.

Do not take any other medication at the same time as you are taking the bowel prep.

Please let us know if you are taking any regular medicines at your pre-assessment appointment (including anything you buy yourself over the counter or any herbal or homeopathic medicines).

Female Patients diarrhoea can make oral contraceptive pill less effective. Continue with the pill and use extra precautions for the next 7 days.

Refer to the manufacturer’s instructions when taking your preparation for a list of ingredients and allergies.

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Moviprep

1. About 6.00pm mix your first litre of MOVIPREP.
2. Empty the contents of ONE sachet A and ONE sachet B in to a jug and add 1 litre (1¾ pints) of cold water and stir until dissolved. (if desired, cordial can be added to taste).
3. Drink 250ml (½ pint) of Moviprep mixture every 15-30 minutes until you have drunk it all (usually over about 1-2 hours - no need to rush).
4. It is important to drink an additional 500ml (1 pint) of water or fluid of your choice (No Milk).
5. At 8.00am on the morning of the appointment, please mix

the remaining sachets of Moviprep following the instructions above.

6. Drink 250ml (½ pint) of Moviprep mixture every 15-30 minutes until you have drunk it all (usually over about 1-2 hours) – no need to rush.
7. It is important to drink an additional 500ml (1 pint) of water/ clear fluids in the morning (No Milk).

You will experience watery bowel movements so stay close to a toilet. If you have not had your bowels open after taking the solution please seek medical advice.

Adult Moviprep instructions for an afternoon appointment

There may be medicines which you are asked to stop taking and these may include:

• Heart/Blood pressure tablets e.g. Lisinopril, Ramipril, Perindopril, Captopril, Losartan, Candesartan, Irbesartan, Valsartan;
• Diuretics (Water tablets) e.g. Furosemide,

Bendroflumethiazide , Spironolactone, Amiloride, Co-Amilofruse, Bumetanide, Metolazone,

Indapamide, Eplerenone;

• Anti-inflammatory drugs e.g. Ibuprofen, Naproxen
• Tolvaptan: Used for progressive Autosomal Dominant Polycystic Kidney disease or conditions causing low sodium.

Your medication will have been discussed and advice given during your clinic or pre-assessment appointment.

Dietary Management – Low Residue Diet

Three days before your procedure you should start to eat a low residue (fibre) diet. This reduces the stool residue in the bowel. The main sources of fibre in the diet are cereal products, vegetables, seeds and fruits, so these foods need to be reduced.

It is important to have regular meals and a varied diet which includes foods such as meat, poultry, fish, eggs and dairy products (milk, cheese, yoghurt).

It is important to drink plenty of fluid and at least 8-10 cups of water, or squash per day. This helps to flush the bowel contents out and will  improve the effect of the bowel preparation. It will also prevent you from becoming dehydrated.

Suggested meals you can eat that are low residue:

BREAKFAST    

Cornflakes / Rice cereals
White bread toasted / egg - (little butter)
(DO NOT EAT WHOLEGRAIN CEREALS e.g. Weetabix, porridge,        bran flakes).

LUNCH    

Chicken soup with white bread/ Chicken or Ham, lettuce sandwich/ Egg on white toast.

EVENING MEAL    

White bread with ham /cheese (little butter) or boiled potatoes (without skins) well cooked vegetable (turnip, carrots.
Small amount of chicken / white fish. White rice/pasta

Vegan option available on request from Endoscopy

While you are following the low residue/low fibre diet you are allowed to drink milk.

After breakfast on the day you start drinking the Bowel preparation you MUST stop drinking milk.

You can eat any combination of the following food choices:

Food Choices you can eat    

White bread or toast,  pastry, plain naan bread and chapatti,     crumpets. (made with white flour).

Cornflakes and rice breakfast cereals, but no bran, Marmite.

Soya or tofu, white rice, white pasta, and noodles, plain couscous

Do not eat lentils or pulses.

Cheese, cottage cheese

Biscuits made with white flour e.g. rich tea, shortbreads, plain cream crackers, arrowroot, plain scones.

Well cooked, lean (low fat) beef, lamb, ham, veal or pork, textured vegetable protein, Quorn®

Poultry, White Fish, Shellfish.

Eggs boiled or poached.

Dessert Choices you can eat

Sponge pudding and custard.
Mousses, plain or set yoghurts, cream.
Lemon Curd, Honey.
Bananas, canned pears, melon, stewed apple (Maximum of 2 portions per day)

Do not eat any seeds, pips, skins or piths

Orange, lime, lemon Jelly. DO NOT EAT RED/PURPLE JELLIES

ONLY the below fluids are allowed the day before your test.

Flavoured water/ Lemonade/ light coloured Squash, black tea/ black coffee, Oxo/ Bovril or other meat/veg extract cubes/clear strained soup e.g. consommé.

Boiled sweets and Jellies are allowed.

Flavoured water/ Lemonade/ light coloured Squash, black tea/ black coffee, Oxo/ Bovril or other meat/veg extract cubes/clear strained soup e.g. consommé.

Boiled sweets and Jellies are allowed.

Potatoes boiled or mashed without skins, sweet potatoes without skins boiled or mashed. Well cooked vegetables, turnip, squashes, carrots.

MOVIPREP INSTRUCTIONS

Five Days before the Test    

Stop taking Iron tablets.

Three Days before the Test    

Stop taking medications such ascodeine and loperamide and stool bulking agents such as fybogel, as these can reduce the effectiveness of the preparation.

If you suffer from constipation speak to your pharmacist or take your usual  laxatives before you need to start drinking the  Moviprep (do not exceed your maximum dose).

Three Days before the test    

You should eat a low residue (low   fibre) diet. This reduces the stool    residue in the bowel. 

The day before your test  

NO more solid food after breakfast

You can continue to have clear fluid, clear soup, soft drinks or black tea or coffee (NO MILK)

At 6.00pm the evening before your test 

Take both litres of Moviprep following the instructions below

The Morning of your test (up to 2 hours before your test).    

You can take essential medicines (as agreed during your clinic/pre-assessment appointment) with a sip of water.

STEP 1

Empty the contents of 1 sachet A and 1 sachet B in to a 1 litre Jug of water.

STEP 2

Stir until the solution is clear

STEP 3

Drink 1 glassful 250ml (¼ litre or

½ pint) of Moviprep every 15 minutes until you have drunk it all.

You can eat any combination of the following:

Adult Moviprep instructions for a morning appointment

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Moviprep

1. At 6pm empty the contents of ONE sachet A and ONE sachet B in to a jug and add 1 litre (1¾ pints) of cold water and stir until dissolved. (if desired, cordial can be added to taste).
2. Drink 250ml (½ pint) of Moviprep mixture every 15-30 minutes until you have drunk it all (usually over about 1-2 hours - no need to rush).
3. It is important to drink an additional 500ml (1 pint) of water or fluid of your choice (No Milk).
4. Make up your second litre of Moviprep as above and continue to drink, followed by 500ml water or fluid of your choice (No Milk).
5. Allow 2 hours after taking the second litre for the Moviprep to work.
6. Go to bed when you stop going to the toilet (e.g. 11.00pm or 12.00 Midnight).

Points to Remember

You will experience watery bowel movements so stay close to a toilet.

If you have not had your bowels open after taking the solution please seek medical advice.

If your health has deteriorated since seeing the

doctor or specialist nurse in clinic, please call the consultants who referred you for this test or your GP.

On the day of your test

IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST.

After your test, you will be advised when to return to your usual diet and medication.

Frequently Asked Questions (FAQ’s)

Q:     How long does the procedure take?

A:     A colonoscopy usually takes between 10 and 45 minutes. A flexible-sigmoidoscopy takes between      10 and 20 minutes. You may be in the department for approximately 3 hours.

Q: Does it hurt?

A: Sometimes patients find the test painful, gas and air (Entonox) or sedation is available to use for pain  relief if needed.

Q: Can I take my tablets as normal?

A: Yes unless you have been instructed otherwise see page 4, 5, 8 & 12. If your tablets need to be taken at the same time you are drinking the Moviprep please take them at least one hour before or at least one hour after drinking Moviprep. Please see separate patient       procedure information that will be sent with your      appointment letter for more advice e.g. Diabetics,      those on antiplatelets and anticoagulants.

Q: Will I be asleep for this procedure?

A: No. Gas and air (Entonox) or sedation is available (if your circumstances permit).

 You will be awake throughout the procedure.

Q:     How can I make the Moviprep more palatable?

A:     It is important to sip the Moviprep and not gulp it down to reduce  nausea. A straw is sometimes helpful to drink the Moviprep with and you can add cordial (not blackcurrant) to taste if you      prefer. Chilling your Moviprep solution can also sometimes help.

Q: What shall I wear to attend the procedure?

A: You will be asked to wear a hospital gown and dignity shorts. You can bring your own dressing gown and slippers.

Q: Can I have milky drinks?

A: It is important that you stop drinking milk on the day that you are asked to take the Moviprep bowel preparation.

If you have any further questions

Please telephone the Endoscopy Booking Office on 01782 676010, this is a voice message facility so please leave your name,    hospital number and contact number.

What is a colonoscopy/flexible sigmoidoscopy?

This is where a soft, flexible tube with a camera at the end is passed through your back passage (anus) and up inside your bowel by a specially trained doctor or nurse. 

You should have received the procedure leaflet with your appointment letter which explains the procedure in more detail. If you have not received a copy of this, please ask us for one.

Why do I need to prepare for this procedure?

Your bowel needs to be empty for the procedure so that the doctor or specialist nurse can see the lining of your bowel.

To achieve this you will need to alter your diet and take specific preparations for a few days before the procedure.

The changes are explained in this leaflet.

What is bowel prep?

You have been supplied with an oral preparation which is a bowel cleansing agent (sometimes called “bowel prep”).

The purpose of this is to clear out your bowels and ensure safety and effectiveness of the planned endoscopic procedure. 

There is a risk of developing dehydration, low blood pressure or kidney problems with this medication. 

The person prescribing the oral bowel cleansing agent will have assessed your risk and identified the most appropriate medication for you. 

You may also require a recent blood test to check your kidney function.

The following conditions apply in all cases:

The bowel prep will cause diarrhoea andurgency so you will need to stay close to toilet facilities. 

If after taking your bowel preparation you have not had your bowels open within 7-8 hours after taking the last sachet of Plenvu, please seek medical advice as soon as possible.

Make sure that you drink plenty of water up to 2 hours before your test as the bowel prep can cause dehydration.

Do not drink dark coloured juices or milk.

If you experience symptoms of dizziness or light headedness (particularly on standing up), thirst or reduction in passing urine, then you may be dehydrated and should seek medical attention. 

All bowel cleansing agents cause diarrhoea so if regular medication is required, it should be taken either one hour or more before taking the cleansing agent.  Or, it should be taken 1 hour or more after taking the cleansing agent. 

Please tell the nursing staff as soon as possible on the number at the end of the leaflet if you:

Take any medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as warfarin, rivaroxaban, dalteparin or clopidogrel).

Have diabetes (contact your nurse specialist).

Have an allergy to Plenvu or its ingredients.

If you only take low dose 75mg aspirin, you do not need to call.

Do not take any other medication at the same time as you are taking the bowel prep.

Please let us know if you are taking any regular medicines at your pre-assessment appointment (including anything you buy yourself over the counter or any herbal or homeopathic medicines).

Female Patients diarrhoea can make oral contraceptive pill less effective.  Continue with the pill and use extra precautions for the next 7 days.

Refer to the manufacturer’s instructions when taking your preparation for a list of ingredients and allergies.

There may be medicines which you are asked to stop taking and these may include:

Heart/Blood pressure tablets e.g. Lisinopril, Ramipril, Perindopril, Captopril, Losartan,  Candesartan,  Irbesartan, Valsartan

Diuretics (Water tablets) e.g. Furosemide, Bendroflumethiazide , Spironolactone, Amiloride, Co-Amilofruse, Bumetanide, Metolazone, Indapamide,  Eplerenone;

Anti-inflammatory drugs e.g. Ibuprofen, Naproxen

Tolvaptan: Used for progressive Autosomal Dominant Polycystic Kidney disease or  conditions causing low sodium.

Your medication will have been discussed and advice  given during your clinic or pre-assessment appointment.

Dietary Management – Low Residue Diet

Three days before your procedure you should start to eat a low  residue (fibre) diet. This reduces the stool  residue in the bowel. The main sources of fibre in the diet are  cereal  products, vegetables, seeds and fruits, so these foods need to be reduced. 

It is important to have regular meals and a varied diet which includes foods such as meat, poultry, fish, eggs and dairy products (milk, cheese, yoghurt).

It is important to drink plenty of fluid and at least 8-10 cups of water, black tea/coffee, or squash per day. This helps to flush the bowel contents out and will  improve the effect of the bowel preparation. It will also prevent you from becoming dehydrated.

Suggested meals you can eat that are low residue.

Vegan option available on request from Endoscopy

BREAKFAST    

Cornflakes / Rice cereals
White bread toasted / egg - (little butter)

(DO NOT EAT WHOLEGRAIN CEREALS e.g. Weetabix, porridge,        bran flakes)

LUNCH    

Chicken soup with white bread/ Chicken or Ham sandwich/ Egg on white toast.

EVENING MEAL    

White bread with ham /cheese (little butter) or boiled potatoes(without skins) cauliflower, turnip
Small amount of chicken / white fish.

White rice/pasta

You can eat any combination of the following:

Food Choices you can eat:

White bread
Pastry (white flour)
Corn and rice breakfast cereals e.g. Corn Flakes, Rice Krispies
White rice
White and tricolour pasta
Biscuits made with white flour e.g. rich tea, custard creams, shortbreads, cream crackers
Cake made with white flour e.g. sponge,
Chicken/White Fish
Potatoes without skins, sweet potatoes without skins, green beans, swede, cauliflower, pumpkin, parsnip, turnip.

Dessert Choices you can eat:

Milk puddings, stewed apple and custard, apple pie, sponge pudding and custard.
Mousses, plain or set yoghurts
Jelly
Lemon Curd
Honey
Marmite
Fresh, peeled fruit
(NO PIPS OR SEEDS)
Tinned fruit (Maximum of 2  portions per day)
PLEASE DO NOT EAT RED/PURPLE JELLIES
Drinks which are allowed during fasting
Flavoured water/ Lemonade/ light coloured Squashes/ black tea/ black coffee/Oxo/ Bovril or other meat/veg extract cubes/clear soup.
Boiled sweets are allowed.
Flavoured water/ Lemonade/ light coloured Squashes/ black tea/ black coffee/Oxo/ Bovril or other meat/veg extract cubes/clear soup.
Boiled sweets are allowed.

ADULT PLENVU INSTRUCTIONS FOR A MORNING APPOINTMENT 

Five Days before the Test    

Stop taking Iron tablets.

Three Days before the Test    

Stop taking medications such as codeine and loperamide and stool bulking agents such as fybogel, as these can reduce the effectiveness of the preparation. 

If you suffer from constipation speak to your pharmacist or take your usual  laxatives before you need to start drinking the  Plenvu (do not exceed your maximum dose).

Three Days before the test    

You should eat a low residue (low   fibre) diet. This reduces the stool    residue in the bowel. 

The day before your test

NO solid food after breakfast

(You can continue to have fluid, clear soup, soft drinks or black tea or coffee (NO MILK)

At 4pm the evening before your test    

Take both 500ml of Plenvu following the instructions below

The Morning of your test (up to 2 hours before your test).    

You can take essential medicines (as agreed during your clinic/pre-assessment appointment) with a sip of water.

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Plenvu

1. About 4.00 pm mix your first 500ml of PLENVU.

2. Empty the contents of sachet DOSE 1 in to a jug and add 500ml of water and stir until dissolved. (First dose – mango flavoured).

3. Drink Plenvu mixture slowly over 60 minutes until you have drunk it all (no need to rush).

4. It is important to drink an additional 500ml (1  pint) of  water or fluid of your choice (No Milk).

5. At 7.00pm please mix the remaining sachets 2, DOSE A & B of Plenvu following the instructions above. (second dose—Fruit punch flavour )

6. Drink Plenvu mixture slowly over 60 minutes until you have drunk it all (no need to rush).

7. It is important to drink an additional 500ml  (1 pint) of water/clear fluids in the morning (No Milk).

You will experience watery bowel movements so stay close to a toilet.  If you have not had your bowels open after taking the solution please seek medical advice.

ON the day of your test IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST.

PLENVU INSTRUCTIONS

Each box contains 3 sachets, making up dose 1 (1 sachet), and dose 2 (sachet A & B)

STEP 1

Empty the contents of  sachet Dose1 in to a Jug add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes

STEP 2

Drink the Plenvu very slowly over 60 minutes, until you have drunk it all. You must also drink an additional 500ml of clear fluids. 

STEP 3

Empty the contents of  sachet 2  Dose A & B in to a Jug add water to make up to 500 ml and stir until all the powder has dissolved. This may take up to approximately 8 minutes 

STEP 4

Drink the Plenvu very slowly over 60 minutes, until you have drunk it all. You must also drink an additional 500ml of clear fluids. 

ADULT PLENVU INSTRUCTIONS FOR AN AFTERNOON APPOINTMENT

Five Days before the Test  

Stop taking Iron tablets.

Three Days before the Test    

Stop taking medications such as codeine and loperamide and stool bulking agents such as fybogel, as these can reduce the effectiveness of the preparation. 

If you suffer from constipation speak to your pharmacist or take your usual  laxatives before you need to start  drinking the Plenvu (do not exceed your maximum dose).

Three Days before the test    

You should eat a low residue (low fibre) diet. This reduces the stool  residue in the bowel. 

The day before your test    

NO solid food after breakfast
You can continue to have fluid, clear soup, soft drinks or black tea or  coffee (NO MILK).

At 6.00pm the evening before your test   

Take Dose 1 500ml of Plenvu following the instructions.  

At 8.00am the morning of your test    

Take sachets 2, Dose  (A & B) of 500ml  Plenvu following the instructions.   

The Morning of your test (up to 2hours before your test)    

Essential medicines (as agreed during your clinic/pre-assessment appointment) can be taken with a sip of water

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Plenvu PLENVU® consists of 2 doses; the first is contained in 1 sachet and the second in 2 sachets 

• About 6.00pm mix your first 500ml of PLENVU.
• Empty the contents of sachet DOSE 1 in to a jug and add 500ml of water and stir until dissolved. (First dose – mango flavoured).
• Drink Plenvu mixture slowly over 60 minutes until you have drunk it all (no need to rush).
• It is important to drink an additional 500ml (1  pint) of  water or fluid of your choice (No Milk).
• At 8.00am on the morning of the appointment, please mix the remaining sachets 2 DOSE A & B of Plenvu following the instructions above.
• Drink Plenvu mixture slowly over 60 minutes until you have drunk it all (no need to rush).
• It is important to drink an additional 500ml  (1 pint) of water/clear fluids in the morning (No Milk).
• You will experience watery bowel movements so stay close to a toilet.  If you have not had your bowels open after taking the     solution please seek medical advice.

ON THE DAY OF YOUR TEST IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  

Points to Remember
You will experience watery bowel movements so stay close to a toilet. 
If you have not had your bowels open after taking the solution please seek medical advice.

If your health has deteriorated since seeing the doctor or specialist nurse in clinic, please call the consultants who referred you for this test or your GP.

On the day of your test 
IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST. 

After your test, you will be advised when to return to your usual diet and medication.

Frequently Asked Questions (FAQ’s)

What is a colonoscopy/flexible sigmoidoscopy?

This is where a soft, flexible tube with a camera at the end is passed through your back passage (anus) and up inside your bowel by a specially trained doctor or nurse. 

You should have received the procedure leaflet with your appointment letter which explains the procedure in more detail. If you have not received a copy of this, please ask us for one.

Why do I need to prepare for this procedure?

Your bowel needs to be empty for the procedure so that the doctor or specialist nurse can see the lining of your bowel.

To achieve this you will need to alter your diet and take specific preparations for a few days before the procedure.

The changes are explained in this leaflet.

What is bowel prep?

You have been supplied with an oral preparation which is a bowel cleansing agent (sometimes called “bowel prep”).

The purpose of this is to clear out your bowels and ensure safety and effectiveness of the planned endoscopic procedure. 

There is a risk of developing dehydration, low blood pressure or kidney problems with this medication. 

The person prescribing the oral bowel cleansing agent will have assessed your risk and identified the most appropriate medication for you. 

You may also require a recent blood test to check your kidney function.

The following conditions apply in all cases:

The bowel prep will cause diarrhoea andurgency so you will need to stay close to toilet facilities. 

If after taking your bowel preparation you have not had your bowels open within 7-8 hours after taking the last sachet of Plenvu, please seek medical advice as soon as possible.

Make sure that you drink plenty of water up to 2 hours before your test as the bowel prep can cause dehydration.

Do not drink dark coloured juices or milk.

If you experience symptoms of dizziness or light headedness (particularly on standing up), thirst or reduction in passing urine, then you may be dehydrated and should seek medical attention. 

All bowel cleansing agents cause diarrhoea so if regular medication is required, it should be taken either one hour or more before taking the cleansing agent.  Or, it should be taken 1 hour or more after taking the cleansing agent. 

Please tell the nursing staff as soon as possible on the number at the end of the leaflet if you:

Take any medicines to thin the blood or to prevent blood from clotting (anticoagulants or antiplatelets, such as warfarin, rivaroxaban, dalteparin or clopidogrel).

Have diabetes (contact your nurse specialist).

Have an allergy to Plenvu or its ingredients.

If you only take low dose 75mg aspirin, you do not need to call.

Do not take any other medication at the same time as you are taking the bowel prep.

Please let us know if you are taking any regular medicines at your pre-assessment appointment (including anything you buy yourself over the counter or any herbal or homeopathic medicines).

Female Patients diarrhoea can make oral contraceptive pill less effective.  Continue with the pill and use extra precautions for the next 7 days.

Refer to the manufacturer’s instructions when taking your preparation for a list of ingredients and allergies.

There may be medicines which you are asked to stop taking and these may include:

Heart/Blood pressure tablets e.g. Lisinopril, Ramipril, Perindopril, Captopril, Losartan,  Candesartan,  Irbesartan, Valsartan

Diuretics (Water tablets) e.g. Furosemide, Bendroflumethiazide , Spironolactone, Amiloride, Co-Amilofruse, Bumetanide, Metolazone, Indapamide,  Eplerenone;

Anti-inflammatory drugs e.g. Ibuprofen, Naproxen

Tolvaptan: Used for progressive Autosomal Dominant Polycystic Kidney disease or  conditions causing low sodium.

Your medication will have been discussed and advice  given during your clinic or pre-assessment appointment.

Dietary Management – Low Residue Diet

Three days before your procedure you should start to eat a low  residue (fibre) diet. This reduces the stool  residue in the bowel. The main sources of fibre in the diet are  cereal  products, vegetables, seeds and fruits, so these foods need to be reduced. 

It is important to have regular meals and a varied diet which includes foods such as meat, poultry, fish, eggs and dairy products (milk, cheese, yoghurt).

It is important to drink plenty of fluid and at least 8-10 cups of water, black tea/coffee, or squash per day. This helps to flush the bowel contents out and will  improve the effect of the bowel preparation. It will also prevent you from becoming dehydrated.

Suggested meals you can eat that are low residue.

Vegan option available on request from Endoscopy

BREAKFAST    

Cornflakes / Rice cereals
White bread toasted / egg - (little butter)

(DO NOT EAT WHOLEGRAIN CEREALS e.g. Weetabix, porridge,        bran flakes)

LUNCH    

Chicken soup with white bread/ Chicken or Ham sandwich/ Egg on white toast.

EVENING MEAL    

White bread with ham /cheese (little butter) or boiled potatoes(without skins) cauliflower, turnip
Small amount of chicken / white fish.

White rice/pasta

You can eat any combination of the following:

Food Choices you can eat:

White bread
Pastry (white flour)
Corn and rice breakfast cereals e.g. Corn Flakes, Rice Krispies
White rice
White and tricolour pasta
Biscuits made with white flour e.g. rich tea, custard creams, shortbreads, cream crackers
Cake made with white flour e.g. sponge,
Chicken/White Fish
Potatoes without skins, sweet potatoes without skins, green beans, swede, cauliflower, pumpkin, parsnip, turnip.

Dessert Choices you can eat:

Milk puddings, stewed apple and custard, apple pie, sponge pudding and custard.
Mousses, plain or set yoghurts
Jelly
Lemon Curd
Honey
Marmite
Fresh, peeled fruit
(NO PIPS OR SEEDS)
Tinned fruit (Maximum of 2  portions per day)
PLEASE DO NOT EAT RED/PURPLE JELLIES
Drinks which are allowed during fasting
Flavoured water/ Lemonade/ light coloured Squashes/ black tea/ black coffee/Oxo/ Bovril or other meat/veg extract cubes/clear soup.
Boiled sweets are allowed.
Flavoured water/ Lemonade/ light coloured Squashes/ black tea/ black coffee/Oxo/ Bovril or other meat/veg extract cubes/clear soup.
Boiled sweets are allowed.

ADULT PICOLAX INSTRUCTIONS FOR A MORNING APPOINTMENT 

Five Days before the Test    

Stop taking Iron tablets.

Three Days before the Test    

Stop taking medications such as codeine and loperamide and stool bulking agents such as fybogel, as these can reduce the effectiveness of the preparation. 

If you suffer from constipation speak to your pharmacist or take your usual  laxatives before you need to start drinking the  Picolax (do not exceed your maximum dose).

Three Days before the test    

You should eat a low residue (low fibre) diet. This reduces the stool    residue in the bowel. 

The day before your test

NO solid food after breakfast

(You can continue to have fluid, clear soup, soft drinks or black tea or coffee (NO MILK)

At 6pm the evening before your test    

Take your first sachet of Picolax.

At 5am the Morning of your test   

Take your second sachet of Picolax

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Picolax

1.Empty the contents of ONE sachet in to a tall glass/beaker.

2.Add approx. 150ml ( ¼ pint) cold water to half fill the glass/beaker, stir the mixture with a spoon for 2 or 3 minutes, the liquid will fizz and become warm.

3. Allow the liquid to cool and drink all of the liquid (no need to rush).

You will experience watery bowel movements so stay close to a toilet.  If you have not had your bowels open after taking the solution please seek medical advice.

It is important to continue with a good fluid intake while taking the Picolax. You should continue to drink 1.25 litres (2 pints) of clear fluid over the next couple of hours, e.g. at least 1 glass (300ml or ½ pint) of water or clear fluid every hour.

ON the day of your test IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST.

PICOLAX INSTRUCTIONS

Empty the contents of ONE sachet in to a tall glass/beaker.

Add approx. 150ml ( ¼ pint) cold water to half fill the glass/beaker, stir the mixture with a spoon for 2 or 3 minutes, the liquid will fizz and become warm.

Allow the liquid to cool and drink all of the liquid (no need to rush).

REPEAT WITH THE 2ND SACHET

REMEMBER TO DRINK 300ml OF CLEAR FLUID EVERY HOUR AND STOP 2 HOURS BEFORE THE PROCEDURE

ADULT PICOLAX INSTRUCTIONS FOR AN AFTERNOON APPOINTMENT

Five Days before the Test  

Stop taking Iron tablets.

Three Days before the Test    

Stop taking medications such as codeine and loperamide and stool bulking agents such as fybogel, as these can reduce the effectiveness of the preparation. 

If you suffer from constipation speak to your pharmacist or take your usual   laxatives before you need to start  drinking the Picolax (do not exceed your maximum dose).

Three Days before the test    

You should eat a low residue (low fibre) diet. This reduces the stool  residue in the bowel. 

The day before your test    

NO solid food after breakfast
You can continue to have fluid, clear soup, soft drinks or black tea or  coffee (NO MILK).

At 6.00pm the evening before your test   

Take your first sachet of Picolax.

At 8.00am the morning of your test    

Take your second sachet of Picolax.

Please adhere to the low residue diet advice sheet as certain foods can affect the outcome of your test and may result in a failed test.

How to take Picolax

1.Empty the contents of ONE sachet in to a tall glass/beaker.

2.Add approx. 150ml ( ¼ pint) cold water to half fill the glass/beaker, stir the mixture with a spoon for 2 or 3 minutes,  the liquid will fizz and become warm.

3. Allow the liquid to cool and drink all of the liquid (no need to rush).

You will experience watery bowel movements so stay close to a toilet.  If you have not had your bowels open after taking the solution please seek medical advice.
It is important to continue with a good fluid intake while taking the Picolax. You should continue to drink 1.25 litres (2 pints) of clear fluid over the next couple of hours, e.g. at least 1 glass (300ml or ½ pint) of water or clear fluid every hour.

ON THE DAY OF YOUR TEST IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST. 

Points to Remember
You will experience watery bowel movements so stay close to a toilet. 

If you have not had your bowels open after taking the solution please seek medical advice.

If your health has deteriorated since seeing the doctor or specialist nurse in clinic, please call the consultants who referred you for this test or your GP.

On the day of your test 
IT IS IMPORTANT THAT YOU ONLY DRINK CLEAR (NO MILK) FLUIDS UP TO 2 HOURS  BEFORE THE TEST. 

After your test, you will be advised when to return to your usual diet and medication.

Frequently Asked Questions (FAQ’s)

Diverticular Disease;

https://patient.info/digestive-health/diverticula-diverticulosis-diverticular-disease-diverticulitis

Barretts Oesophagus:

https://patient.info/digestive-health/acid-reflux-and-oesophagitis/barretts-oesophagus

Colonic Polyps:

https://patient.info/cancer/colon-rectal-bowel-cancer-colorectal/bowel-polyps-colonic-polyps

Coeliac Disease:

https://patient.info/digestive-health/coeliac-disease-leaflet

Duodenal Ulcer:

https://patient.info/digestive-health/dyspepsia-indigestion/duodenal-ulcer

Gastristis:

https://patient.info/digestive-health/dyspepsia-indigestion/gastritis

Hiatius Hernia:

https://patient.info/digestive-health/acid-reflux-and-oesophagitis/hiatus-hernia

Helicobacter pylori:

https://patient.info/digestive-health/dyspepsia-indigestion/helicobacter-pylori

Piles/Haemorrhoids:

https://patient.info/digestive-health/rectal-bleeding-blood-in-faeces/piles-haemorrhoids

Stomach ulcer:

https://patient.info/digestive-health/dyspepsia-indigestion/stomach-ulcer-gastric-ulcer

Ulcerative Colitis:

https://patient.info/digestive-health/inflammatory-bowel-disease/ulcerative-colitis

Bronchoscopy 

Colonoscopy

ERCP

Flexible sigmoidoscopy

Gastroscopy