Patient Info

Colonoscopy

What is a Colonoscopy?

The procedure involves passing a long, thin and flexible tube with a video camera at the tip all the way from your rectum to caecum / terminal ileum. It is both a diagnostic (inspection) as well as therapeutic (removal of polyps) procedure.

Why have a colonoscopy?

There are many indications or reasons for performing a colonoscopy. The most common would be to detect for polyps, investigate after a positive faecal occult blood test (FOBT), because of family history of colonic disease, because of a personal history of cancer or polyps or simply to further investigate specific symptoms or signs such as bleeding, a change in bowel habit, abdominal pains, anaemia or weight loss.

Colonoscopies provide the most accurate assessment of the colon however it is not perfect. A colonoscopy can miss 2-8% of lesions. Serious lesions such as cancers is much less than this but can still occur.

How do I prepare for my colonoscopy?

It is essential to empty the bowel completely prior to the procedure. This is assisted by,

1. Taking the bowel prep

2. Modifying your diet

3. Increasing your fluid intake

How is a colonoscopy performed?

A Colonoscopy usually take around 20-30mins. An anaethetist will give you a sedation/twilight anaesthetic - meaning you are not under a general anaesthetic however it is unlikely you will feel or remember anything. Medical staff monitor your vital signs and ensure you are well looked after.

While lying on your left side, your surgeon inserts the scope through the anus and navigates it through the colon in order to inspect the entire gut lining. Any polyps (small abnormal growths) are removed. Larger ones may require subsequent procedures. Polyps are very common and are usually benign however if left may turn into a colorectal cancer. Therefore removing the polyp prevents bowel cancer.

Following the colonoscopy

After the procedure you will be moved to the recovery bay and once awake will be able to have something to eat and drink. This is usually a couple of hours. Your surgeon will then see you to discuss the findings of the procedure. Results from biopsies or polyps usually take 1-2 weeks to be finalised and you will then be informed of these results.

What are the risks?

As with any procedure, complications may occur. However, they are uncommon. There is a 1:1000 chance of the scope or gas causing a hole or perforation in your bowel. This usually requires an operation to fix it. Severe bleeding is also rare again occuring in 1:1000 cases. Your may experience minor bleeding and discomfort which is common particularly after minor procedures.

If you experience any of the following we recommend you contact the hospital or our rooms.

1. Severe abdominal pains

2. Black tarry motions

3. Persistent heavy bleeding from the anus

4. Fevers

5. Any other symptoms that concerns you.

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Bowel Prep - Pico Prep-3

Your surgeon has likely prescribed a bowel preparation for you to take prior to your colonoscopy. It is extremely important you,

1. Follow the instructions given to you (PDF link below) - There is important information regarding the timing of your prep and special instructions regarding your medications (if any)

2. Drink all of your prep and fluids.

3. Inform the staff at the hospital if you haven't taken all of the prep or if your motion isn't clear.

4. Stop any medications that has been asked of you.

If your bowel isn't appropriately clean it can make the procedure more difficult, longer and may require it to be repeated. Small lesions such as polyps could also be missed.

Bowel Prep - Moviprep

Your surgeon has likely prescribed a bowel preparation for you to take prior to your colonoscopy. It is extremely important you,

1. Follow the instructions given to you (PDF link below) - There is important information regarding the timing of your prep and special instructions regarding your medications (if any)

2. Drink all of your prep and fluids.

3. Inform the staff at the hospital if you haven't taken all of the prep or if your motion isn't clear.

4. Stop any medications that has been asked of you.

If your bowel isn't appropriately clean it can make the procedure more difficult, longer and may require it to be repeated. Small lesions such as polyps could also be missed.

Preparing for your Bowel Resection

Preparing for surgery

Any surgery, but especially a bowel resection can have a significant impact on your body. Many aspects around preparing and recoverying from such an operation have been studied. It is important that your health and medical conditions are optimised. Mantaining a healthy diet is vital and undergoing some exercise every day leading up to the operation can aid in your recovery. It is also important to avoid smoking and other tobacco products and to minimise alcohol.

Nutrition

Your surgeon may prescribe special drinks for you to take in the 5 days leading up to the operation. A final drink is usually given 2-3hrs prior to coming into the theatre. These can help reduce the risk of infections and help your body deal with the stress of an operation.

Enhanced Recovery After Surgery (ERAS)

Your surgeon will most likely use an enhanced recovery after surgery approach. This has been shown to improve both patient recovery while in hospital and returning to normal activities when at home. This approach may seem quite different from more traditional preparation and recovery methods so it is important that you are aware of what may be expected of you after your operation.

Bowel Preparation - It is unlikely that you will need to take a full bowel prep prior to your operation (except in special circumstances). You may need to be given an enema on the day of your operation to empty the rectum however your surgeon will inform you of this.

Diet - You will be encouraged to eat and drink what you wish immediately after your surgery (pending how you feel). You don't need to finish everything however as you recover so will your appetite.

Pain Control - Pain control is important to help with your recovery by allowing you to move around, deep breathe and cough. We use many different methods; tablets, catheters/tubes placed into wounds/abdomen, pumps controlled by yourself and occasionally spinals/epidurals (medication placed into your back). 

Exercise - If you are well enough after your surgery we expect you to be able to get up out of bed and freely walk around. The nurses and physiotherapists will help you with this. Moving around is extremely important for your recovery.

Finally

There is a lot to take in after meeting your surgeon for the first time. If you have any questions regarding your treatment plan / operation please contact your surgeon via our rooms.

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Useful Definitions and Descriptions

Colon

The term given to describe the large bowel. It starts at the caecum on the right side of your abdomen and extends around to the left finishing at the sigmoid where it then continues on as the rectum.

Rectum

This is the last ~15cm of the large bowel. It is the direct continuation of the colon and ends as the anus. It is located in the pelvis and can be the most difficult section of the bowel to remove.

Staging

Staging is a process that doctors use to decide how to treat cancers. It describes how far the cancer has spread and is directly related to your prognosis.

  • Stage 1 - Cancer is limited to the inside surface of the bowel
  • Stage 2 - Cancer involves the outside layers of the bowel
  • Stage 3 - Cancer has spread to lymph nodes in the area surrounding the bowel
  • Stage 4 - Cancer has spread to other organs or sites in the body away from the original cancer

Surveillance

Surveillance is the act of close observation through regular follow up with your surgeon. This will usually continue while you remain fit enough to undergo any subsequent treatment if required. This involves clinical examination, blood tests, scans and colonoscopy.

Stoma

A stoma or bag is the general term given to an opening of the bowel onto the surface of the skin. Stomas can be made from small (ileostomy) or large (colostomy) bowel. They can be temporary or permanent.

CEA - Carcinoembryonic Antigen

This is a protein found in blood. Some, but not all, bowel cancers cause this protein to be elevated at higher concentrations than normal and can be detected in a specific blood test. We measure this before your operation and during your surveillance. 

CT Scan - Computed Tomography Scan

This is a detailed type of X-ray which can help us find potential spread of cancer in other areas of the body. It is routine to organise this in the workup of your cancer and will likely be repeated during your surveillance period. 

MRI Scan - Magnetic Resonance Imaging Scan

This is a detailed and standard scan used to investigate all rectal cancers. It can sometimes be used to look further at the liver if it is thought cancer has spread there. It is used to determine whether patients require specific treatment prior to their operation such as radiotherapy or chemotherapy. 

PET Scan - Positron Emission Tomography Scan

This scan is similar to a CT Scan however is not routinely used in the treatment of bowel cancer. It is used in instances where cancer spread is suspected to other areas of the body. A special tracer is injected into your blood stream to highlight these distant areas which are then picked up and displayed on the scan.

 

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Research

Your surgeon may ask you to be involved in current colorectal research projects being conducted at the John Hunter and Newcastle Private Hospitals. This is a great way for you to contribute personally to the continual development in colorectal management.

There are many benefits for you as a patient by getting involved, such as,

  1. A sense of autonomy in your own healthcare,
  2. Being empowered knowing you are helping others,
  3. Accessing advanced treatments by experts not yet widely available.

Researchers and ethics committees work closely together to ensure patients are treated safely and that their wellbeing and wishes are respected.

You shouldn’t feel pressured to commit your involvement so please, discuss this with your surgeon.

Current projects

  1. LAPLAP Study - A randomised clinical trial assessing postoperative recovery using intraperitoneal local anaesthetic.
  2. Skin Prep Study - A randomised clinical trial in participants undergoing incisional surgery, to assess the efficacy of surgical skin preparation: A three armed comparison of chlorheidine+alcohol verses povidine-iodine preparations.
  3. CRP - A prospective observational study to validate the utility of C-reactive protein trajectory as a predictor of anastomotic leak in patients with bowel anastomoses.
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Stomal Therapy

What is a stoma?

A stoma or bag is the general term given to an opening of the bowel onto the surface of the skin. Stomas can be made from small (ileostomy) or large (colostomy) bowel and they can be temporary or permanent. Patients may require one of these as part of their treatment depending on the section of bowel which needs to be removed, the immediate health of the patient or the physical inability to connect the two ends of bowel. They can act to help defunction an anastomosis (juoin in the bowel) which is downstream or be an end opening. Your surgeon will inform you of the likelihood or not of a stoma during your treatment and answer any other questions you have regarding them.

What is a stomal Therapist?

A stomal therapist is a specially trained and quialifed nurse who will help patients with stomas. For a planned operation you will generally meet the therapist prior to your operation for further education and marking of the 'best' stoma location on your abdomen. Stomal therapists will then see you again after the operation to help you with learning to manage the bag, deal with problems which arise and answer any questions you may have. They will also arrange all the supplies you require for going home.

Stomal Therapy Contacts

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Public Patients

All patients do require a referral from a general practitioner to see one of our Colorectal Surgeons for the first time. Our practice can make an appointment for you by following the details on the 'Get in Contact' page.

Public patients can be seen in the rooms or at the John Hunter Hospital Public Colorectal Clinic. If seen in the private rooms there may be a cost for the consultation. There is no cost to be seen in the public clinic however the waiting time is usually longer for less urgent conditions. 

Dr Brendan McManus also consults fortnightly from Nelson Bay offering this service to both public and private patients.

If you require an operation this will be booked to be done at one of the public hospitals. The three surgeons visit the John Hunter Hospital with minor cases and colonoscopies performed at Belmont and Cessnock Hospitals. Contact details for these hospitals can be found under 'Links'.

 

Requests for admission / Booking forms

If you are given an 'RFA' (Request for admission) form you need to complete this yourself and either post it to the address on the form or hand it into the admission desk at the main entry into the relevant hospital. You will not be placed on the waitlist or dated for your operation if you do not hand it in.

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Private Patients

All patients do require a referral from a general practitioner or specialist to see one of our Colorectal Surgeons for the first time. Our practice can make an appointment for you by following the details on the 'Get in Contact' page. Dr Brendan McManus also consults fortnightly from Nelson Bay offering this service to both public and private patients.

If you require an operation this will be booked to be done at one of the private hospitals. Our four surgeons operate primarily out of Newcastle Private Hospital and occasionally Lingard Private Hospital. Contact details for these hospitals can be found on the 'Links' page.

 

Request for admission / Booking forms

If you are given an 'RFA' (Request for admission) form you need to complete this yourself and either post it to the address on the form or hand it into the admission desk located at the main entry into the relevant hospital. You may not be given a date for your operation if you do not hand it in.

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Endoanal/Rectal Ultrasound

This is a procedure in which an ultrasound probe is inserted into the anus or rectum.  The sound waves bounce off tissues or organs displaying the internal structures.  Transrectal ultrasound may be used to look at a rectal cancer/adenoma and nearby structures in order to determine their depth of growth and spread. This determines possible further treatment. This may be used in combination with a rectal MRI scan.

Endoanal ultrasound is used to look at the layers of the anal sphincter muscle (continence muscle) and to identify possible injuries. It can also be used to identify perianal abscesses and fistulas. Ultrasound is painless however the procedure will be uncomfortable. This is a very easy procedure.  Unlike other imaging techniques, it uses no radiation and thus requires no special precautions.

Procedure

Usually the patient lies on their side on the examination table.  A small amount of water soluble gel is applied over the area or in the rectum.  The gel does not harm your skin or internal organs and can be wiped off after the procedure.  A ultrasound probe is covered with a protective covering and inserted in the patient.  The probe is small and there is a minimal amount of discomfort associated with the procedure itself.  Once inserted, your surgeon moves the probe forward and backward to best evaluate the area being examined.  This procedure generally takes five to ten minutes.  Afterwards your surgeon will interpret and inform you of the results and send a report back to your referring doctor.

Preparation

The patient requires no anaesthetic or sedation, and no special bowel preparation is required.

Risks

Multiple studies have shown that the sound waves used with ultrasound imaging are harmless and may be directed at patients with complete safety.  The procedure is painless although you may feel a little discomfort during the procedure.

 

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Anorectal Manometry

What is anorectal manometry?

It is a test that evaluates bowel function in patients with constipation or incontinence. It can be done in the rooms with mild discomfort.

It measures;

  • Strength of the anal sphincter muscles
  • Sensation of fullness in the rectum
  • Reflexes that govern bowel movements

Who should have anorectal manometry?

It is useful in the diagnosis of the following conditions;

  • Constipation and obstructive defaecation
  • Faecal incontinence
  • Anorectal function before or after bowel surgery

How is it performed?

The test takes a matter of minutes. A small flexible sensor is placed into your anus and is connected to a recording device that measures the pressure and strength of the anal muscles. If rectal sensations are to be measured a balloon will need to be inflated in your rectum.

What are the risks?

It is a safe test. It is unlikely to cause pain and complications are rare. It is possible that some bleeding may occur if the sensor causes a small tear however this usually settles within the day. 

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