11/13/24, 8\:16 PM Guide | Colonoscopy explanation

Colonoscopy explanation

Table of contents

Introduction

This article provides a step-by-step guide to explaining a colonoscopy in an OSCE setting, including information you will be
expected to give and how to structure the consultation.
This guide will cover what a colonoscopy is, what the procedure involves and the risks of the procedure.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain the reason for the consultation\:
“ I u n d e r s t a n d t h a t y o u’ r e h e r e t o t a l k a b o u t h a v i n g a c o l o n o s c o p y , i s t h i s c o r r e c t ?”
.
Due to the sensitive nature of the consultation, it's important to establish a good rapport and open line of communication with
the patient early in the consultation\:
“ I f y o u h a v e a n y q u e s t i o n s a t a n y p o i n t , o r i f s o m e t h i n g i s n o t c l e a r , p l e a s e f e e l f r e e t o
i n t e r r u p t a n d a s k m e .
”
Make sure to check the patient’s understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as ‘chunking and checking’).
Throughout the consultation, be receptive to the patient's language and try only to use words and terminology they are
comfortable with.

Ideas, concerns & expectations

A key component of history taking involves exploring a patient’s ideas, concerns, and expectations (often referred to as ICE) to
gain insight into the patient's thoughts about having a colonoscopy, what they are worried about and what they expect from the
consultation. When discussing concerns, do so in a sensitive and honest manner.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but we have provided
several examples for each of the three areas below.
Ideas
“ W h a t d o y o u a l r e a d y k n o w a b o u t h a v i n g a c o l o n o s c o p y ?”
Concerns
“ I s t h e r e a n y t h i n g w o r r y i n g y o u a b o u t h a v i n g a c o l o n o s c o p y ?”
Expectations
“ W h a t w e r e y o u h o p i n g w e w o u l d c o v e r t o d a y r e l a t i n g t o h a v i n g a c o l o n o s c o p y ?”
“ I s t h e r e a n y t h i n g y o u p a r t i c u l a r l y w a n t e d t o f o c u s o n o r d i s c u s s t o d a y ?”
“ W h a t a r e y o u h o p i n g t o g e t o u t o f t h i s c o n s u l t a t i o n ? ”
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Patient history

Although the purpose of this station is to explain the procedure, it is a good idea to gather a quick, focused history early in the
consultation.
This should include exploring the patient’s condition and reason for requiring a colonoscopy\:
p a g e , c o u l d y o u t e l l m e a b i t a b o u t w h y y o u n e e d a c o l o n o s c o p y ?”
“ J u s t s o w e a r e o n t h e s a m e
Understanding the indication for the procedure will allow you to tailor your explanation.

What is a colonoscopy?

Explain to the patient colonoscopy is a procedure to look at the lining of the colon (large bowel) performed by an endoscopist
(a doctor or specialist nurse). A long, thin,
colon (large bowel), allowing the endoscopist to visualise the bowel.
Colonoscopy also allows biopsies to be taken and the painless removal of any suspicious growths (polyps).
1,2,3
“ A c o l o n o s c o p y i s a t e s t t o l o o k i n s i d e y o u r c o l o n / l a r g e b o w e l . A l o n g , t h i n ,
( c o l o n o s c o p e ) i s p a s s e d i n t o y o u r b o t t o m / b a c k p a s s a ge . W e w i l l b e a b l e t o h a v e a c l e a r v i e w o f t h e b o w e l a n d m a y t a k e s o m e
s a m p l e s c a l l e d b i o p s i e s .
”

Why is a colonoscopy performed?

Colonoscopy is the main diagnostic investigation for colon cancer. However, it can diagnose and monitor other bowel
conditions (e.g. Crohn’s disease, diverticular disease, and ulcerative colitis).
Indications for performing a colonoscopy include\:
4,5
Rectal bleeding or blood in the stool (either occult or detected via a faecal immunochemical test)
Changes in bowel habit (persisting for more than six weeks)
Men or non-menstruating women with unexplained iron de
Unexplained weight loss
Persistent abdominal symptoms with raised faecal calprotectin or CRP
Colonoscopy can also be used as a screening tool for polyps and bowel cancer.
3, 6
“ C o l o n o s c o p y i s u s e d t o l o o k i n s i d e y o u r b o w e l s w h e n y o u h a v e s y m p t o m s l i k e b l o o d i n t h e p o o , u n e x p e c t e d w e i g h t l o s s . I t i s a l s o u s e d a s a s c r e e n i n g t e s t f o r b o w e l p o l y p s a n d b o w e l c a n c e r . w h e n y o u h a v e n o s y m p t o m s , a i m i n g t o c a t c h t h e d i s e a s e e a r l y b e f o r e s y m p t o m s a p p e a r .
”
a c h a n ge i n b o w e l h a b i t , o r
S c r e e n i n g i s t e s t i n g f o r a d i s e a s e

What are polyps?

Polyps are growths of cells protruding from the lining of the bowel. Polyps can be attached to the bowel by a stalk, but others
are
chance of them being pre-cancerous or cancerous.
4, 5, 7
“ P o l y p s a r e l i t t l e g r o w t h s o f c e l l s i n t h e b o w e l . T h e m a j o r i t y a r e n o t s e r i o u s a n d w i l l n e v e r c a u s e y o u a n y p r o b l e m s . W h e n
p o l y p s a r e f o u n d , t h e y a r e r e m o v e d b y t h e e n d o s c o p i s t t o b e l o o k e d a t i n m o r e d e t a i l a s t h e r e i s a c h a n c e t h e y c o u l d gr o w a n d
l a t e r c a u s e p r o b l e m s .
”

What are the alternatives to colonoscopy?

Colonoscopy is not appropriate for some patients. The main alternative is CT colonography (CTC) or ‘virtual colonoscopy’
3
.
CT virtual colonoscopy is a diagnostic imaging test. It is minimally invasive and doesn’t require sedation. A small tube is
inserted into the rectum, and air is pumped in to expand the colon. The CT scanner takes images of the large bowel from
di
This can provide detailed images of the colon and is less invasive than a traditional colonoscopy. However, colonoscopy is
preferred as it allows detailed observation of the colonic mucosa, biopsies, and removal of any lesions.
5
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“ T h e m a i n a l t e r n a t i v e t o c o l o n o s c o p y i s a C T v i r t u a l c o l o n o s c o p y . T h i s i s l e s s i n v a s i v e a n d d o e s n’ t i n v o l v e s e d a t i o n . T h i s u s e s x-
r a y s a n d c o m p u t e r s t o c r e a t e a d e t a i l e d m o d e l o f y o u r l a r ge b o w e l h o w e v e r , i t d o e s n’ t a l l o w a d i r e c t l o o k a t t h e l i n i n g o f y o u r
b o w e l o r s a m p l e s ( b i o p s i e s ) t o b e t a k e n .
"

Preparing for a colonoscopy

Before the colonoscopy, patients should receive a letter inviting them to the procedure and informing them of the bowel
preparation required.
Patients should eat a low-
procedure, they must take a very strong laxative (e.g. Moviprep) to clear the bowel.
It is important to warn the patient this causes diarrhoea, so the patient should stay close to a bathroom. This can be very
unpleasant for the patient. Patients shouldn't eat anything on the day of the procedure but can drink clear
before the colonoscopy.
5,8
“ Y o u r b o w e l n e e d s t o b e e m p t y f o r t h e c o l o n o s c o p y s o w e c a n h a v e a c l e a r v i e w , o t h e r w i s e t h e b o w e l m a y n o t b e c l e a r , a n d w e
m i g h t h a v e t o r e p e a t t h e t e s t . I n t h e d a y s b e f o r e , y o u w i l l b e g i v e n a d i e t s h e e t o f f o o d s y o u c a n a n d c a n’ t e a t . M a k e s u r e y o u
a r e d r i n k i n g l o t s o f
n e e d t o s t a y c l o s e t o a b a t h r o o m . O n t h e d a y o f t h e c o l o n o s c o p y , y o u w o n’ t b e a b l e t o e a t b u t y o u c a n h a v e c l e a r
t w o h o u r s b e f o r e .
”

What happens during the procedure?

On arrival

When the patient arrives, they will have the procedure's risks explained to them and be asked to sign a consent form. Then
they will be given a hospital wristband and asked to change into a hospital gown.
Basic observations will be taken, and an intravenous cannula will be inserted (usually into the back of the hand). Patients will be
o
2,4
“ W h e n y o u a r r i v e , a n u r s e w i l l e x p l a i n t h e p r o c e d u r e a n d i t s p o s s i b l e r i s k s . Y o u w i l l n e e d t o s i gn a c o n s e n t f o r m t o s a y y o u
u n d e r s t a n d a n d a g r e e t o t h e p r o c e d u r e . Y o u w i l l b e a s k e d t o c h a n ge i n t o a h o s p i t a l go w n a n d t h e n h a v e y o u r v i t a l s i g n s t a k e n ,
l i k e y o u r b l o o d p r e s s u r e , a n d h e a r t r a t e . A c a n n u l a w i l l b e i n s e r t e d , u s u a l l y i n t o t h e b a c k o f y o u r h a n d . A c a n n u l a i s a l i t t l e
p l a s t i c t u b e t o g i v e s e d a t i o n a n d o t h e r m e d i c i n e s . Y o u w i l l b e o
p r o c e d u r e m o r e c o m f o r t a b l e .
”

Colonoscopy procedure

A colonoscopy takes 20 to 40 minutes. The patient is taken to a room with the endoscopist and two nurses. They will be asked
to lie on their left side in the fetal position. Before inserting the colonoscope, the endoscopist will perform a rectal exam.
2,4
The endoscopist will pass the colonoscope through the anus into the rectum and colon. Carbon dioxide gas in
for a better view and manoeuvring. The colonoscope will pass through the whole length of the large intestine.
The patient may be asked to adjust their position during the procedure. This facilitates moving the scope and improves
visualisation, as well as helping the patient to be as comfortable as possible. During the procedure, polyps can be removed and
biopsies taken. This is not painful.
2,3,4
“ F o r t h e c o l o n o s c o p y , y o u w i l l b e t a k e n t o a r o o m w i t h a n e n d o s c o p i s t a n d t w o n u r s e s . Y o u w i l l b e a s k e d t o l i e o n y o u r l e f t s i d e
a n d b r i n g y o u r k n e e s u p t o y o u r c h e s t . B e f o r e t h e d o c t o r c a n i n s e r t t h e s c o p e , t h e y w i l l n e e d t o d o a
b a c k p a s s a g e .
T h e e n d o s c o p i s t w i l l i n s e r t t h e s c o p e t h r o u gh t h e b a c k p a s s a ge a n d i n t o t h e b o w e l . A i r i s t h e n p a s s e d t h r o u gh t o i n
b o w e l , t h i s g i v e s a b e t t e r v i e w o f t h e b o w e l l i n i n g. T h e d o c t o r m a y a s k y o u t o c h a n ge y o u r p o s i t i o n d u r i n g t h e p r o c e d u r e . T h i s
h e l p s t h e m o v e m e n t o f t h e s c o p e a n d i m p r o v e s t h e i r v i e w o f y o u r b o w e l . I t w i l l a l s o h e l p m a k e y o u m o r e c o m f o r t a b l e , s o t h e y
m a y n e e d y o u t o s h i f t a r o u n d a b i t . T h e c o l o n o s c o p e w i l l go t h r o u gh t h e w h o l e l a r g e b o w e l r e l a y i n g p i c t u r e s t o a m o n i t o r .
D u r i n g t h e p r o c e d u r e , t h e d o c t o r w i l l r e m o v e a n y gr o w t h s ( p o l y p s ) o r t a k e a s a m p l e o f c e l l s ( b i o p s y ) ; t h i s d o e s n’ t h u r t .
”

After the procedure

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Patients are moved to a recovery room and monitored until ready to go home. The patient should arrange for someone to take
them home as they shouldn’t drive for 24 hours after the procedure. In addition, for 24 hours after the procedure, patients
should have a responsible adult with them. They shouldn’t sign any legal documentation or operate heavy machinery.
3,4
Before the patient leaves, a nurse or doctor will discuss the colonoscopy
a further two to three weeks. These are used to con
9
“ A f t e r t h e p r o c e d u r e , y o u w i l l b e t a k e n t o t h e r e c o v e r y r o o m a n d n u r s e s w i l l m o n i t o r y o u u n t i l y o u’ r e r e a d y t o g o h o m e . E n s u r e
y o u h a v e a r r a n g e d f o r s o m e o n e t o p i c k y o u u p a s y o u c a n’ t d r i v e a f t e r t h e p r o c e d u r e . H a v e a r e s p o n s i b l e a d u l t w i t h y o u f o r 2 4
h o u r s a f t e r t h e p r o c e d u r e a n d d o n’ t d r i v e . A f t e r t h e c o l o n o s c o p y , a n u r s e o r d o c t o r w i l l r e v i e w t h e r e s u l t s w i t h y o u b e f o r e
l e a v i n g . H o w e v e r , i t m a y t a k e t w o t o t h r e e w e e k s t o r e c e i v e t h e r e s u l t s o f a n y s a m p l e s ( b i o p s i e s ) t a k e n d u r i n g t h e p r o c e d u r e .
”

What are the side e

Common side e
4,5
Nausea
Bloating
Crampy abdominal pain
Minor rectal bleeding
Possible risks of a colonoscopy include\:
2,3,4
Allergic reaction to sedation, equipment or materials used
Heavy bleeding
Bowel perforation caused by the colonoscope
Incomplete examination requiring a repeat test
Small risk of missed pathology
“ D u r i n g a n d a f t e r t h e p r o c e d u r e , y o u m a y e x p e r i e n c e s o m e a b d o m i n a l p a i n a n d c r a m p i n g.”
“ A s w e i n
”
I t i s n o r m a l t o h a v e a
“ I n r a r e c a s e s , c o l o n o s c o p y c a n h a r m t h e b o w e l . T h e c o l o n o s c o p e c a n c a u s e a h o l e i n t h e b o w e l ( p e r f o r a t i o n ) , a n d s o m e
p a t i e n t s m a y e x p e r i e n c e h e a v y b l e e d i n g. Y o u m u s t s e e k u r g e n t m e d i c a l a d v i c e i f y o u e x p e r i e n c e h e a v y b l e e d i n g, s e v e r e
a b d o m i n a l p a i n o r d e v e l o p a f e v e r a f t e r a c o l o n o s c o p y .
”
“ W h i l e c o l o n o s c o p y i s a s a f e a n d e
”
i t i s n o t 1 0 0 % p e r f e c t . T h e r e i s a s m a l l c h a n c e t h a t d u r i n g t h e p r o c e d u r e , a

Closing the consultation

Close the consultation by summarising what you have discussed. This allows you to emphasise the key points of the
consultation.
Finally, thank the patient for their time and o
Dispose of PPE appropriately and wash your hands.

Reviewer

Dr Ian Beales
Consultant in Gastroenterology
Clinical Reader in Gastroenterology and Therapeutics

References

1. NHS. What is a colonoscopy? 2022. Available from\: [LINK]
https\://app.geekymedics.com/osce-guides/counselling/colonoscopy-explanation/ 4/511/13/24, 8\:16 PM Guide | Colonoscopy explanation
2. NHS. Colonoscopy - what happens on the day. 2022. Available from\: [LINK]
3. GOV UK. Bowel cancer screening\: having a colonoscopy. 2022. Available from\: [LINK]
4. Milton Keynes University Hospital NHS. Available from\: [LINK]
5. U.S. Department of Health and Human Services. Colonoscopy. Available from\: [LINK]
6. NHS. Bowel cancer screening. 2021. Available from\: [LINK]
7. NHS. Bowel polyps. 2020. Available from\: [LINK]
8. Guy’s and St Thomas’ NHS. Colonoscopy diet advice and bowel preparation. 2019. Available from\: [LINK]
9. NHS. Colonoscopy - Results. 2022. Available from\: [LINK]
10. BSG. Guidance on the indications for diagnostic upper GI endoscopy,
from\: [LINK]
Source\: geekymedics.com
https\://app.geekymedics.com/osce-guides/counselling/colonoscopy-explanation/ 5/5