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do not drive a car, operate machinery, sign legal documents or drink alcohol for 24 hours (BSG 2003). This is irrespective of whether their sedation has been reversed with flumazenil.The patient must be accompanied home if they have been given a sedative. The accompanying adult should stay with the patient for 12 hours at home if they live alone. It is important to remember that aspiration pneumonia may develop hours or days later and the patient should be informed to report any symptoms such as temperatures or breathing difficulty (BSG 2003, Smith and Watson 2005).

Documentation

Any samples should be clearly documented with the appropriate forms as previously discussed in this chapter. All drugs administered, complications and/or findings should be documented.

Complications

Respiratory depression

If oversedation occurs, respiratory function will be affected. It is essential that close monitoring occurs during and after the procedure. A reversal agent may be required such as flumezanil for midazolam (BSG 2003, Smith and Watson 2005).

Perforation

Although rare, it is possible that perforation of the oesophagus, stomach or duodenum may occur. Further medical and/or surgical intervention will be required to manage this potential complication (Putcha and Burdick 2003, Smith and Watson 2005).

Haemorrhage

Where biopsy samples have been taken, this may increase the risk of postprocedural bleeding. Further intervention may be required to stop the bleeding. Patients should be advised to seek medical assistance if there are signs of bleeding which include the presence of fresh blood in the sputum and melaena.

This will be dependent on the specific aetiology of the bleed, for example whether it is from varices when variceal band ligation may be required (SIGN 2008, Smith and Watson 2005).

Colonoscopy

Definition

A colonoscopy is conducted by inserting a colonoscope through the anus into the colon. It provides information regarding the lower GI tract and allows a complete examination of the colon. The colonoscope is similar to the endoscope used in gastroscopy. Its length ranges from 1.2 to 1.8 metres long. It is the most effective method of diagnosing rectal polyps and carcinoma (Smith and Watson 2005, Swan 2005, Taylor et al. 2009).

Anatomy and physiology

The colon is about 1.5 metres long. It begins at the caecum and ends at the rectum and anal canal (Waugh et al. 2006). See Figure 11.4.

Caecum

The caecum is about 8–9 cm long and opens from the ileum and ileocaecal valve (Waugh et al. 2006).

Colon

The colon consists of three parts. The ascending colon runs from the caecum and joins the transverse colon and the hepatic flexure. The transverse colon is in front of the duodenum where it joins the descending colon at the splenic flexure. The descending colon travels down toward the middle of the abdomen where it joins the sigmoid colon which is S-shaped and becomes the rectum (Waugh et al. 2006).

Rectum and anal canal

The rectum is approximately 13 cm long and is a dilated section of the colon. It joins the anal canal which is approximately 3.8 cm long (Waugh et al. 2006).

Evidence-based approaches

Rationale

A colonoscopy is performed to investigate specific symptoms originating from the lower GI tract such as bleeding. The doctor or nurse endoscopist is able to use direct vision to diagnose, sample and document changes in the lower GI tract (Swan 2005, Taylor et al. 2009).

Indications

Screening of patients with family history of colon cancer, a serious but highly curable malignancy.

Determining the presence of suspected polyps.

Monitoring ulcerative colitis.

Monitoring diverticulosis and diverticulitis.

Active or occult lower gastrointestinal bleeding.

Unexplained bleeding or faecal occult blood.

Abdominal symptoms, such as pain or discomfort, particularly if associated with weight loss or anaemia.

Chronic diarrhoea, constipation or a change in bowel habits.

Palliative supportive treatments such as stent insertion.

Contraindications

Upper gastrointestinal bleeding.

Inflammatory bowel disease