Colonoscopy

Colonoscopy involves the use of an endoscope to examine the large intestine (colon). An endoscope is a flexible tube (about 1.3cm in diameter) that has a tiny video camera at the front end. It is introduced gently into the large intestine through the anus. Direct visual inspection of the inner lining of the intestine enables doctors to detect abnormalities such as polyps and cancer. Using accessory instruments, polyps can be removed and biopsy taken from suspected cancer tissue for further examination.

Points to note and procedure

Preparation prior to colonoscopy Three days before the examination, stop eating high-fiber foods and drinks, melons, beans, vegetables and fruits etc.; but eating porridge, flour, noodles, rice, fish and meat are allowable. Special dietary instructions (low-residue meal), administration of drugs to clean and empty the large bowel. Adopt the fluid diet only, but no milk is allowed one day before the examination. Taking laxatives at the night before the examination to clear the large intestine. Inform the doctor of any drug allergy and regular medication, including but not limited to drugs for diabetes, hypertension and cardiovascular disease, aspirin, warfarin group drugs, because patient may be advised not to take the drugs before the examination. Prior to the procedure, there will be a brief consultation to explain the procedure and the risks involved. A consent form will then be signed by the patient.

Preparation on the day of colonoscopy Eating is prohibited since 8 hours before the examination. Clear fluid and laxatives are allowed. Patient will change into examination gown before the examination and take off the accessories, metal objects and denture. For the patient who will be wearing contact lens, please prepare a case for storage.

Points to note about laxatives Laxatives should be refrigerated and used up within 24 hours after open. The remaining or unused laxatives should be discarded. Stop taking the laxatives if no feeling of urgency after two hours of ingestion. Resume after defecation started. Stop taking laxatives in case of abdominal distension and nausea. Continue only after symptom have disappeared. Sugary drink or honey can be added to the laxative to provide a better taste. All oral medications should be dosed at least one hour before the intake of laxatives.

Procedure Patient will lie down on his/her left side, with the knees bent towards the chest. The sedative and pain medication can be given to induce a state of deep sleep. The procedure may take 15 to 30 minutes to complete. Depending on actual circumstances, the duration may vary and the duration mentioned is for reference only. Doctor may biopsy tissues for further examination or remove polyp during the procedure. Colonoscopy has its own risks, which include allergic reaction to sedative, bleeding from site of polyp removal, bowel perforation, infection, heart/lung problems and so forth. The risk, however, is low especially if no abnormality is found.

After the procedure In case of sedation, the patient may take 30 minutes to 2 hours before to become fully awake. The actual time may be varied from different cases and the time mentioned above is for reference only. The patient may normally resume oral intake after 2-3 hours of the examination, subject to advice by medical personnel. Patient may feel mild abdominal distention and discomfort after procedure. This is normal in most cases and will resolve within 3-5 hours. In case of severe pain or bleeding soon after procedure, please inform the doctor or centre for assessment without delay. In case of severe abdominal pain or marked rectal bleeding, please consult the doctor immediately. Doctor will explain result at appropriate time after the procedure. If biopsy is collected or polyps is removed, it will take a few days for the tissue to be properly examined. Patient should make an appointment to see the doctor in about a week to discuss the results. The report will be sent directly to the doctor. If sedative medication has been given, the patient should be accompanied by an adult on leaving the clinic and must not drive, operate any machinery or drink alcohol, making important decision or sign legal documents within 24 hours after the colonoscopy.

Gastroscopy

Gastroscopy involves the use of an endoscope to examine the upper gastrointestinal tract which includes oesophagus, stomach and duodenum. An endoscope is a thin flexible tube (about 1 cm in diameter) that has a tiny video camera at the front end. The endoscope is introduced carefully and gently through the mouth into the oesophagus. Direct visual inspection of the inner lining of these organs helps doctors to detect abnormalities such as ulcers and cancer.

Points to note and procedure

Preparation Inform the doctor of any drug allergy and regular medication, including but not limited to drugs for diabetes, hypertension and cardiovascular disease, aspirin, anti-coagulants such as warfarin, because patient may be advised not to take the drugs before examination. Prior to the procedure, there will be a brief consultation to explain the procedure and the risks involved. A consent form will then be signed by the patient.

Preparation on the day of colonoscopy Eating and drinking are prohibited since 10 hours before the examination. Patient may change into examination gown before examination and take off the accessories, metal objects and denture. For those wearing contact lens, please prepare a case for storage. Please also inform the nurse in case of loose teeth.

Procedure Patient will lie down on his/her left side. After oral anesthetic spray has been applied to the throat, a plastic mouth guard is put between upper and lower teeth. Intravenous sedative medication can be given to induce a state of deep sleep. The procedure takes about 5-10 minutes to complete. It may take longer time if the doctor finds abnormalities that necessitate further action such as biopsy for gastritis or suspected cancer. Stomach tissue will also be taken to test for Helicobacter pylori, which is an important cause of stomach / duodenal ulcer and stomach cancer. If polyps are found, they will also be removed immediately. Gastroscopy has its own risks, which include allergic reaction to anaesthetic/sedative, perforation, infection, heart/lung problems and so forth. The risks, however, are very low especially if no abnormality is found.

After the procedure In case of sedation, patient may take 30 minutes to an hour to become fully awake. The actual time may be varied from different cases and the time mentioned above is for reference only. In case of severe abdominal pain soon after procedure, please inform the doctor or centre for assessment without delay. Patient may have sore throat, abdominal distention and dizziness after procedure. This may resolve within hours after rest. Doctor will explain result at appropriate time after the procedure. If biopsy is collected or polyps is removed, it will take a few days for the tissue to be properly examined. Patient should make an appointment to see the doctor in about a week to discuss the results. The report will be sent directly to the doctor. If sedative medication has been given, the patient should be accompanied by an adult on leaving the clinic and must not drive, operate any machinery or drink alcohol, making important decision or sign legal documents within 24 hours after the gastroscopy.

Cystoscopy

Cystoscopy is the use of a flexible fibre-optic endoscope to examine the lower urinary system which includes urethra, bladder and prostate (male). At the front end of the endoscope, there is a tiny video camera attached. During the examination, the endoscope will be introduced gently into bladder through the urethra. Direct visual inspection helps the doctors to detect abnormalities such as stones, ulcers, inflammation, filling defect, bleeding or cancer.

Points to note and procedure

Preparation Inform the doctor of any drug allergy and regular medication, including but not limited to drugs for diabetes, hypertension and cardiovascular disease, aspirin, warfarin group drugs, because patient may be advised not to take the drugs before the examination. Prior to the procedure, there will be a brief consultation to explain the procedure and the risks involved. A consent form will then be signed by the patient.

Preparation on the day of cystoscopy There is no special preparation for the procedure if the examination is performed under local anaesthetic. Patient may eat and drink as usual on the examination day. However, if intravenous sedation or monitored anaesthetic care is required, patient will need to keep nil by mouth for at least six hours prior to the examination. Before the examination, patient will be required to empty the bladder as completely as possible to enable clear visualization of inner lining of the bladder. Patient will change into examination gown before examination and take off the accessories, metal objects and denture. For those wearing contact lens, please prepare a case for storage.

Procedure A local anaesthetic lubricant jelly will be instilled into the urethra by the operating doctor. Patient may also choose to have intravenous sedation or monitored anaesthetic care during the procedure which will induce a state of deep sleep. During the examination, the bladder will be irrigated with sterile saline to enable clear visualization. During the procedure under local anaesthetic, patient may feel the urge to pass urine as the bladder is being filled. The procedure takes about 10-15 minutes. Occasionally the doctor may need to take further biopsy from the bladder, which may take longer time. Patient may experience some discomfort during the procedure, but rarely painful. Cystoscopy does incur small risk which includes allergic reaction to anaesthetic agent, bladder perforation, urinary tract injury. The risk, however, is very low.

After the procedure It may take up to 60 minutes to have full recovery from the sedation or monitored anaesthetic care. It is advisable to drink plenty of water to clear the bladder immediately after the procedure and in the subsequent 24 hours. Patient may experience burning sensation or blood in urine after the procedure, which will be settled in the next few days. Patient should seek immediate medical advice in case of develop a temperature, unable to pass urine, abdominal pain or persistent blood in urine. Doctor will explain the examination result at appropriate time after the procedure. If biopsy is collected, it will take a few days for the tissue to be properly examined. Patient should make an appointment to consult the doctors after a few days of procedure. If sedative medication or monitored anaesthetic care has been given, the patient should be accompanied by an adult on leaving the clinic and must not drive, operate any machinery or drink alcohol, making important decision or sign legal documents within 24 hours after the cystoscopy.