Gastroenterology - Requiring a Pouchoscopy

This leaflet has been prepared after speaking to patients who have had the procedure.

It may not answer all your questions, if you have any further questions or worries please do not hesitate to ask.

What is a Pouchoscopy?

Pouchoscopy is a procedure that examines the lining of your ileo- anal pouch for any inflammation, abnormal growths or tissue.

During a pouchoscopy, a doctor or nurse inserts a flexible tube called an endoscope, which has a camera on its end into the anus. The procedure usually takes about 10 minutes but times vary considerably. If it takes longer, you should not worry.

Sometimes it is helpful for diagnosis to take a sample (biopsy) - a sample of the lining of the pouch. A small instrument called forceps passes through the endoscope to ‘pinch’ out a tiny bit of the lining.

This sample is sent to the laboratory for analysis. It is also possible to remove polyps in a similar way. Pain medication and/or sedation are not generally needed for this examination.

On arrival at the department

• A member of the nursing team will complete an initial assessment
• You will be given a consent form to sign
• You will be asked to change into a gown, and given a pair of dignity shorts, all trolley areas have curtains around them
• The unit operates single sex days, you will therefore not meet patients of the opposite sex whilst you are in a hospital gown
• If you have chosen to have this procedure with sedation, a nurse will insert an intravenous (IV) line into your hand or arm

Intravenous sedation option:

An intravenous injection is given to make you feel relaxed and sleepy but not unconscious (this is not a general anaesthetic). This option means you may not be aware of the procedures

• You will need to stay in the unit to recover for 1 hour following the administration of sedation
• You will need a responsible adult to collect you from the unit, escort you home and stay with you for a minimum of 12 hours
• The injection will continue to have a mild sedative effect for up to 24 hours and may leave you unsteady on your feet for a while

No sedation option:

If you do not have sedation, you can leave straight after the procedure and resume your normal activities for example working, driving. You will be fully aware of the procedure, most patients find this acceptable and not too unpleasant.

What happens during the procedure?

You will be taken into one of our 4 procedure rooms. We will ask you to make yourself comfortable on your left side with your knees bent.

For your comfort and reassurance, a trained nurse will stay with you throughout the procedure. A plastic ‘peg’ will be placed on your finger to monitor your pulse and oxygen levels during the procedure. We will give you a small amount of oxygen if a sedative is used.

The endoscopist will then gently insert the endoscope through your anus into your pouch. Air is passed into your pouch through the endoscope which allows a clear view of its lining. You may experience some wind like pains but they should not last long.
You may also feel that you need to go to the toilet, this is perfectly natural.

There may be periods of discomfort as the tube goes round bends in the bowel. Usually these will ease once the bend has been passed. If you are finding the procedure too uncomfortable, please inform the Endoscopist and nurse.

In order to make the procedure easier you may be asked to change position (for example roll onto your back). However, if you have made it clear that you are too uncomfortable the procedure will be stopped.

Potential risks

Pouchoscopy procedures carry a very small risk of bleeding or perforation (tear) to the bowel. These are more likely to occur after the removal of a polyp.

Removing a polyp can rarely cause it to bleed although this is usually stopped during the procedure.

Occasionally a patient who bleeds severely may require a blood transfusion.

A rare complication is an adverse reaction to the intravenous sedative and analgesic drugs.

Following the procedure

If you do not have sedation, you may go home as soon as you are dressed.

If you do have sedation, you will be monitored for 1 hour in our recovery area.

When you are sufficiently awake (usually about an hour after the sedation has been given) you will be able to get up and dressed, you will then be offered a drink and biscuits.

We advise you not to drive, operate machinery, return to work, drink alcohol or sign any legally binding documents for a 24-hour period. We also advise you to have a responsible adult to stay with you for the next 12 hours.

You may feel a little bloated and have some wind-like pains because of air in your bowel; these usually settle down quickly.

When will I know the result?

Some information will be given to you on the day of the procedure.

If you had a biopsy or a polyp removed, you should receive the final diagnosis either from the healthcare professional who requested the procedure or by letter.

Alternatives:

In some cases, depending on individual factors such as the symptoms present and the condition being investigated, there may be alternatives to having a pouchoscopy.

These may include:

• A contrast study
• A CT scan

For more information:

Contact the GI Endoscopy Unit Salford Royal Hospital on 0161 206 5959 8:00am to 5:00pm

Appointment Line: 01706 906788