12 October 2022

A quick recap, in part one of this post I had decided not to have sedation, had drunk all the prep solution and hadn’t eaten any solid food for 36 hours.

On the day of the procedure, I set off for London early so that I could take some photos of the River Thames before my own, internal, photo session….

Scoping – having found the Endoscopy Suite, despite the lack of signage, I was greeted by the receptionist. “Hello sweetheart, what’s your name?” I was shown to a cubicle and given two surgical gowns, some hospital socks and a pair of “modesty” shorts. A nurse ran through a checklist, took my blood pressure and gave me a COVID LFT. He left whilst I changed into the hospital clothes. The modesty shorts have an opening at the back. On a previous occasion I had managed to put them on the wrong way round and they had proved to be anything but modest.

If I had opted for sedation a cannula would have been inserted (and I would have obeyed the second law of cannulation that you must take a photo and post it on social media). A few minutes later my consultant appeared, ran through the potential risks and I signed the consent form. With that completed he led me to the procedure room. The nurses introduced themselves and I lay down on the trolley. I was shown how to use the Entonox which is delivered via a mouthpiece. If you feel any discomfort, you can take a few deep breaths to mask it.

I rolled over onto my left side and drew my knees up. The monitor showed my heart rate was 65 bpm. With the camera inserted it was an easy run until the first sharp bend (splenic flexure). That is where the skill of the endoscopist comes into play. I was asked to roll onto my back. Air is used to inflate the gut and make the passage of the camera easier. Every so often a water spray is deployed to clean the lens or flush any debris that the prep solution hasn’t dislodged.

I watched the whole procedure on the big monitor. There was a small “satnav” window that shows the 3D position of the endoscope. I had some very mild inflammation in the colon but “nothing that needed treating or to worry about and your last calprotectin was 37. I’ll take a few biopsies on the way out”.

The camera made its way ever onwards. There were some difficult manoeuvres that required withdrawing a few centimetres and then re-orientating with the assistance of the 3D image. The camera reached just beyond my anastomosis – the surgical join between my small and large intestines – made easier as my ileocaecal valve and terminal ileum were removed in 2010.

“You can tell we’ve now entered the small intestine as the walls have a different structure.”

As the camera was withdrawn biopsies were taken. The endoscope tube has a cavity through it that allows access for a separate instrument with a small pair of forceps at the end. The tool takes a biopsy from the gut wall, directed by the endoscopist, and is then withdrawn and the sample retrieved. Watching the biopsies being taken is slightly disconcerting but you feel nothing as the gut wall has no nerves. I had hardly used the Entonox and will choose the no sedation option for future colonoscopies. Biopsy results would be ready in two weeks’ time.

Recovery – if you have had sedation, you will be taken to a recovery area until you have regained full consciousness and can then change out of the hospital clothes. Your escort will be told you are ready for collection. Before you leave the cannula is removed and you are given a copy of the colonoscopy report. My one concluded with a series of “IBD Scores”. The only one greater than zero was the SES-CD (Simple Endoscopic Score for Crohn’s  Disease). The score was three which equates to “mild endoscopic activity” and is the lowest of the scores after “remission”.

You may feel some discomfort caused by the inflation of the gut. I didn’t notice any of this. The prep will have decimated your gut microbiome and this takes time to re-establish. I started taking a pro-biotic yogurt and it seems to have helped the process along.

Final thoughts – for those about to have their first colonoscopy I would suggest that you arrange an escort and opt for sedation. It can make the procedure a lot less stressful. If you subsequently become an “old hand” at scoping you may want to review your options.

I think we have all felt embarrassed about where they are going to stick that camera but I try to remember that the Endoscopy team will have seen it all before. It is a routine procedure that they carry out multiple times a day. When it is your turn I hope it all goes well.

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