Scope Procedures
Author – James Mackintosh Editor – Mohona Sengupta
Last updated 10/10/23
Table of Contents
Introduction
You may be asked to explain a procedure or investigation to a patient. These will include scope tests. You would not be expected to know how to perform the procedure. However, you should be able to provide a basic explanation, give them information in a patient centred way, and signpost the patient to other resources if you do not know the answer to their specific questions.
These are common types of scope procedures that you may be asked to explain:
Gastroscopy
Bronchoscopy
Colonoscopy
Cystoscopy
Approach
When explaining a procedure to a patient it is important that demonstrate a patient centred approach. You should find out what they already know, regularly check their understanding, and encourage them to ask questions. It is more important to address the patient’s agenda and concerns, than ensuring that you provide specific information. (In contrast to consenting for a procedure where you must ensure that the patient understands the potential risks, benefits, and complications.)
As a doctor or medical student, you should not consent a patient for a procedure that you cannot perform yourself.
We recommend a ‘chunk and check’ approach. This is where you give a short ‘chunk’ of information, pause to let the patient process it, and then check that they understand what you have told them.
General Structure
1. What does the patient understand so far?
2. Explain what the procedure is.
3. Why are they having this test?
4. Before the procedure.
5. During the procedure.
6. After the procedure.
7. Risks/complications.
8. Any further questions?
It is not essential that you stick to this structure. In your OSCEs the patients/actors should prompt you for any information that you may not have mentioned. They want to give the best opportunity to demonstrate your knowledge and skill. If you do not know the answer to a question, be honest and offer to find out from a senior colleague and/or offer them a patient information leaflet.
1. What does the patient understand so far?
2. Explain what the procedure is.
A small camera on the end of a thin, flexible tube is inserted into your throat through your mouth.
It is passed down your throat into your stomach. It allows the doctors to look at the lining of your oesophagus (food pipe), stomach, and sometimes the start of your small intestine.
Sometimes the doctors will take a tissue sample (biopsy) or use the scope to treat a problem when they see it during the procedure.
3. Why are they having this test?
Common indications include difficulty swallowing, indigestions, persistent vomiting, and black tarry stools. Sometimes people are referred for the test to look for cancers.
4. Before the procedure.
On the day of the test, you will need to stop eating at least 6 hours before the test. You may be allowed to have sips of water.
You do not need to remember this. You should receive a letter in the post with clear instructions about when to stop eating and drinking. You may need to stop certain medications such as antacids before the procedure.
You will be offered medication for sedation. This will make you sleepy, but you will be awake during the procedure.
5. During the procedure.
A small thin camera is inserted into your throat and passed down to your stomach.
This might make you feel sick. But should not be painful.
Air is pumped into your stomach. This can make you feel bloated.
A sample may be taken. You will not feel this.
The procedure can be uncomfortable. You can ask for the procedure to stop at any time.
The procedure lasts approximately 15-45 mins.
6. After the procedure.
You may still be drowsy from the sedation.
You will need to stay in the hospital for a few hours before going home.
You will need someone else to drive you home.
You should not drink alcohol, drive or sign important legal documents for 24 hours after the procedure.
7. Risks/complications.
Sore throat
Bleeding
Infection
Side effects of sedation
Very small chance of perforation
8. Any further questions?
1. What does the patient understand so far?
2. Explain what the procedure is.
A small camera on the end of a thin, flexible tube is inserted into your throat through your mouth or nose.
It is passed down your windpipe into your lungs.
The doctors may take a tissue sample (biopsy).
3. Why are they having this test?
Common indications include persistent cough, coughing up blood, and a shadow on a chest x-ray. Sometimes people are referred for the test to look for cancers.
4. Before the procedure.
On the day of the test, you will need to stop eating at least 6 hours before the test. You may be allowed to have sips of water.
You do not need to remember this. You should receive a letter in the post with clear instructions about when to stop eating and drinking. You may need to stop certain medications such as aspirin, warfarin and other blood thinning medications before the procedure.
Antiplatelets 1 week before
Warfarin 5 days before
DOACs 48 hours before
You will be offered medication for sedation. This will make you sleepy, but you will be awake during the procedure.
You will be given a numbing throat spray.
5. During the procedure.
A small thin camera is inserted into your throat and passed down to your lungs.
This might make you gag. But should not be painful.
The doctor may squirt liquid into an area of lung and syringe it back out for testing (bronchiolar lavage).
You will be awake during the procedure but will likely not remember it afterwards.
6. After the procedure.
You may still be drowsy from the sedation.
You will need to stay in the hospital for a few hours before going home.
You will need someone else to drive you home.
You should not drink alcohol, drive or sign important legal documents for 24 hours after the procedure.
7. Risks/complications.
Sore throat
Bleeding / coughing up blood
Pneumothorax
Side effects of sedation e.g. amnesia
8. Any further questions?
1. What does the patient understand so far?
2. Explain what the procedure is.
A small camera on the end of a thin, flexible tube is inserted into bottom.
It allows the doctor to look at your bowels.
The doctors may take a tissue sample (biopsy).
3. Why are they having this test?
Common indications include rectal bleeding, blood in stool, diarrhoea/constipation that doesn’t go away, fatigue, weight loss and iron deficiency anaemia. Often people are referred for the test to look for cancer. The doctors may be looking for ulcerative colitis, Crohn’s or diverticular disease.
4. Before the procedure.
2 days before plain, low fibre foods only.
1 day before laxatives to empty the bowels.
2 hours before no eating or drinking.
You will be sent a letter explaining exactly what to do.
You will be offered medication for sedation. This will make you sleepy, but you will be awake during the procedure.
5. During the procedure.
A small thin camera is inserted into your bottom.
This might be uncomfortable. But should not be painful.
The doctor may inflate your bowels with air. This may cause you to feel bloated.
If the doctor takes a biopsy you will not feel it.
6. After the procedure.
You may still be drowsy from the sedation.
You will need to stay in the hospital for a few hours before going home.
You will need someone else to drive you home.
You should not drink alcohol, drive or sign important legal documents for 24 hours after the procedure.
7. Risks/complications.
Bleeding
Infection
In rare cases perforation
Side effects of sedation
8. Any further questions?
1. What does the patient understand so far?
2. Explain what the procedure is.
In a flexible cystoscopy a small camera on the end of a thin, flexible tube is inserted into your urethra and passed up to your bladder.
A rigid cystoscopy is done if an intervention is required. In this procedure the tube is rigid and you are put to sleep to have it done.
3. Why are they having this test?
Common indications include blood in urine, recurrent UTIs and bladder stones.
4. Before the procedure.
No preparation required for a flexible cystoscopy.
You will be told when to stop eating and drinking if you are having a general anaesthetic for a rigid cystoscopy.
5. During the procedure.
A small thin camera is inserted into your urethra.
This might be uncomfortable. But should not be painful.
The doctor may squirt water into your bladder.
6. After the procedure.
After a flexible cystoscopy you can go home once you have passed urine.
After a rigid cystoscopy you will need to recover from the anaesthetic.
7. Risks/complications.
Bleeding
Infection
Urinary retention
8. Any further questions?
Quick Summary Table
Procedure | Gastroscopy | Bronchoscopy | Colonoscopy | Flexi Sig | Cystoscopy |
Anatomy examined | Oesophagus, stomach | Bronchi, lungs | Large bowel | Sigmoid, rectum | Urethra, bladder |
Indication | Dysphagia Reflux Persistent vomiting Melena | Haemoptysis Persistent cough CXR changes suggestive of cancer | Altered bowel habit PR bleeding IDA Weight loss Positive FIT | Altered bowel habit PR bleeding IDA Weight loss Positive FIT | Haematuria Recurrent UTIs Bladder stones Pelvic pain |
Preparation | NBM 6 hours before | NBM six hours before Stop: Antiplatelets 1 week before. Warfarin 5 days before. DOACs 48 hours before. | 2 days before plain, low fibre foods only. 1 day before laxatives. 2 hours before NBM. | 2 hours before NBM and phosphate enema | None |
Complications | Bleeding. Infection. In rare cases perforation. Side effects of sedation.
| Bleeding. Pneumothorax Sore throat. Side effects of sedation.
| Bleeding. Infection. In rare cases perforation. Side effects of sedation.
| Bleeding. Infection. In rare cases perforation. Side effects of sedation.
| UTI Urinary retention |
Other |
|
|
|
| Rigid is done over flexible cystoscopy if an intervention is planned. Rigid is done under GA. Felxi under local. |