Explaining scope procedures

Explain what the procedure is

Explain the reason for the procedure

Before

Oral intake

• 6 hours before – clear fluids (sips) only
• 2 hours before – NBM

Also if high-risk (e.g. transbronchial biopsy) depending on risk/benefit

• Stop clopidogrel 1 week before (unless high risk, e.g. drug-eluting stent)
• Stop warfarin 5 days before (± give LMWH)
• Stop DOAC 48 hours before

During

• Midazolam sedative (→amnesia)
• Lidocaine spray/gel to the nose, throat and windpipe

After

• No eating/drinking 2 hours after as throat still numb
• No driving, alcohol, operating machinery, or signing legal documents for 24 hours
• Keep someone with you for 24 hours
• Arrange follow-up

Risks

• Lung damage/collapse
• Infection
• Bleeding (haemoptysis)
• Sore nose/throat
• Sedation side effects
• Pneumothorax

Explain what the procedure is

Explain the reason for the procedure

Before

• Oral intake

  • 6 hours before – sips of water only (sips)
  • 2 hours before – NBM

• Also

  • Stop acid suppressive medications 2 weeks before

During

• Lidocaine throat spray or midazolam sedative (→amnesia)
• Continuous suction
• Air passed through scope (→fullness, belching)

After

• Arrange follow-up
• If had throat spray

  • No eating/drinking 2 hours after as throat still numb

• If had sedation

  • No driving, alcohol, operating machinery or signing legal documents for 24 hours
  • Keep someone with you for 24 hours

Risks

• Perforation (<0.1%)
• Bleeding
• Infection (aspiration pneumonia)
• Sore throat
• Dental damage
• Sedation side effects

Explain what the procedure is

Explain the reason for the procedure

Before

• Oral intake

  • 2 days before – low fibre diet (no bran/roughage)
  • 1 day before – clear fluids only after light breakfast
  • 2 hours before – NBM

• Also

  • Sodium picosulfate sachet afternoon before and morning of the procedure
  • Stop iron tablets 1 week before, and constipating agents 4 days before (e.g. codeine)

During

• Midazolam sedative (→amnesia)
• Digital rectal examination prior to scope insertion
• Air passed through scope (→bloating, you may feel like you need to go to the toilet)

After

• No driving, alcohol, operating machinery, or signing legal documents for 24 hours
• Keep someone with you for 24 hours
• Arrange follow-up

Risks

• Perforation (0.1%)
• Bleeding
• Infection
• Abdominal discomfort
• Sedation side effects

Explain what the procedure is

Explain the reason for the procedure

Before

• Oral intake

  • 2 hours before – NBM

• Also

  • Phosphate enema 2 hours before (can be self-administered at home)

During

• Digital rectal examination prior to scope insertion
• No sedation required

After

• Arrange follow-up

Risks

• Perforation
• Bleeding
• Infection
• Abdominal discomfort

Explain the reason for the procedure

Before

• None

During

• Anaesthetic jelly
• Water passed through scope

After

• Home after passed urine
• Arrange follow-up

Risks

• Bladder damage (hole)
• Bleeding (haematuria – normal for a few days)
• Infection (UTI)
• Dysuria
• Urethral stricture
• Retention
• May need temporary catheter afterwards

Explain what the procedure is

Explain the reason for the procedure

Before

• Oral intake

  • 6 hours before – clear fluids only
  • 2 hours before – NBM

• Also

  • Normal pre-operative assessment (including stopping anticoagulants/ antiplatelets – see pre-operative assessment)

During

• Usually have anaesthetic
• Water passed through scope

After

• Home after recovered from anaesthetic and passed urine
• No driving, alcohol, operating machinery, or signing legal documents for 24 hours
• Keep someone with you for 24 hours
• Arrange follow-up

Risks

• Bladder damage (hole)
• Bleeding (haematuria – normal for a few days)
• Infection (UTI)
• Dysuria
• Urethral stricture
• Retention
• May need temporary catheter afterwards
• Anaesthetic side effects