Investigations

Banding is a procedure that is sometimes used to treat second and third degree haemorrhoids.

Banding involves a very tight elastic band being placed around the base of your haemorrhoids to cut off their blood supply. The haemorrhoids should fall off within seven days of having the treatment.

Banding is usually carried out as a day procedure and you should be able to return to work the following day. However, you may feel some pain or discomfort for a day or so. Normal painkillers are usually effective but, if necessary, your GP may prescribe something stronger.

You may not realise the haemorrhoids have fallen off because they should pass out of your body when you go to the toilet. If you notice some mucus discharge within a week of the procedure, it usually means that the haemorrhoid has fallen off.

Directly after the procedure, you may notice some blood on the toilet paper after going to the toilet. This is normal, but there should not be a lot of bleeding. If you pass a lot of bright red blood or blood clots (solid lumps of blood), go to your nearest accident and emergency department immediately.

Infections or ulcers (open sores) can occur at the site of the banding. However, these complications are rare and can be easily treated.

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What we mean by screening

Screening means looking for early signs of a disease in healthy people who do not have symptoms. Bowel cancer screening aims to detect bowel cancer at an early stage when treatment is more likely to work. If you already have symptoms, you need to see your doctor straight away. Don't wait for a screening appointment. 

Research has looked at 2 main ways of screening for bowel cancer

• Testing for blood in the stool (faeces)
• Examining the inside of the bowel

UK Bowel Cancer Screening

UK bowel cancer screening programmes aim to detect bowel cancer at an early stage. Regular bowel screening has been shown to reduce the risk of dying from bowel cancer by 16%.

As well as finding cancer at an early stage, bowel cancer screening can find polyps on the inner lining of the bowel. Polyps develop when cells grow too quickly and form a clump known as a bowel polyp or an adenoma. These are usually benign (non cancerous) but some may contain cancer cells. They may develop into a cancer over a number of years. Polyps can easily be removed, which reduces the risk of bowel cancer developing.

There are separate bowel screening programmes in England, Wales, Scotland and Northern Ireland. In England, men and women aged between 60 and 69 years old are sent a stool testing kit (faecal occult blood test) every 2 years. This is gradually being extended to include people up to the age of 75. Currently, people aged 70 and over can request a kit by contacting the bowel cancer screening helpline on 0800 707 6060.

Stool Testing

Stool testing means looking for hidden (occult) blood in your stool (faeces). It is also called faecal occult blood testing, or FOB, for short.

If you are within the age range of the bowel cancer screening programme, you will get a testing kit through the post every 2 years. This is a simple way for you to collect small samples of your bowel motions. You do this in your own home. You wipe the sample on a special card, which you then send to a laboratory for testing in a hygienically sealed, prepaid envelope. There are detailed instructions with each kit. You may think that the test sounds a bit embarrassing or unpleasant, but collecting the samples only takes a minute. You will be sent the results of your test by post within 2 weeks.

Only around 2 out of every 100 people tested (2%) are likely to have blood in their stool sample (an abnormal result). Other medical conditions or some things in your diet can cause an abnormal FOB result so this does not necessarily mean you have cancer. If you have an abnormal result, you will be offered an appointment with a specialist nurse at a bowel screening centre. You will have a more detailed examination, and may be offered a colonoscopy to see whether there is a problem that needs treatment.

In England, for every 1,000 people who have the FOB test, around 20 will have an abnormal result and may be asked to do the test again. Around 16 of those people will have a colonoscopy. Of those 16

• About 8 people will have nothing abnormal found at colonoscopy
• About 6 will have polyps
• About 2 will have cancer

Some people have an unclear result, which means there was a slight suggestion of blood in your FOB test sample. If you have an unclear result, you will be sent another FOB test kit and asked to do the test again. This is because the result could have been caused by medical conditions such as haemorrhoids (piles) or stomach ulcers. 

An abnormal result can happen if you eat a lot of red meat, turnips, or horseradish in the 3 days before the test. You can also have an abnormal result if you have had recent dental work that caused bleeding.

A normal test result doesn't completely rule out cancer. So, it is important to be aware of the symptoms of bowel cancer and see your GP if you are worried. 

Examining the bowel

People who have an abnormal stool test (faecal occult blood test) as part of the NHS bowel cancer screening programme are offered a test called a colonoscopy. Colonoscopy involves a doctor or specialist nurse examining the inside of your bowel with a long flexible tube. You can read detailed information on the colonoscopy drop down. 

Patients needing a colonoscopy through the Bowel Cancer Screening Programme are usually seen at Burnley General Teaching Hospital. 

Related sites

Bowel Cancer Screening - NHS Choices

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Coronation Street Star backs bowel cancer screening campaign

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Understanding Bowel Cancer Screening

What is a Colonoscopy?

Colonoscopy is a test which allows the doctor to look directly at the lining of the large bowel (colon) using a colonoscope. The colonoscope is a flexible tube about the thickness of your index finger. The doctor gets a clear view of the lining of the bowel and can check whether or not any disease is present. Sometimes the doctor takes a biopsy – a small sample of the lining for examination in the laboratory. A small piece of tissue is removed painlessly through the colonoscope using biopsy forceps.

For further information on colonoscopy please download the East Lancashire NHS Trust Having a Colonoscopy leaflet or view an easy read version here. 

As this test involves the bowel it is important that you follow the bowel preparation instructions that have either been given to you in clinic or sent with your appointment letter, this will ensure that your bowel is clean so we can see the lining of your bowel.

You may take medication for heart conditions, high blood pressure, asthma, epilepsy or any steroids with a small sip of water, but you should not take any other medication.

If you take oral iron tablets you should stop these tablets one week prior to the procedure.

If you are an Insulin/tablet controlled diabetic or you are taking Warfarin, or you have a latex allergy please telephone the endoscopy unit you are attending.

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Your doctor has advised you to undergo these combined procedures to help find the cause of your symptoms.

The first test is called a gastroscopy; this is to look directly into the gullet (oesophagus), stomach and the first part of the small bowel (duodenum). The second procedure you will be having is called a colonoscopy. This is an examination of the large bowel (colon).

The gastroscope is passed into the mouth by the endoscopist and then swallowed once it is in the correct position. The test allows the endoscopist to look directly at the lining of your oesophagus (gullet), stomach and duodenum (the first part of the small intestine).

Colonoscopy is a test which allows the doctor to look directly at the lining of the large bowel (colon). The doctor gets a clear view of the lining of the bowel and can check whether or not any disease is present.

During the tests the endoscopist may take samples (also called biopsies) for any disease or infection. The samples are removed painlessly through the endoscope, using tiny forceps. The endoscope is removed once the procedure has been completed.

If you take a proton pump inhibitor (eg Omeprazole or Lansoprazole) please stop taking these tablets two weeks prior to the date of your examination. If you are attending for a repeat procedure you may continue to take these tablets. 

You may take medication for heart conditions, high blood pressure, asthma, epilepsy or any steroids with a small sip of water, but you should not take any other medication.

If you take oral iron tablets you should stop these tablets one week prior to the procedure.

If you are an Insulin/tablet controlled diabetic or you are taking Warfarin, or you have a latex allergy please telephone the endoscopy unit you are attending.

As this test involves the bowel it is important that you follow the bowel preparation instructions that have either been given to you in clinic or sent with your appointment letter, this will ensure that your bowel is clean so we can see the lining of your bowel.

View the leaflet having a gastroscopy and colonoscopy

This is a new test that is available in some areas of the UK to identify Barrett’s oesophagus in people who have persistent heartburn and reflux symptoms. It is also used for patient with known Barrett's as an alternative to having an Endoscopy for surveillance. 

For the Cytosponge test you will be asked to swallow a small capsule with a sponge inside, which is attached to a piece of thread.

Approximately seven minutes after swallowing it, the capsule dissolves in the stomach, and the sponge inside is released. A nurse will then gently pull the thread to remove the sponge.

On the way out the sponge collects cells from the lining. The cells are then examined in the laboratory to check if there are any changes in the cells using a special stain  called TFF3. If this does show cell changes you will then be asked to attend
for an endoscopy to confirm whether there is Barrett’s present.

This procedure will be performed by a consultant who has been trained in endoscopic mucosal resection and is experienced in specialist endoscopy techniques.

What is endoscopic mucosal resection (EMR)?

Endoscopic mucosal resection is the name given to a procedure where specialised Endoscopic devices are used to remove abnormal areas in the lining of the oesophagus (gullet) or the stomach.

Who is suitable for endoscopic mucosal resection (EMR)?

EMR is potentially suitable for patients with small polyps in the stomach or gullet. For patients with early cancers or those at risk of developing cancer (Barrett’s Oesophagus) EMR may also be used. There is discussion at length by a team of specialists in a multidisciplinary meeting in order to decide a recommended treatment option.

For more information please read the EMR leaflet.

Information about having an EMR of the lower bowel.

This procedure will be performed by a consultant who has been trained in endoscopic mucosal resection and is experienced in specialist endoscopy techniques.

What is Endoscopic Mucosal Resection (EMR) of the lower bowel?

Endoscopic mucosal resection is the name given to a procedure where polyps of a larger size can be removed from the lower bowel safely.

For more information please read the EMR leaflet for the lower bowel.

ERCP is a procedure performed under x-ray control using an endoscope, which allows the bile, pancreas and liver ducts to be examined. These ducts are outlined with x-ray dye. If gallstones or a narrowing of the bile duct are found, they can sometimes be treated during ERCP.

All ERCPs are undertaken at the Royal Blackburn Teaching Hospital.

Read patient leaflet

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EUS is an investigation that uses a thin flexible tube (an endoscope) with a small ultrasound probe attached to the tip.  This tube is inserted via the mouth into your gullet (oesophagus), stomach and upper part of the small intestine (duodenum).  You may already have had an endoscopy (gastroscopy) to assess your symptoms as a first investigation.  EUS is a similar test but is more elaborate and assesses the gut in an in-depth manner.  You may also have had an ultrasound (US) or heard of it being done to look at baby in pregnant women.  This is generally performed from the outside of the body via an US probe placed on the skin.  Although this gives good images the US waves are distant from the organs inside your abdomen.  EUS brings the US probe closer to the organs and provides clearer images.

View patient leaflet. 

For more information on endoscopic ultrasound scans (EUS) of the rectum please see this patient leaflet. 

A PEG is a small feeding tube which passes through the abdominal wall directly into the stomach. It allows nutrition to be provided without the need to swallow and thus is a method of providing long term nutrition and hydration. This may be required because a person cannot eat enough to meet their nutritional requirements. Common indications for a PEG tube include strokes (CVA), head injuries, cancer, neurological diseases such as multiple sclerosis and motor neurone disease or surgery to the head and neck. The food is usually provided in a special liquid form that is dripped into the stomach slowly with a special pump or syringe. Medications can also be taken through the tube.

In order to position the tube correctly an endoscope (camera) will be passed through your mouth, down the oesophagus (gullet) and into the stomach. The tube can then be inserted through a small incision in the abdominal wall.

The PEG team includes a doctor, nurse, dietitian, speech and language therapist and district nurses who will be able to give more information as necessary and answer any questions you may have. For further information on having a PEG tube fitted, please download the leaflet on Having a PEG Feed.

A sigmoidoscopy is a test which allows the doctor to look directly at the lining of the large bowel (colon ) using a sigmoidoscope. The examination is limited to the lower segment of your large bowel. The sigmoidoscope is a flexible tube, about the thickness of your index finger. The doctor gets a clear view of the lining of the bowel and can check whether or not any disease is present. Sometimes the doctor takes a biopsy – a small sample of the lining for examination in the laboratory. A small piece of tissue is removed painlessly through the sigmoidoscope using biopsy forceps.

For more information on having a sigmoidoscopy, please download the East Lancashire NHS Trust Having a Flexible Sigmoidoscopy leaflet or view an easy read version here. 

Most patients will need to take a laxative in order to clear their bowel before the examination. This will be discussed either by your GP or at the hospital when you attend for your appointment.

You may take medication for heart conditions, high blood pressure, asthma, epilepsy or any steroids with a small sip of water, but you should not take any other medication. If you take oral iron tablets you should stop these tablets one week prior to the procedure. If you are an Insulin/tablet controlled diabetic or you are taking Warfarin, or you have a latex allergy please telephone the endoscopy unit you are attending. 

As this test involves the bowel it is important that you follow the bowel preparation instructions that have either been given to you in clinic or sent with your appointment letter. 

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What is a Gastroscopy?

An endoscope is a thin flexible tube with a light at the end, it is passed into the mouth by the endoscopist and then swallowed once it is in the correct position. The test allows the endoscopist to look directly at the lining of your oesophagus (gullet), stomach and duodenum (the first part of the small intestine). During the test the endoscopist may take samples (also called biopsies) for analysis or to check for infection in the lining of the stomach with the bacteria Helicobacter pylori. The samples are removed painlessly through the endoscope, using tiny forceps. The endoscope is removed once the procedure has been completed.

For further information about having a Gastroscopy please download the East Lancashire NHS Trust Having a Gastroscopy leaflet or view an easy read guide here. 

Please have nothing to eat or drink for 6 hours before you arrive at the Endoscopy unit. 

You may take medication for heart conditions, high blood pressure, asthma, epilepsy or any steroids with a small sip of water, but you should not take any other medication.

If you take a proton pump inhibitor (eg Omeprazole or Lansoprazole) please stop taking these tablets two weeks prior to the date of your examination. If you are attending for a repeat procedure you may continue to take these tablets. 

If you are an Insulin/tablet controlled diabetic or you are taking Warfarin, or you have a latex allergy please telephone the endoscopy unit you are attending. 

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Capsule endoscopy is a procedure that uses a tiny wireless camera to take pictures of your digestive tract. A capsule endoscopy camera sits inside a vitamin-size capsule you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist. 

Capsule endoscopy helps doctors see inside your small intestine — an area that isn't easily reached with more-traditional endoscopy procedures. Traditional endoscopy involves passing a long, flexible tube equipped with a video camera down your throat or through your rectum. 

Click here for more information.

Some patients may be required to have a patency capsule first prior to the capsule endoscopy. You can find our more about this below:

You have been referred for a Capsule Endoscopy.

We feel however, it would be prudent to perform a patency capsule first, before proceeding to the real video pill. Patency capsules should be considered in patients when there is a suspicion of narrowing of the bowel lumen.

A patency capsule is a capsule of the same size as the video pill. At either end there is a small wax plug which breaks down when exposed to intestinal fluids and enzymes. Inside the patency capsule is a mixture of barium and lactose. The wax plugs and lactose begin to dissolve at about 40 hours after ingestion. The idea is that even if there is a narrowing (stricture) of the small bowel the dissolving capsule means that it is very unlikely that it will cause impaction and symptoms of obstruction.

The Patency Capsule procedure:

1) The patency capsule is enclosed. Please store it in a dry, safe place for now. Await for your radiology appointment/letter (low radiation CT scan or xray). You will need this before you swallow the capsule.

2) The best results are given if you swallow the capsule 20 to 26 hours before your imaging test. Please swallow the capsule (whole and not chewed) with a glass of water the morning before your planned imaging test. It is vital you swallow the capsule at the correct time as this is a time sensitive test.

3) Please eat and drink normally.

4) The next day you must attend the radiology department of Royal Blackburn Hospital to be scanned. This is again time sensitive.

5) If the capsule is not detected on the scan or has already passed in the large bowel, it should be considered safe to proceed with the wireless capsule endoscopy. We will let you know of the outcome through a new letter.

6) If you have a colostomy/ileostomy and observe the patency capsule excretion, please inform our VCE coordinator Physician Associate Mobeen Afiz through the switchboard of Royal Blackburn Hospital as there is no need to attend for the scan.

If you require any information about this test please do not hesitate to contact Physician Associate, Mobeen Afiz, through the switchboard of Royal Blackburn Teaching Hospital.