Pouchoscopy: examining an ileo-anal pouch

After some operations for ulcerative colitis or similar conditions, the colon and rectum are removed and a reservoir is made from the end of the small bowel, joined to the anus. This is called an ileo-anal pouch, or a J pouch. Crohn’s & Colitis UK describes the pouch as made by the ileum and joined to the bottom.

A pouchoscopy is an examination of that pouch. Northern Care Alliance explains that a doctor or nurse inserts a flexible tube called an endoscope, with a camera on its end, into the anus to look at the lining of the pouch.

The leaflet says the test examines the pouch lining for inflammation, abnormal growths and to take biopsies. In practice this is most often because of symptoms such as passing stools more often, blood in the stool or pain, which can be signs of pouchitis.

Crohn’s & Colitis UK says it is not really known what causes pouchitis, that around half of people with pouch surgery get it at some point, that symptoms can include needing to poo more frequently, blood in poo and pain, and that it is usually treated with antibiotics. The risk is increased if you have both colitis and primary sclerosing cholangitis. A look inside, with biopsies, helps tell pouchitis from other causes of similar symptoms.

The leaflet also lists abnormal growths (polyps) as something looked for. Whether you need any routine checks, and when, is a decision for your own surgical or gastroenterology team.

The leaflet describes what happens on arrival: a nurse completes an assessment, you sign a consent form, and you change into a gown. Preparation instructions, such as whether you need an enema or any bowel preparation, differ between hospitals and are not specified in the leaflet read for this guide, so follow your appointment letter.

If you plan to have sedation, arrange for a responsible adult to collect you, escort you home and stay with you for a minimum of 12 hours, as the leaflet says. Without sedation, the leaflet says you can leave straight after and resume normal activities, including working and driving.

You are asked to lie on your left side with your knees bent. A nurse stays with you, and a clip on your finger monitors pulse and oxygen. The endoscopist gently inserts the endoscope through the anus into the pouch, and air is passed in to give a clear view of the lining.

The leaflet says you may feel wind-like pains that should not last long, and may feel the need to go to the toilet, which is natural. There may be periods of discomfort as the tube goes round bends. If it is too uncomfortable, tell the endoscopist and nurse, and the procedure will be stopped if you have made it clear you are too uncomfortable.

If a biopsy is needed, forceps pass through the endoscope to pinch out a tiny bit of the lining, which is sent to the laboratory for analysis.

The leaflet says pouchoscopy carries a very small risk of bleeding or perforation of the bowel, more likely after a polyp is removed, and that a rare complication is an adverse reaction to the intravenous sedative and pain medicines.

Afterwards, you may feel a little bloated with wind-like pains because of air in the bowel, which usually settle quickly. If you had sedation you will be monitored for about an hour and advised not to drive, operate machinery or sign legal documents for 24 hours.

The leaflet says some information is given on the day, and that if you had a biopsy or polyp removed you should receive the final diagnosis from the person who requested the test or by letter. It lists a contrast study or a scan as possible alternatives in some cases.

Contact the unit or your GP, or use urgent services if needed, if you have heavy bleeding, severe or worsening tummy pain, a fever, or feel unwell in the days after. These are general safety points consistent with the very small risk of bleeding or perforation the leaflet lists, and your own leaflet will give the contact route.