How to prepare for your endoscopy procedure. What is the best way to clean your colon before a colonoscopy. Why is a clean colon important for an effective endoscopy. What dietary restrictions should be followed before an endoscopy. How to properly use the endoscopy prep drink for optimal results.

Understanding the Importance of Colonoscopy for Colon Cancer Prevention

Colonoscopy stands as the gold standard for colon cancer screening and prevention. This crucial procedure allows doctors to examine the entire length of the colon using a flexible scope equipped with a light and camera. During the examination, physicians can detect and remove polyps – abnormal tissue growths that may potentially develop into cancer.

Why is colonoscopy so effective in cancer prevention? The ability to remove polyps during the procedure effectively eliminates the risk of these growths progressing to malignancy. This proactive approach significantly reduces the incidence of colon cancer, making colonoscopy an invaluable tool in preventive healthcare.

The Colonoscopy Procedure: What to Expect

During a colonoscopy, the doctor carefully inserts a flexible scope through the rectum and guides it to the beginning of the colon. This specialized instrument allows for a thorough examination of the colon’s inner lining. If any polyps or suspicious areas are identified, the physician can remove them immediately or take biopsies for further analysis.

The procedure typically takes about 30 to 60 minutes, although patients should plan to be at the endoscopy center for two to two and a half hours to account for preparation and recovery time. To ensure comfort during the examination, sedation is administered through an IV, making the experience virtually painless for most patients.

The Crucial Role of Colon Cleansing in Successful Endoscopy

A thorough colon cleanse is paramount for a successful colonoscopy. Why is a clean colon so important? A properly cleansed colon allows the doctor to have a clear, unobstructed view of the colon walls, ensuring that no potential issues are missed during the examination.

Research has shown that the most effective method for colon cleansing involves a two-dose regimen of an oral liquid laxative. This approach ensures optimal visibility during the procedure, significantly improving the accuracy of the examination and reducing the likelihood of missed polyps or other abnormalities.

The Two-Dose Laxative Regimen: Timing and Importance

The first dose of the laxative is taken the evening before the scheduled colonoscopy, while the second dose is administered on the morning of the procedure. This split-dose approach is crucial for several reasons:

• The first dose initiates the cleansing process, removing most of the solid waste from the colon.
• The second dose eliminates any remaining debris and clears out fluids produced by the body overnight.
• This two-step process ensures the colon is as clean as possible, providing optimal conditions for the examination.

It’s important to note that even if the colon appears clean after the first dose, the second dose is still essential. Many patients who skip the second dose often need to reschedule their procedure due to inadequate colon preparation.

Preparing for Your Endoscopy: A Step-by-Step Guide

Proper preparation is key to a successful endoscopy. Here’s a comprehensive guide to help you prepare effectively:

One Month Before Your Procedure

Approximately one month before your scheduled colonoscopy, you will receive detailed instructions and a paper prescription for the liquid laxative. Upon receiving these materials:

1. Take the prescription to your pharmacy to obtain the liquid laxative.
2. Arrange for a responsible person to accompany you to the endoscopy center, remain on-site during the procedure, and drive you home afterward.

If you haven’t received your instructions within two weeks of your procedure, contact the medical office promptly.

One Week Before Your Procedure

In the week leading up to your colonoscopy:

• Avoid foods containing nuts or seeds, as these can interfere with the scope.
• Stop taking iron supplements.
• Review the medication section in your instruction letter and plan for adjusting blood thinners, diabetic medications, or anti-diarrhea medicines as needed.
• Consult with your prescribing doctor before making any changes to blood thinners.

Three Days Before Your Procedure

Begin a low-residue diet. This involves avoiding high-fiber foods and opting for easily digestible options:

• Avoid: Fresh fruits, fresh vegetables, whole grain breads, and beans
• Choose: White bread, white rice, pasta, meat, fish, eggs, and tofu
• Canned vegetables or fruits without skins or seeds are acceptable
• Check food labels and avoid items with more than 1 gram of fiber per serving

The Day Before Your Endoscopy: Dietary Restrictions and Prep Drink Instructions

The day before your colonoscopy is crucial for proper preparation. Here’s what you need to know:

Dietary Restrictions

Starting at midnight, you must switch to a clear liquid diet. This means no solid food for the entire day before your procedure. Acceptable clear liquids include:

• Apple juice, white cranberry juice, or white grape juice
• Clear sports drinks (e.g., Gatorade)
• Soda pop
• Black coffee and tea (without milk)
• Clear broths (beef, chicken, or vegetable)
• Jell-O and popsicles (avoid red or purple colors)

Avoid the following:

• Opaque juices (e.g., tomato or orange juice)
• Kombucha
• Milk, coffee, or tea with cream
• Ice cream
• Cream soups
• Protein drinks

Preparing and Taking the Laxative

In the morning, mix your prep drink according to the instructions provided. Once the powder is completely dissolved, you may refrigerate the solution if desired. Many patients prefer the laxative cold.

Between 4 p.m. and 6 p.m., drink the first half of your liquid laxative. If you have diabetes, take half your usual dose of evening insulin at this time. Be prepared to stay near a restroom, as the laxative typically takes effect within an hour.

Continue drinking clear liquids throughout the evening. Aim to consume about 1 gallon of clear liquids throughout the day to stay hydrated and support the cleansing process.

The Day of Your Endoscopy: Final Preparations

On the day of your procedure, follow these important steps:

Taking the Second Dose of Laxative

Four hours before leaving for your appointment, drink the remaining half of your liquid laxative. This second dose is crucial for removing any fluids produced by your body overnight and ensuring your colon is completely clean for the procedure.

Assessing Your Readiness

After completing the laxative regimen, your bowel movements should resemble clear liquid, similar to urine. If you notice any solid material or if your bowel movements look cloudy two hours before your scheduled departure time, contact the medical office immediately.

Final Fasting Period

Two hours before your arrival time at the endoscopy center, stop consuming all food and liquids. This fasting period is essential for your safety during the procedure.

Post-Procedure Care and Follow-Up

After your colonoscopy, it’s important to follow the care instructions provided by your healthcare team. Here are some general guidelines:

• Rest for the remainder of the day following your procedure.
• Do not drive or operate heavy machinery for at least 24 hours after receiving sedation.
• Gradually reintroduce solid foods as tolerated.
• Stay hydrated by drinking plenty of fluids.
• Avoid alcohol for at least 24 hours after the procedure.
• Contact your doctor if you experience severe abdominal pain, fever, or prolonged bleeding.

Your doctor will provide you with the results of your colonoscopy and any necessary follow-up instructions. They may recommend a schedule for future screenings based on your individual risk factors and the findings of the current examination.

Understanding the Risks and Benefits of Colonoscopy

While colonoscopy is generally a safe procedure, it’s important to be aware of both its benefits and potential risks:

Benefits of Colonoscopy

• Early detection of colon cancer and precancerous polyps
• Ability to remove polyps during the procedure, preventing their progression to cancer
• Diagnosis of other bowel conditions such as inflammatory bowel disease
• Peace of mind from a thorough colon examination

Potential Risks and Complications

Although rare, potential risks of colonoscopy include:

• Bleeding, especially after polyp removal
• Perforation of the colon wall
• Adverse reaction to sedation
• Infection (very rare with proper sterilization techniques)

Your doctor will discuss these risks with you and answer any questions you may have before the procedure.

Frequently Asked Questions About Colonoscopy Preparation

Here are answers to some common questions patients have about preparing for a colonoscopy:

Can I drink coffee during the clear liquid diet?

Yes, you can drink black coffee without any cream or milk. However, avoid coffee with any additives during your clear liquid diet phase.

What if I feel nauseous while drinking the laxative solution?

If you experience nausea, try the following:

• Slow down your intake of the solution
• Use a straw to bypass your taste buds
• Chill the solution before drinking
• Suck on a lemon or hard candy between doses

If nausea persists or becomes severe, contact your healthcare provider.

How long will the effects of the laxative last?

The effects of the laxative typically begin within an hour of taking the first dose and may continue for several hours. Plan to stay near a bathroom during this time. The effects should subside a few hours after completing the second dose.

What if I accidentally eat solid food on the day before my procedure?

If you accidentally consume solid food during the clear liquid diet phase, contact your healthcare provider immediately. They will advise you on whether your procedure needs to be rescheduled or if additional preparation steps are necessary.

Can I take my regular medications while preparing for the colonoscopy?

Most medications can be continued as usual, but some may need to be adjusted or temporarily stopped. Always consult with your doctor about your specific medication regimen, especially regarding blood thinners, diabetes medications, and iron supplements.

By following these comprehensive guidelines and working closely with your healthcare team, you can ensure the best possible outcome for your colonoscopy procedure. Remember, thorough preparation is key to a successful examination and plays a crucial role in maintaining your colorectal health.

Preparing for Your Endoscopy Procedure

Thank you for choosing OHSU for your colonoscopy. And congratulations on taking an important first step in preventing colon cancer.

Colonoscopy is the best way to screen for and prevent colon cancer. During the procedure, the doctor will pass a flexible scope with a light and camera through your rectum to the beginning of your colon. Polyps are abnormal tissue in your colon that may turn to colon cancer. If any polyps are found, your doctor will remove them during the procedure preventing them from being able to turn into cancer.

Your colon must be very clean on the day of your procedure so the doctor has a clear view of the walls of your colon.

Researchers have found that the best way to clean your colon is with two doses of an oral liquid laxative.

The first dose is taken the evening before your colonoscopy. The second dose is taken the morning of your scheduled colonoscopy.

It may appear that your colon is clean after drinking the first dose, but your stomach is still making fluids that can make it difficult for your doctor to see the walls of your colon. The second dose removes the fluids your body produced overnight to completely clear all material from your colon.

It’s very important you don’t miss the second dose. Many patients who don’t drink the second dose of the liquid laxative have to be rescheduled because their colon is not clean enough.

You will receive sedation medicine through an IV to make you sleepy and comfortable during the procedure. Patients who receive sedation are not able to drive after the procedure. You must have a responsible person drive you home or accompany you home in a taxi or public transportation.

You will receive instructions and a paper prescription mailed to your address on file approximately one month before your procedure. If you have not received this within two weeks of your procedure, please contact our office. Keep an eye out for the instructions and prescription in your mailbox.

Two things to do as soon as you receive your instructions: One, take your paper prescription to the pharmacy to get your liquid laxative. Two, coordinate for someone to go with you to the endoscopy center, remain on site, and drive you home or accompany you home in a taxi or public transportation. You should plan to be at the endoscopy center for two to two and half hours.

Haven’t gotten your instructions yet? Call our office 503-494-4373.

• Avoid foods with nuts or seeds. They can plug up the scope.
• Stop taking iron today.
• Review the medication section in your instruction letter, and create a plan for adjusting blood thinners, diabetic medications, or anti-diarrhea medicines.
• Check with your prescribing doctor before you make changes to blood thinners.

Still have questions? Call our office.

Begin a low residue diet. You should avoid foods high in fiber, such as fresh fruits and fresh vegetables, and whole grain breads and beans, and choose foods such as white bread, white rice, pasta, meat, fish, eggs, and tofu. You can have canned vegetables or fruits without skins or seeds. If in doubt, check the label. And avoid all foods with fiber content greater than 1 gram.

Starting at midnight the day before your procedure, no solid food. You may drink clear liquids only. Acceptable clear liquids are apple juice, white cranberry, or white grape juice, clear sports drinks, like Gatorade, soda pop, black coffee, and tea without milk, clear broth, like beef, chicken, or vegetable, Jell-O, and popsicles. No red or purple colored items. Avoid juices that you cannot see through, like tomato or orange juice, kombucha, milk, coffee, or tea with cream, ice cream, cream soups, or protein drinks.

In the morning, mix your prep with water as indicated in the instructions. Once the powder is completely dissolved, you may place the liquid in the refrigerator. Many patients prefer the laxative cold.

Between 4 p.m. and 6 p.m. the night before your appointment, drink the first half of your liquid laxative. If you are diabetic, take half your dose of evening insulin tonight. You will start feeling the effect of the laxative within an hour. You’ll want to be near a restroom once you begin drinking the solution.

Continue drinking clear liquids the remainder of the evening. The goal is to drink 1 gallon of clear liquids throughout the day.

If you have not had a bowel movement by 10 p.m., call the hospital and ask to speak with a GI fellow on call.

Four hours prior to leaving the house, drink the remaining half of your liquid laxative. Once your colon is properly cleaned, you should not see any solids in the toilet. Your liquid bowel movements should look like urine. If your liquid bowel movements look like images one, two, or three, two hours before leaving the house, please call our office.

Two hours before your arrival time, do not eat or anything.

We’re looking forward to seeing you on your scheduled colonoscopy day. Thank you for choosing OHSU for your health care.

Funding for this video provided by Colon Cancer Coalition.

FAQ as You Prepare for Your Colonoscopy or Upper Endoscopy

Thank you for choosing to have your procedure with Mass General Gastroenterology Associates. Patients often have questions as they prepare for their colonoscopy or upper endoscopy. Below are answers to some frequently asked questions.

Information on preparing for your procedure can also be found in the bowel preparation packet that you received in the mail. If you still have questions after reviewing your bowel preparation packet and the information below, please call the GI office at 617-726-7663.

Medicines

Do I need to stop taking my blood thinner?  

If you take blood thinners, we recommend you take them unless your gastroenterology doctor told you to stop taking them.  We also encourage you to communicate with your prescribing provider (heart doctor or primary care provider). Blood thinners may include Coumadin, Plavix, Pradaxa, Eliquis and Lovenox.

If I had a knee replacement, should I take antibiotics ?

If you previously had a knee replacement, antibiotics are generally not needed to prevent joint infections. However, if your orthopedic doctor or primary care doctor recommends antibiotics, please contact their office for a prescription and instructions.

If I had a heart valve replacement, should I take antibiotics?

If you previously had a heart valve replacement, antibiotics are generally not needed to prevent valve infections. However, if you have a high-risk heart condition, antibiotics may be recommended. Please check with your heart doctor to see if antibiotics are recommended for you.

Can I continue my vitamins, iron pills, or liquid antacids?

If you take vitamins, iron pills, or liquid antacids, stop taking them 5 days before your procedure. Liquid antacids include Mylanta and Gaviscon. If you are unsure, check with your prescribing provider.

Should I take my medicine for diabetes?

If you are taking Canagliflozin (Invokana), Canagliflozin and Metformin (Invokamet), Dapagliflozin (Farxiga), Xigduo XR Dapagliflozin and Metformin extended-release, or Empagliflozin (Jardiance), please stop it at least three days before your colonoscopy. If you are taking ertugliflozin (Steglatro, Steglujan, or Segluromet), please stop it at least four days before your scheduled colonoscopy. Make sure to contact your primary care physician or diabetes doctor about the suggested changes above and get their guidance as well

If you take insulin, we usually recommend that you take ½ your normal dose on the day of the procedure.

Should I take other medicines prescribed for me?

Contact the provider who prescribed the medicine for you about any changes needed before your procedure. In general, we recommend that you take your usual medicine as prescribed when possible. 

Bowel Prep Laxative

What should I do if a prescription for laxative wasn’t included in my bowel preparation packet?

Some bowel preparations require prescription laxative. If your bowel preparation instructions say that you will need to take prescription laxative, your prescription will be sent electronically to your pharmacy. Many pharmacies place these prescriptions on hold, so contact your pharmacy and ask to have it filled.

What should I do if my pharmacy hasn’t received the prescription for laxative yet?

Please call your pharmacy first.  If your pharmacy does not have the prescription for laxative, please call your gastroenterology doctor’s office for a prescription. If your procedure is more than 1 week away, you may also send a Patient Gateway message to request a prescription at patientgateway.massgeneralbrigham.org

I was given PEG laxative. Is it the same as GoLYTELY?

Yes, PEG and GoLYTELY laxatives are the same. The generic name is PEG-3350 with Electrolytes (polyethylene glycol electrolyte solution). Brand names include GoLYTELY, NuLYTELY, Colyte, Trilyte, or GaviLyte.

What if a prior authorization is needed for my prep/laxative?Please check with your insurance upon scheduling to understand if your prep requires a prior authorization (insurance coverage).   It is important to you notify the office as soon as possible to avoid scheduling issues.

I took magnesium citrate as a laxative the last time. Can I have that this time?

We no longer recommend magnesium citrate as a laxative for our patients. Magnesium citrate doesn’t work as well and can have more risks and side effects than other laxatives.

My friend had a laxative that was easier to drink. Can I have a different laxative?

We strongly recommend that you use the laxative prescribed for you. Other laxatives may not work as well, may not be covered by your insurance, and can be more expensive.

Do I need to drink half of the laxative the night before my procedure and half the morning of my procedure?

Yes, it is important to drink half of the laxative the night before your procedure and half the morning of your procedure. Make sure you follow the schedule in your bowel preparation packet carefully. Following this schedule will clean your bowels completely and allow your gastroenterology doctor to see inside your colon better.

If your bowels are not clean, your procedure may get postponed, cancelled, or need to be repeated. You may also be given a different bowel preparation to clean your bowels better.

Please follow our instructions and disregard the bottle which may tell you to take the laxative all at once.

Do I need to wake up in the middle of the night to finish drinking the laxative?

It is very important that you finish the laxative 4 hours before your scheduled arrival time as instructed in your bowel preparation packet. This may require you to wake up in the middle of the night to finish drinking the laxative. The correct timing of drinking the laxative is important in cleaning your bowels completely and allowing your gastroenterology doctor to see inside your colon better.

We understand early appointments and travel time may be difficult however please make every effort to follow the prep instructions, it is to your benefit to avoid having to re-schedule your procedure for poor prep.  

You may drink a small amount of clear liquids up until 2 hours before your procedure. 

If your bowels are not clean, your procedure may get postponed, cancelled, or need to be repeated.

Can I drink all the laxative the night before my procedure?

No. It is important to follow the schedule in your bowel preparation packet. Drinking the last half of the laxative closer to your procedure time will give better results and a cleaner colon for your procedure.

If your bowels are not clean, your procedure may get postponed, cancelled, or need to be repeated. You may also be given a different bowel preparation to clean your bowels better.

What should I do if I have a long travel time to MGH for my procedure?

If you have a long travel time to MGH for your procedure, we recommend that you drink the last half of the laxative earlier. For example, we generally recommend drinking the last half of the laxative 4-5 hours before your scheduled arrival time. However, if it will take you 2 hours to get to MGH, you may want to drink the last half of the laxative 6-7 hours before your scheduled arrival time instead. This will allow the laxative to work before you leave for your procedure.

What are some tips for drinking the laxative if I feel sick to my stomach?

It is common to feel nauseous or sick to your stomach during your bowel preparation. Here are some tips you can try to help you drink the laxative:

• Rest for 30 minutes then continue to drink the laxative every 20-30 minutes as tolerated.
• Use a straw to drink the laxative.
• Chill the laxative in the fridge and drink it cold.
• Add some fruit juice, Crystal Light, or ice to the laxative to help make it taste better. Don’t use any red, purple or orange colored fruit juice or Crystal Light.
• Chew gum or suck on lemon or hard candy in between drinks to help with the taste.

These tips can also be found in your bowel preparation packet.

What if the amount of laxative will be too much for me to drink?

If you think the amount of laxative will be too much for you to drink, talk with your gastroenterologist about your options.

What should I do if I already drank the first half of the laxative, but haven’t had a bowel movement yet?

If you haven’t had a bowel movement after the first half of the laxative, continue to drink the laxative until you have a bowel movement then stop. In the morning, finish drinking the rest of the laxative as instructed in your bowel preparation packet.   

Be sure to drink plenty of clear liquids to keep yourself hydrated.

What should I do if I have severe constipation or gastroesophageal reflux disease?

If you have a history of severe constipation, GERD (gastroesophageal reflux disease), or any other problems with digestion, contact your gastroenterology doctor at least 2 weeks before your procedure to discuss the right laxative and diet plan for you.  

What should I do if I don’t think the laxative prescribed for me will clean out my bowels completely?

If you don’t think the laxative prescribed for you will clean out your bowels completely, contact your gastroenterology doctor at least 2 weeks before your procedure to discuss the right laxative and diet plan for you. 

How can I tell if my bowels are clean before my procedure?

After finishing your laxative, your stool should be watery. The color of your stool should also be clear or yellow.

If your stool is thick, brown, or has particles in it, call your gastroenterology doctor to [complete instructions here].

What do you recommend if I did not tolerate the prep for my last colonoscopy?

Please discuss prep options with your endoscopist and or primary care provider when the procedure is booked.  It is important to have the best prep possible to ensure a thorough examination of your colon.

If I have constipation, what can I do improve this?

If you move your bowels 2 times a week or less or if you use a laxative more than 2 times a month, at bedtime, take 4 tablespoons of milk of magnesia.  

Anti-Gas Pills

What are anti-gas pills?

Anti-gas pills are chewable simethicone tablets. They are available over the counter at your pharmacy. Some brand names include Gas-X, Maalox Anti-Gas, Mylicon, and Mylanta Gas. Any brand is fine.  Please take two tablets of the regular strength simethicone.  Ask your pharmacist if you would like help finding them.  Please avoid the cherry flavor (red color).

Do I need to take the anti-gas pills?

Yes, the anti-gas pills will help reduce air bubbles in your colon and allow your gastroenterology doctor to see inside your colon better. Check your bowel preparation packet for instructions on taking anti-gas pills. 

Diet and Nutrition

I ate breakfast the morning of my procedure. Can I still have my procedure?  

If you ate breakfast the morning of your procedure, your procedure must be rescheduled for a later date. To reschedule your procedure, please call [GI office/617-726-2426 option #3] as soon as possible.

It is important to follow the instructions in your bowel preparation packet carefully to prevent your procedure from getting rescheduled.

Can I drink protein drinks?

No, protein drinks, including shakes, are not allowed.

One day before your procedure, stop drinking protein drinks. Follow a clear liquid diet as instructed in your bowel preparation packet.

I “juice” my food. Can I continue to drink them?

No, juiced foods are not allowed.

One day before your procedure, stop drinking juiced foods. Follow a clear liquid diet as instructed in your bowel preparation packet.

Should I hold my TPN feed the night before or the morning of my procedure?

If you are on TPN (total parenteral nutrition), there is no need to hold your TPN feed before your procedure. Continue your usual TPN feed as scheduled.

Should I hold my G-tube feedings the night before or the morning of my procedure?

If you receive G-tube (gastronomy tube) feedings, hold all tube feedings starting midnight the night before your procedure.

Arrival and Procedure Times

Why do I need to arrive early to the endoscopy unit?

It is important to arrive at the time listed in your bowel preparation packet to allow us to get you ready for your procedure. This includes filling out paperwork, changing into a hospital gown, taking your vital signs, placing an IV (intravenous) catheter in your arm for medicine, and answering any questions you have about the procedure. Please arrive on time to prevent delays in starting your procedure.

How long will my procedure last?

Plan on spending about 3 hours total in the Endoscopy Unit. This includes time needed to prepare for the procedure, perform the procedure, and recover after the procedure.

Average length of each procedure:

• Colonoscopy – 20-30 minutes
• Flexible Sigmoidoscopy – 10 minutes
• Upper Endoscopy – 10 minutes

The length of your procedure will depend on the type of procedure you will have and the care you will need during the procedure.  

Escort

Why do I need an escort?

You will receive medicine to help you feel relaxed and comfortable during your procedure. It will take some time for the medicine to completely wear off after. For this reason, you will need an escort, an adult aged 18 or over, to come up to the endoscopy unit in person to pick you up.  Ride services such as Uber, Lyft, etc will not suffice as an escort.

When you arrive for your procedure, you must provide the name and phone number of your escort. Before your procedure begins, we will confirm with you, the patient, that your escort will be able to pick you at the Endoscopy Unit and bring you home.

If we cannot confirm that you have an escort, your procedure will be rescheduled for a later date. We follow this policy strictly for the safety of our patients.

What time should my escort pick me up?

Your escort should be able to pick you up 30 minutes after we call them.  

Procedure Questions

What is conscious (procedural) sedation? Will I be going to sleep?

It is combination of sedatives and narcotics. Our goal is not for you to go to sleep but for you to feel comfortable during the exam. You will feel the effects of the medications for a couple hours after the procedure. Therefore, you cannot drive the day of your examination. 

What are the common complications that arise from colonoscopy or endoscopy?

The common complication from these procedures is related to conscious sedation. Many patients feel sleepy and tired after the procedures. After colonoscopy, bloating and cramps is common. The more serious complications include bleeding or perforation. Bleeding may occur after a polyp is removed. With significant bleeding, you will see fresh, red blood in your stool. A perforation of your bowel will cause severe abdominal pain and fever. For these serious complications, it is important for you to be evaluated quickly in the MGH emergency department or a one closer to you.  

Post-Procedure Questions 

What if I haven’t received my results from my procedure after 14 days?

Please contact your gastroenterology doctor’s office via telephone or patient gateway.  

What if I am having pain after my procedure?

Some mild gas pain may be expected following your colonoscopy. Walking can be helpful. If pain is persistent and accompanied by fever, chills, blood in stools, hard abdomen, abdominal swelling or inability to pass gas, you should seek urgent medical attention. 

What is a biopsy and how to I get the report?

A biopsy is a sample of tissue taken during a procedure. Biopsies are often taken of ulcers, tumors, polyps, and abnormal tissue in order to examine the samples with a microscope. The reports are usually available in 10-14 days. After your procedure, you should receive a written letter with the biopsy results. 

Will I see my physician after the procedure?

Since you will be receiving sedatives for your procedures, you may not remember much of the test or the discussions afterwards. You will have the opportunity to see your physician prior to the procedure and your discharge paperwork will inform you if polyps were removed or biopsies taken. The results of the procedure will be given to you in written form. This will help you remember what was found during the procedure. All reports are sent to the referring physician(s) after the procedure.  

What if I am breast feeding?

If you receive anesthesia, please discuss with your pediatrician for recommendations for breast feeding after sedation/anesthesia. 

Other GI Endoscopy Procedure Questions

What is an ERCP?

ERCP (endoscopic retrograde cholangiopancreatography) is a term for a procedure in which the bile and pancreatic ducts are examined with an endoscope. X-ray dye is injected into the ducts and x-ray pictures are taken. If there is a blockage, a stent will be placed to unblock the duct. 

What is an MRCP?

MRCP (Magnetic Cholangiopancreatography) is a term for a uses a powerful magnetic field, radio waves and a computer to evaluate the liver, gallbladder, bile ducts, pancreas and pancreatic duct for disease. It is noninvasive and does not use radiation. A dye is used to better examine the given area.

What is an EUS?

EUS, or endoscopic ultrasound, is an endoscopic exam using an endoscope with an ultrasound probe on the tip of the scope. This type of exam is often performed to evaluate patients with abnormalities in the pancreas and tumors in the esophagus and stomach.

Rules for preparing for endoscopic examinations in Voronezh at the Eucalyptus clinic

Date: 07/31/2019

Rules for preparing for EGD

parts of the digestive tract: esophagus, stomach and duodenum.

2 days before the date of the upcoming study RECOMMENDED TO EXCLUDED seeds, nuts, alcohol, and foods that can cause bloating (fresh vegetables and fruits, sauerkraut, legumes, etc.) from the daily diet.

In the evening before the upcoming examination, it is recommended to avoid eating after 18.00. Dinner should consist of easily digestible food.

Breakfast is EXCLUDED on the day of the study . If the study is scheduled for the afternoon, it is highly undesirable to take any food.

NOT RECOMMENDED DO NOT smoke, take any medicines by mouth in tablets/capsules unless absolutely necessary in the morning before the test.

Exam day IT IS ALLOWED to brush your teeth, drink water and a weak hour with sugar 2-4 hours before the EGD (no bread, biscuits, sweets, etc.), take medicines that can be dissolved in the mouth or sprayed.

ATTENTION! Do not forget to remove dentures before the examination. Free the head and neck area as much as possible from clothing and accessories: take off your glasses and tie, unbutton the collar on your shirt.

If you are ALLERGY to any drugs, NOTIFY of this doctor before starting the study.

Take with you your regular prescriptions so that you can take them after the test, as well as your previous endoscopy results, if any. The latter will help the doctor assess the dynamics of the disease.

*There are contraindications. Specialist consultation is required.

Rules for preparing for EGD.pdf

Rules for preparing for colonoscopy

Colonoscopy is an instrumental examination method used to diagnose pathological conditions of the colon and rectum.

Preparation starts 3 DAYS BEFORE THE STUDY with a slag-free diet and bowel cleansing the day before the test. Remember that proper preparation directly affects the quality of the study.

General preparation rules:

• first day of preparation – 3 days before the study: slag-free diet
• second day of preparation – 2 days before the study: slag-free diet
• the third day of preparation – 1 day before the study (on the eve of endoscopy): liquids + “Fortrans” * + “Espumizan” **
• day of the study: “Fortrans” * + “Espumizan” **.

FOOD-FREE DIET PRINCIPLES during colonoscopy preparation:

EXCLUDED FROM THE DIET: cereals: all grain-containing products (whole grains, products containing crushed grains, nuts, poppy seeds, coconut flakes etc.), black bread, legumes, peas, lentils and other cereals not included in the list of permitted

ALLOWED TO USE:

• flour products and rice: cereals (rice, oatmeal), plain crackers (no additives), vermicelli and noodles made from premium flour
• meat: low-fat meat broth soups; various, well-cooked dishes from lean beef, veal; boiled chickens, also in the form of cutlets, meatballs, soufflé; egg
• fish: dishes from cod, zander, perch, pike (low-fat varieties of fish)
• dairy products: foods rich in calcium (low-fat cottage cheese, cheeses), natural yogurt (no additives), no more than two glasses of skimmed milk
• vegetables: vegetable broths, potatoes (without peel)
• fruits and drinks: weak tea, compotes, kissels and juices preferably transparent (without pulp, dried fruits, berries and grains)
• sweet: sugar, honey

On the 1st day of preparation (3 days before the study), food may contain pureed vegetables (beets and carrots), fish, liver pate, meat (boiled chicken, boiled lean meat), on the next day of preparation, vegetables should be excluded in any form .

DAYS BEFORE THE STUDY (taking into account the time for which the study is scheduled) IT IS NECESSARY TO COMPLETELY EXCLUDE FOOD . In the morning you can take no more than 200 ml of kefir. Then drink only water or weak tea. 2 hours before the study, stop taking any liquid; if the study is performed under anesthesia, then fluid intake should be stopped at least 3-4 hours before.

INTESTINE CLEANING is recommended to be carried out using FORTRANS

DAY BEFORE THE STUDY (3D PREPARATION DAY):

1. 18:00-20:00 – “Fortrans” * 2 liters: 1 sachet of the drug dissolve in 1 liter of water (DO NOT reduce the amount of liquid!). Drink the solution gradually: 1 liter for 1 hour (250 ml every 15 minutes). Approximately 1 hour after the start of taking the solution, painless loose stools will appear. The emptying of the intestines will end with the release of a clear or slightly colored liquid 2-3 hours after taking the last dose of the Fortrans solution *.
2. 19:00 – “Espumizan”** 30 ml (can be washed down with water).

EXAMINATION DAY:

1. 05:30-07:30 – Fortrans* 2 liters: dissolve 1 sachet of the drug in 1 liter of water (DO NOT reduce the amount of liquid!). Drink the solution gradually (1 liter for 1 hour, 250 ml every 15 minutes). Approximately 1 hour after the start of taking the solution, painless loose stools will appear. The emptying of the intestines will end with the release of a clear or slightly colored liquid 2-3 hours after taking the last dose of the Fortrans solution *.
2. 06:00 – Espumizan** 50 ml (can be washed down with water).

WARNING! The time of the study when preparing in this mode is 11:00-15:30. Only at the study time of 14:00-15:30 is it allowed to shift the morning intake of drugs by 30-60 minutes: 06:00-08:00 or 06:30-08:30. In any case, 3-4 hours before the study, the intake of the drug “Fortrans” * must be completed.

DO NOT eat on the day of the test! Only permanent drugs are allowed (to control blood pressure, blood sugar, etc.).

If you are allergic to any medications, DO tell your doctor.

Rules for preparing for colonoscopy.pdf

Rules for preparing for video endoscopy three divisions small intestine: duodenum, jejunum and ileum. The capsule is the size of a large vitamin (11mm x 24mm).

Preparation starts 3 DAYS BEFORE THE STUDY with a zero-slag diet and bowel cleansing on the eve of the test. Remember that proper preparation directly affects the quality of the study.

General preparation rules:

• first day of preparation – 3 days before the study: slag-free diet
• second day of preparation – 2 days before the study: no-slag diet
• the third day of preparation – 1 day before the study (on the eve of video endoscopy): breakfast + liquids during the day + “Fortrans” * + “Espumizan” **
• day of the study: “Espumizan” **.

FOOD-FREE DIET PRINCIPLES follows these principles in preparation for a colonoscopy.

THE DAY BEFORE THE CAPSULE VIDEOENDOSCOPY (on the eve of the study) You can have breakfast, and then, during the day, consume only liquids (clear broth, green tea, clear juices, jelly without berries, still water).

Bowel cleansing is recommended to be carried out using FORTRANS* preparation according to the scheme:

15:00 – Fortrans*3-4 liters: 1 packet of the preparation must be dissolved in 1 liter of water. The amount of solution for one patient is taken at the rate of 1 liter per 15-20 kg of body weight. On the eve of capsule endoscopy, starting at 15-00, at a rate of approximately 1 glass per hour. the solution is drunk in fractional parts. Approximately 1 hour after the start of taking the solution, painless loose stools will appear. The emptying of the intestine will end with the release of a clear or slightly colored liquid 2-3 hours after taking the last dose of the Fortrans solution *.

22:00 – Espumizan** 50 ml.

On the DAY OF THE EXAMINATION BY CAPSULE VIDEOENDOSCOPY, it is forbidden to eat any food.

07:00 – “Espumizan”** 50 ml

The time of the study when preparing in this mode is 08:30 – 09:00 (the time and methods of preparing for the study can be adjusted by the attending physician).

Dress code: top and bottom must be separate (eg shirt and trousers, blouse and skirt).

DURING STUDY , especially during the first three hours, it is necessary to move (passive behavior contributes to the slow movement of the video capsule along the gastrointestinal tract) and to make breathing movements with the stomach – raising the anterior abdominal wall – every 10-15 minutes for 1-2 minutes. Avoid strong electromagnetic fields. Handle the recording device with care. Avoid sudden movements and shocks of the recorder

AFTER THE STUDY is completed, you must return to the clinic to remove the equipment and hand over the device to the doctor.

Rules for preparing for video endoscopy.pdf

Peculiarities of preparing children for endoscopic examinations

• Try to explain to the child the significance of the examination.
• Calm the child in a calm voice, try to make a story in the form of a fairy tale, so that the child has a playful nature of the procedure in his head.
• Avoid eating 8-9 hours before endoscopy.
• Take a change of clothes for the child, as well as dry, wet wipes, a toy.
• If ​​FGDS is necessary, try to rehearse the correct breathing technique with a small patient: the baby should breathe through the nose, slowly, evenly.
• If ​​necessary, the examination can be performed under anesthesia.

FOR PREPARING CHILDREN FOR RECTOMANOSCOPY/COLONOSCOPY

1. It is necessary to follow the principles of a zero-slag diet for 3 days
2. On the eve of the study, in the morning and in the evening, a hypertonic enema is performed with a solution of NaCl-10% -150 ml (a heaping tablespoon of coarse salt per glass of water). In the morning, afternoon and evening, use one tablespoon of castor oil.
3. On the day of the study, one hypertonic enema with a solution of NaCl-10%-150 ml is performed at home in the morning and 30 minutes before the study, a second hypertonic enema with a solution of NaCl-10%-150 ml.

WARNING! FOR CHILDREN UNDER 3 YEARS OF AGE, A 5% NACL SOLUTION IS USED FOR AN ENEMAS.

From the age of 9 years preparation for sigmoidoscopy/colonoscopy can be carried out using the preparation “PIKOPREP”***. The contents of one package should be diluted in a glass of water at room temperature (about 150 ml), stirred for 2-3 minutes and drunk the resulting mixture. If the solution has warmed up, you need to wait until it cools down to a temperature suitable for drinking.

The drug is taken in the evening the day before the procedure (one packet), repeated after 6-8 hours (one packet).

From the age of 15, preparation for colonoscopy corresponds to that in adults using FORTRANS *.

Rules for preparing children for endoscopic examinations (sigmoidoscopy, colonoscopy).pdf – a diagnostic study that requires some preparation.

1. Examination is carried out on an empty stomach, the last meal on the eve at 18.00.
2. To relieve nervous tension, you can take a mild sedative, such as valerian, this can be done on the evening before the examination.
3. Smoking on the day of the study is highly discouraged.
   A pulmonologist’s report stating the purpose of fiberoptic bronchoscopy, chest x-ray or chest CT scan, blood tests for HIV and viral hepatitis is required.
4. Patients over 40 years of age must have ECG data (no more than a week old).
5. We would like to draw your attention to the fact that the study is performed under local anesthesia, the effect of which lasts for 1 hour. In this regard, it is better not to drive a car immediately after a bronchoscopy, so you should not drive a car immediately after the study.

In the conditions of the Eucalyptus family medicine clinic, bronchoscopy is performed without anesthesia and under anesthesia. For bronchoscopy without anesthesia, you need a certificate from the therapist that the patient is somatically healthy. Such a certificate can be taken on the day of treatment from our therapist.

* “Fortrans” – There are contraindications. Before use, please read the instructions for the drug. For more information, please contact your physician. Information on the drug is provided in accordance with paragraph 4 of Art. 74 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” to inform the patient about the availability of similar drugs in circulation.

** “Espumizan” – There are contraindications. Before use, please read the instructions for the drug. For more information, please contact your physician. Information on the drug is provided in accordance with paragraph 4 of Art. 74 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” to inform the patient about the availability of similar drugs in circulation.

*** “Pikoprep” – There are contraindications. Before use, please read the instructions for the drug. For more information, please contact your physician. Information on the drug is provided in accordance with paragraph 4 of Art. 74 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” to inform the patient about the availability of similar drugs in circulation.

****There are contraindications. Specialist consultation is required.

*****This manipulation is performed on the direction of a doctor

New low-volume bowel preparation scheme for colonoscopy and capsule endoscopy – Dr. Ekaterina Ivanova’s website

When we talk about bowel preparation, we always start with the basic rules that will ensure high-quality preparation.

To understand what is necessary for good preparation, you need to know a few rules:

1. Follow a slag-free diet 3 days, and preferably 4 days before the study liquids (it is desirable to exclude lunch and dinner)
2. Know the time of your colonoscopy
3. Divide the dose of your chosen prep into two doses (usually evening, early morning)!
4. The last dose of the drug should be completed 4-5 hours before the scheduled time of the colonoscopy and should not exceed 8 hours.

Patients have been asking for an easier-to-administer, low-volume bowel preparation for research for a long time.

In 2018, a new low-volume drug Eziklen was registered, and in 2019 appeared in pharmacies. The drug provides guaranteed effective – up to 98.0% preparation: good to excellent quality, compare standard Fortrans preparation scheme.

Eziklen – contains three sulfate salts (sodium sulfate, magnesium sulfate and potassium sulfate), and does not contain unsafe phosphates!

Up to 70% of sulfates are not absorbed from the colon , remaining in the lumen, and when interacting with water (1-1. 5 l) they have a laxative effect necessary for colon cleansing. It is this mechanism that ensures the safety of taking the drug Eziklen.

Of course, there are contraindications to taking the drug (as to any other laxative), they can be found in the instructions for use, available in the package.

So, the main and most effective scheme for preparing for colonoscopy with Eziklen is a separate scheme.

On the evening before the day of colonoscopy

18:00-19:00 1 bottle (176g) Esiclene is poured into a measuring cup, then water is added up to the mark on the glass. The resulting solution – 500 ml of the solution is cooled and drunk for 1 hour, fractionally, you can drink through a straw.

19:00-20:00 In addition, be sure to drink 1-1.5 liters of clean, uncolored liquid! It can be water, green tea, clear juice, low-fat clear broth.

After this step, you can drink water. At 10 p.m., it is recommended to take 15 ml of liquid antifoam (drugs Sab Simplex, Bobotic, Espumizan, it is possible with the inscription children’s drops).

On the morning of the colonoscopy

05:30-06:30 1 vial (176g) Esiclene is poured into a measuring cup, then water is added up to the mark on the glass. The resulting solution – 500 ml of the solution is cooled and drunk for 1 hour, fractionally, you can drink through a straw.

06:30-07:30 In addition, be sure to drink 1-1.5 liters of clean, uncolored liquid! It can be water, green tea. In the same time period, it is recommended to take 15 ml of a liquid defoamer (preparations, Sab Simplex, Bobotic, Espumizan, you can label children’s drops).

After this stage, and at least 2 hours before the examination, do not drink liquids! Be on an empty stomach. Especially if you want to do the study under anesthesia (intravenous sedation)!

If the study is scheduled for a time earlier than 10:30 am, then taking Eziklen should be postponed to an earlier time, for example, start preparation early in the morning, at 4-5 am.

If the study is scheduled for a later time (after 13-14h), then the entire dose of the drug can be transferred to the morning without taking anything in the evening.