California Advanced Gastroenterology

"One of the essential gifts one should look for in a wife is the ability to administer an enema daily and pleasantly"   Voltaire 1694-1778

   

Colonoscopy

 

 

 


 

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PREPARING FOR COLONOSCOPY

You have been scheduled for a colonoscopy. This procedure allows us to look at the inside of your colon (large intestine) with a flexible tube created with a specialized lens and video chip system at its tip. As the instrument is passed through the bowel, a vivid image is displayed on a TV monitor within the examination room.

Colonoscopy is most commonly recommended for:

  1. Identifying and removing colon polyps.
  2. Identifying a cause for rectal or “internal” bleeding.
  3. Explaining abnormal or changing bowel habits.
  4. Further defining abnormal findings on barium lower GI series, CT scan, etc.
  5. Evaluating other problems as deemed necessary by your physician such as anemia or weight loss.

This exam is most commonly utilized to identify and remove polyps. Polyps are usually benign or non-cancerous growths in the bowel. If identified and removed at an early stage, they pose little health hazard. If allowed to grow however, they may transform into malignant or cancerous polyps. Therefore, it is best to remove them early when possible. Polyp removal, or polypectomy involves slipping a wire loop through the colonoscope and around the polyp tissue, tightening the wire, then heating the wire so that the growth is both cut off and cauterized simultaneously. This is usually a simple procedure and virtually always painless. In addition to polyp removal, biopsies (or tissue samples) can be obtained by painlessly pinching off a piece of tissue for microscopic review.

This procedure may sound uncomfortable but usually, this is not the case. Before the procedure is begun, an IV is inserted into your vein. Sedatives and pain relievers are administered into your IV both before and during the examination. These medications are so effective that most patients do not remember having had the colonoscopy performed.

 Colonoscopy is quite safe and complications occur infrequently. It is estimated that less than 1 patient in 2000 will have a serious side effect from this exam. Potential problems include an adverse reaction to the intravenous medications, bleeding from a polyp removal site, or the inadvertent puncture or perforation of the bowel wall. Serious problems such as bleeding or tears may require surgery. Remember however, that these complications are rarely encountered.

 

THINGS TO REMEMBER

BOWEL PREPARATION: In order to effectively visualize the bowel and to identify and treat any abnormalities, you will need to be thoroughly cleaned out. This may be the toughest, but most important element of a successful examination. Cleansing instructions will accompany this form and should be followed to the best of your ability.

ARRIVAL TIME AND DURATION: You will be asked to arrive approximately one hour prior to your scheduled procedure time. This will allow for registration, insertion of an IV, and introduction to the staff. You can expect to be at the facility approximately 3 hours from the time you arrive until the time you are released to go home.

TRANSPORTATION: Because of the use of sedatives, you will not be allowed to drive yourself home. You must make arrangements for a friend or family member to take you home.

SPECIAL MEDICATION INSTRUCTIONS: In general, you will be able to continue your normal medications. There are a few major exceptions, however. Coumadin, other blood thinners, aspirin, and arthritis anti-inflammatory pain relievers may increase the risk of bleeding from polyp removal. We will therefore ask you to miss two day’s doses of each and any of these medications so that the day of the colonoscopy will be your third day without such blood thinners. In addition, insulin and oral diabetic agents should not be taken on the day of your procedure until the exam is complete. Your blood sugar level will be checked at the facility.

 

 

BOWEL PREPARATION PRIOR TO COLONOSCOPY

Cleansing of the bowel is the most challenging, yet one of the most important aspects of colonoscopy. We are aware of the burden that preparation places upon you and only ask that you try your best to follow the instructions. If there are discrepancies between instructions on this form and those on the product you purchase, follow the instructions written here.

There are three choices available for bowel cleansing. None involve enemas.

BOWEL PREP #1 produces the best results in our opinion, takes less time to complete, but involves drinking nearly 4 quarts of fluid over 3-5 hours that will “flush” the bowels clean. You will receive prescriptions for the prepping agents.

BOWEL PREP #2 produces adequate results, takes longer to complete, may produce a few more cramps, but has the advantage of avoiding the large volume of fluid used in Bowel Prep #1. In general, Bowel Prep #2 is not recommended for patients undergoing afternoon colonoscopies. This prep does not require prescriptions.

BOWEL PREP #3 is the newest bowel preparation system available. The encouraging aspect of this prep is the use of pills, rather than liquid laxatives. The downside is that there are a lot of rather large, but breakable, pills to take (20 the night before and at least 9 the day of the procedure). Bowel prep #3 is not recommended for patients undergoing morning colonoscopies.

You will be asked to choose one of these preparations and follow the instructions below.

Note that the instructions may change depending upon whether your procedure is scheduled for the morning or the afternoon.

 

 

BOWEL PREP #1

During the days prior to your colonoscopy, take the attached prescription for Colyte (or Nulytely) and Reglan (or Metaclopramide) to your pharmacy.

 

MORNING PROCEDURE (if your arrival time is before 12noon)

One day prior to your colonoscopy:

1.   In the morning, add warm water to the fill line on the plastic jug, replace the cap and shake well. Refrigeration is optional. These products are currently available in several flavors. You may also add any flavorings of your choosing to enhance the taste. Please avoid red or orange products if possible.

2.   Eat breakfast and lunch as you normally would. Please avoid fresh fruits and vegetables.

3.    Eat a light dinner, if desired. Avoid fresh fruits and vegetables. Many patients skip dinner (that is your option) since the laxative tends to be quite filling (although not very tasty or satisfying!).

4.    At approximately 5:30 pm, take one Reglan (metaclopramide) pill by mouth.

5.    At approximately 6:00 pm, begin to drink the laxative preparation. Attempt to drink the entire bottle of fluid over three to five hours, if possible. Keep in mind that the purpose is to cleanse the bowel of solid and dark colored stool. Therefore, if your fecal contents become clear in color, you needn’t complete the entire jug. If you develop bloating or nausea, feel free to take a short break. Within 30 to 60 minutes, this discomfort should resolve itself. It is better to take a longer period to consume the laxative than to push yourself to nausea and perhaps, vomiting. You may take another Reglan (metaclopramide) pill if needed for nausea at any time after 8:00pm.

6.    You can expect some mild cramping and urgency, followed by several bouts of diarrhea. This, of course, is the desired goal.

 

On the day of your colonoscopy:

1.    You may have a small amount of liquids (1-2 cups) up to four hours before your arrival time.

 

 

 

AFTERNOON PROCEDURE (if your arrival time is 12noon or after)

One day prior to your colonoscopy:

1.    Eat breakfast and lunch as usual.

2.    Eat a normal dinner but avoid fresh fruits and vegetables.

3.    Add warm water to the fill line on the plastic jug and shake well. Refrigeration is optional. These products are currently available in several flavors. You may also add any flavorings of your choosing to enhance the taste.

 

On the day of your colonoscopy:

1.    At approximately 6:30 am, take one Reglan (metaclopramide) pill by mouth.

2.    At approximately 7:00 am, begin to drink the laxative preparation. Attempt to drink the entire bottle of fluid over three to five hours, if possible. Keep in mind that the purpose is to cleanse the bowel of solid and dark colored stool. Therefore, if your fecal contents become clear in color, you needn’t complete the entire jug. If you develop bloating or nausea, feel free to take a short break. Within 30 to 60 minutes, this discomfort should resolve itself. It is better to take a longer period to consume the laxative than to push yourself to nausea and perhaps, vomiting. You may take another Reglan (metaclopramide) pill if needed for nausea, but not before 9:00 am.

3.    You can expect some mild cramping and urgency, followed by several bouts of diarrhea. This, of course, is the desired goal.

4.    You may take you medicines as normal one hour after you finish your laxative preparation. Please do not take insulin or other diabetic medications prior to your colonoscopy.

5.    If necessary, you may take small amount of juice, coffee, or tea up to two hours before your arrival time.

 

 

BOWEL PREP #2

In anticipation of this preparation, please purchase either two (2) 1.5 ounce bottles or one (1) 3 ounce bottle of FLEET PHOSPHO-SODA BUFFERED ORAL SALINE LAXATIVE. This is available at any pharmacy (and most supermarkets) without a prescription.

 

One day prior to your colonoscopy:

1.    You may eat a “light” breakfast before 9:00 am.  Please avoid fresh fruits, vegetables or fiber cereals.

2.    You may take medications as normal.

3.    Lunch and dinner should consist of liquids only. This may include fruit juices, water, milk, broth or bouillon, coffee or tea. In addition, Gatorade-type drinks, carbonated or non-carbonated soft drinks, Jell-O, popsicles and powdered drinks are acceptable BUT PLEASE avoid red or orange colored liquids.

4.    At approximately 1:00 pm, add 1.5 ounces (or 3 tablespoons) of Fleet Phospho-Soda to one-half glass of water or juice and drink it. Follow with one full glass (approximately 8 ounces) of one of the liquids mentioned above.

5.    Over the next 2-4 hours, drink at least three more 8 ounce glasses of the liquids listed above.

6.    At approximately 7:00 pm, add 1.5 ounces (or 3 tablespoons) of Fleet Phospho-Soda to one-half glas of water or juice and drink it. Shortly thereafter, follow with one full glass (approximately 8 ounces) of one of the liquids listed above.

7.    You may drink additional liquids as you desire through the night.

 

On the day of your colonoscopy:

1.       You may have liquids up until 3-4 hours prior to your arrival time.

 

 

BOWEL PREP #3

This relatively new preparation involves pills rather than liquid laxatives to flush out your bowels. The pills are somewhat large but can be easily broken in half if necessary. You will still need to drink a fair amount of liquids for this bowel prep, but your choices are quite wide and are can be largely suited to your tastes.

If you are using this bowel prep, your exam could be scheduled for the very late morning, but an afternoon appointment is preferable, since you’ll be taking these pills both the night before and the morning of the day of your colonoscopy.

 You’ll notice that the prep schedule requests that you take the pills 15 minutes apart. Sometimes this is hard to do and you might feel a bit full.  If so, please don’t be concerned—simply take a bit longer between doses to let your stomach empty. We’d rather you get the prep done slowly than experience nausea or vomiting and risk having to start over.

 

Several days prior to your colonoscopy:

1.       If not yet done, please have your prescription for Visicol tablets filled at your pharmacy.

 

The day prior to your colonoscopy:

1.       You may eat a regular breakfast.

2.       You may eat lunch, but please complete this meal by 1:00pm. Please do not eat fruits or vegetables with this meal.

3.       If you’d like, you may have a liquid dinner, but if you read on, you’ll see that there will be plenty of liquids for you to drink this evening.

4.       Beginning at 6-7:00 pm,  you should take three (3) Visicol tablets every 15-20 minutes, for a total of twenty (20) pills (the last dose will have only 2 pills).

5.       Each dose should be followed by a large glass of fluid (approximately 8 ounces). You can use any kind of clear or nearly clear fluid you wish.  Suggestions include water, apple juice, lemonade, or Gatorade (there are several colorless flavors—please no red or orange colored drinks).

6.       Of course, don’t stray from home. You’re to expect diarrhea and rarely, mild cramping.

 

On the day of your colonoscopy:

1.       Sorry, no solid food breakfast and no more than one cup of black coffee or tea.

2.       Approximately 3-4 hours before you’re scheduled to leave home, you should take three (3) Visicol tablets, followed by a large glass (approximately 8 ounces) of fluid as described above.

3.       Thereafter, take three (3) tablets every 15-20 minutes with a large glass of the approved liquids, for a total of nine (9) pills.

4.       Your stools should be clear or liquid yellow this morning, perhaps with small stool fragments. If you are still passing dark or solid stools at this time, take an extra three (3) to six (6) pills (again doses are to be separated by 15-20 minutes and followed by liquids)—these final doses are not usually necessary.

5.       You may take any of your daily medications 1-2 hours after your last dose of Visicol except do not take aspirin, blood thinners, anti-inflammatory arthritis pain relievers, or diabetic medications.

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    Want to see colonoscopy informational brochures from:

American Gastroenterological Association (AGA) ?

American Society for Gastrointestinal Endoscopy (ASGE) ?

 

 

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