Colonoscopy

Colonoscopy Procedure

What is a colonoscopy?

A colonoscopy is the most accurate test for detecting colon polyps and colon cancer, and the only test where polyps can be removed. During this procedure, a doctor examines the lining of your large intestine and rectum through a flexible tube called a colonoscope. The colonoscope is inserted into the anus and advanced slowly through the colon. If polyps or other abnormalities are found, the doctor may remove them for further examination or biopsy.

The bowel prep is the most important factor in ensuring you get the most thorough and complete exam during your colonoscopy. Small polyps can be missed if they are covered with retained stool. If your bowel prep is incomplete, your exam may need to be repeated on another day or you may need to return sooner for your next colonoscopy. Studies have clearly shown that the best preps are obtained when half of the prep is taken the night before your colonoscopy and the other half is taken the morning of the colonoscopy. This is called a split dose prep. The American College of Gastroenterology recommends a split dose prep for all patients. This regimen allows you to drink roughly half the total volume of liquid as compared to the 4 liter preps like Golytely that are completed the night before.

The preps used for split dose preps are Plenvu, Osmoprep Tablets, Clenpiq, and Suprep. Osmoprep tablets and Suprep should not be used if you have heart or kidney problems.

PRE-PROCEDURE CHECKLIST

If you have diabetes, ask your regular doctor for diet and medication restrictions. Do not take your oral diabetes medicine on the day of your procedure. If you take metformin, stop taking it the day before your colonoscopy. Also, please bring your Insulin and Insulin syringes with you to your procedure; we will check your blood sugar before and after the procedure.

If you take a medication to thin your blood

• Do NOT stop taking your daily Aspirin or NSAIDs. If you are taking a daily Aspirin or NSAIDS we want you to continue to take your medication. On the day of your procedure you can make your gastroenterologist aware of the medication you are taking and the amount you are taking.
• If you take a medication to thin your blood (such as Coumadin, Plavix, Pradaxa, Lovenox, Xarelto, Eliquis, Brilinta, Effient, Ticlid, Disgren, Pletal…) you must be seen in our office prior to your procedure. At the time of your office visit a plan will be made in conjunction with your prescribing physician about use of your blood thinner.

If you currently are taking other prescription medications, you may continue to take all other medications as instructed by the prescribing physician.

If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.

You MUST arrange for a ride for the day of your exam. If you fail to arrange transportation with a responsible adult, your procedure will need to be cancelled and rescheduled. Your driver must check in with you and stay in our office the entire time that you are there. We cannot start your procedure if you do not have a driver present. In addition to this, you may not take a taxi or ride the bus by yourself. This is for your safety.

If you must cancel or reschedule your appointment, please call (520) 795-3090 at least three days prior to your procedure to avoid any late cancellation fees.

If you have any special needs, such as a pacemaker, internal defibrillator, latex allergy, need for an interpreter, or if you are allergic to eggs, nuts or soy, please contact our office immediately. Your procedure may need to be rescheduled.

Remember your prep is a split dose. You will be taking the prep the day before the procedure as well as the day of the procedure. You can start your split prep 5 hours before the procedure.

Remember even while taking split prep you cannot have any liquids, ice chips, water or food THREE hours before your procedure. If you do, the procedure may be delayed.

STOP AND READ:

• If you do not follow these instructions your procedure may be delayed or cancelled.
• Please note that you cannot have any solid foods starting the day before your procedure.
• The day of the procedure you may not have gum, mints, ice chips, hard candies or cigarettes.
• You may have clear liquids up to THREE hours before your procedure. This includes the prep solution.
• You cannot have anything in your mouth (gum, mint, cough drop, ice chips etc.) THREE hours before your procedure.

Before the exam:

• You will change into a gown and robe.
• Your medical history will be reviewed with you and you will be given a consent form to sign.
• A nurse will insert an intravenous (IV) line into your hand or arm.

During the exam:

• Medicine will be given through the IV line to sedate you.
• Your heart rate and oxygen levels will be monitored. If your blood pressure is low, you may be given fluids through the IV line.
• The doctor will insert a flexible tube – called a colonoscope – into your anus and will advance it slowly through the rectum and colon, looking for abnormal tissue or polyps.
• If abnormal tissue or polyps are found, the doctor may remove them through the colonoscope for closer examination or biopsy. Tissue removal is painless.

What happens after the exam?

• The doctor will talk with you about the initial results of your exam.
• The doctor will prepare a full report for the physician who referred you for the colonoscopy.
• You may feel bloated after the procedure. This is normal.
• Medication given during the exam will prohibit you from driving for the rest of the day.
• Following the exam, you may resume your normal diet. Avoid alcohol until the next day.
• You may resume your regular activities the day after the procedure.
• A nurse will provide you with complete discharge instructions before you leave the endoscopy center. Be sure to ask the nurse for specific instructions if you take blood thinners such as aspirin, Coumadin or Plavix.
• Any tissue samples or polyps removed during the exam will be sent to a lab for evaluation. It may take 5-7 working days for you to be notified of the results.

Are there possible complications from a colonoscopy?

Although serious complications are rare, any medical procedure has the potential for risks. A nurse will review all potential warning signs with you before you leave the endoscopy center. Risks include:

• Perforation, or a tear, of the lining of the colon.
• Bleeding from the biopsy or polypectomy site if tissue was removed.
• Reaction to medications used during the procedure.

Colonoscopy Preparations:

PREPARATION

To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

Colyte/Nulytly/Trilyte/Golytely Prep

5 - 7 DAYS BEFORE THE PROCEDURE - Have your prescription filled

5 DAYS BEFORE THE PROCEDURE - If you routinely have less than 2 bowel movements per week then you will also need to purchase an 8.3oz bottle of Miralax. Begin taking a dose of Miralax twice a day 5 days prior to your procedure. Take the last dose of Miralax in the morning the day before your procedure.

3 DAYS BEFORE THE PROCEDURE - STOP eating fruits and vegetables including beans, corn and seeds.

THE DAY BEFORE THE PROCEDURE - You may only have clear liquids the entire day such as water, coffee, tea, broth, sodas, apple juice, Gatorade, Kool-aid, Jell-O, popsicles and hard candy. You may not have any solid food. It is important to drink extra clear liquids before your prep to maintain adequate hydration. Do not drink liquids that are not clear such as milk. Do not drink liquids that are red or purple in color.

THE DAY BEFORE THE PROCEDURE

MORNING:

• Mix the prep according to instructions. Shake until the powder is mixed and chill in the refrigerator. BETWEEN 3 AND 6PM – START YOUR PREP:
• Shake the container. Begin drinking the solution. Drink an 8 ounce glass of the solution every 10 - 15 minutes. It is recommended that you drink the whole glass rapidly rather than sip small amounts. A straw may help.
• Keep drinking the solution every 10-15 minutes until you drink 3 liters (bottle is 3/4 empty). Shake the container before pouring each dose. Refrigerate the unused portion.
• Make a conscious effort to drink as much clear liquids as you can before, during and after the preparation. NOTE:
• If you experience nausea - slow down your prep intake and walk around until nausea is relieved.
• Use baby wipes and/or Balneol cleansing cream or lotion during the prep to reduce irritation.

THE DAY OF THE PROCEDURE - 4 HOURS BEFORE YOU LEAVE HOME FOR YOUR APPOINTMENT

STEP 1:

• Begin drinking the remainder of the solution (1 liter). Drink an 8 ounce glass of the solution every 10 -15 minutes as directed above. Do not rush. If you need to wait longer between glasses, do so.
• Keep drinking the solution until the bottle is empty. This solution must be completed at least 3 hours prior to your appointment arrival time.

STEP 2:

• You may drink clear liquids until 3 hours before your appointment time.
• You may take your prescription medications (except those listed in the booklet) with water up to 3 hours before your appointment arrival time.
• Do not use smokeless tobacco on the day of your procedure.
• Starting 3 hours before your appointment arrival time absolutely nothing by mouth including gum, hard candy, breath mints.

Suprep bowel prep Instructions

1. Please read instructions at least 5-7 days before your procedure. This prep causes multiple bowel movements. It may work within ten minutes or take as long as three hours. Remain within easy access of toilet facilities.

2. Five to Seven DAYS BEFORE THE PROCEDURE - Have your prescription filled. Purchase at any pharmacy 4 Tablets of Dulcolax laxative (no prescription needed). Do not follow instruction from the pharmacy. This sheet is the only instruction you will need.

3. 5 DAYS BEFORE THE PROCEDURE - If you routinely have less than 2 bowel movements per week then you will also need to purchase an 8.3oz bottle of Miralax. Begin taking a dose of Miralax twice a day 5 days prior to your procedure. Take the last dose of Miralax in the morning the day before your procedure

4. If you are taking any blood thinners like: Plavix, Coumadin, or Pradaxa, Xarelto, Nabumetome, Eliquis, or _________ please stop taking them FIVE DAY’S PRIOR.

5. Three DAYS BEFORE THE PROCEDURE - STOP eating fruits and vegetables including beans, corn and seeds.

6. If you are taking Metformin of Glucophage, Stop taking Metformin (Glucophage) 24 hour prior to procedure. Please bring a list of your current medications including dosage and frequency to your procedure appointment

7. THE DAY BEFORE THE PROCEDURE - You may only have clear liquids the entire day such as water, coffee, tea, broth, sodas, apple juice, Gatorade, Kool-aid, Jell-O, popsicles and hard candy. You may not have any solid food. It is important to drink extra clear liquids before your prep to maintain adequate hydration. Do not drink liquids that are not clear such as milk. Do not drink liquids that are red or purple in color. Solid food, milk or milk products are not allowed.

8. At 5:00 pm the day before your procedure: pour the entire contents of one bottle of SUPREP Bowel prep kit into the mixing container provided. Then add 16 oz. of water to the container to fill line as indicated on the mixing container. Drink the entire amount. Step 2: over the next hour, drink two additional 16 oz. containers of plain water.

9. The day of the procedure: at least 5 hours before your procedure, pour the entire contents of the remaining bottle of SUPREP Bowel prep kit into container provided. Then add 16 oz. of water to the container to fill line as indicated on the mixing container. Drink the entire amount Step 2: over the next hour, drink two additional 16 oz. containers of plain water.

10. Diabetic Patients: Avoid diet sodas and juices. Drink regular sodas and juices during the preparation for this procedure. You will need the extra calories. If you take oral medications for diabetes take the oral medications in the morning the day prior to your procedure then hold medications until after your procedure. If you take insulin for diabetes please make sure to monitor your glucose levels carefully. During the preparation take half of the normal insulin dose. Do not take long acting insulin the evening prior to your procedure. Check your glucose level the morning of your procedure. Hold insulin if level is low, otherwise you may take half the regular insulin in the morning.

11. A 48 hour (business days) notice is required if you need to cancel or reschedule your appointment or you will be charged a cancellation fee of $100.00.

Plenvue bowel prep Instructions:

Please read instructions at least 5-7 days before your procedure. This prep causes multiple bowel movements. It may work within ten minutes or take as long as three hours. Remain within easy access of toilet facilities.

Five to Seven DAYS BEFORE THE PROCEDURE - Have your prescription filled. Purchase at any pharmacy 4 Tablets of Dulcolax laxative (no prescription needed). Do not follow instruction from the pharmacy. This sheet is the only instruction you will need. 5 DAYS BEFORE THE PROCEDURE - If you routinely have less than 2 bowel movements per week then you will also need to purchase an 8.3oz bottle of Miralax. Begin taking a dose of Miralax twice a day 5 days prior to your procedure. Take the last dose of Miralax in the morning the day before your procedure

If you are taking any blood thinners like: Plavix, Coumadin, or Pradaxa, Xarelto, Nabumetome, Eliquis, or _________ please stop taking them FIVE DAY’S PRIOR.

Three DAYS BEFORE THE PROCEDURE - STOP eating fruits and vegetables including beans, corn and seeds.

If you are taking Metformin of Glucophage, Stop taking Metformin (Glucophage) 24 hour prior to procedure. Please bring a list of your current medications including dosage and frequency to your procedure appointment

THE DAY BEFORE THE PROCEDURE - You may only have clear liquids the entire day such as water, coffee, tea, broth, sodas, apple juice, Gatorade, Kool-aid, Jell-O, popsicles and hard candy. You may not have any solid food. It is important to drink extra clear liquids before your prep to maintain adequate hydration. Do not drink liquids that are not clear such as milk. Do not drink liquids that are red or purple in color. Solid food, milk or milk products are not allowed

At 5 pm: Use the mixing container to mix contents of the Dose 1 pouch with at least 16 oz of water by shaking or using a spoon until it is completely dissolved. This may take up to 2 to 3 minutes. Take your time- slowly finish the dose within 30 minutes. Drink ALL of the solution. -Refill the container with at least 16 oz of clear liquid. Again, take your time and slowly finish all of it within 30 minutes. -Continue to drink clear liquids until bedtime. *The more hydrated you are, the better the prep results.

Day of the procedure

- 6 hours before leaving for the procedure: Use the mixing container to mix the contents of Dose 2 (Pouch A and Pouch B) with at least 16 oz of water by shaking or using a spoon until it is completely dissolved. This may take up to 2 to 3 minutes. Take your time- slowly finish the dose within 30 minutes. Drink ALL of the solution. -Immediately refill the container with at least 16 ounces of clear liquid. Again, take your time and slowly finish all of it within 30 minutes. - Put nothing else in your mouth except a small sip of water with your heart, blood pressure or seizure medication. - You must have NOTHING in your mouth 4 hours prior to your procedure. This means NO water, ice chips, gum, candy, cough drops, etc. ***Any contents in your stomach could come up, getting into your lungs while under anesthesia.

Clenpiq/Perpopik bowel prep

** 5-7 days before your procedure have your prescription filled.

** If you routinely have less than 2 bowel movements per week then you will also need to purchase an 8.3oz bottle of Miralax from the pharmacy to provide you with 10 doses of this laxative. Begin taking a dose of Miralax twice a day for the 5 days prior to your procedure. Take the last dose of Miralax the morning before your procedure.

** 3 days prior to your procedure begin following the Pre-colonoscopy diet plan.

Eat exactly what is permitted: do not take liberties.

THE DAY BEFORE YOUR PROCEDURE – BETWEEN 3 AND 6 PM – START YOUR PREP

• Step One – Fill the dosing cup provided with cold water up to the lower line on the cup (5 ounces).

• Step Two – Pour in the contents of ONE (1) packet – Stir for 2-3 minutes until dissolved. Drink the entire contents. A straw may help.

• tep Three – Follow with FIVE (5) - 8 ounce cups of clear liquid, taken at your own pace within the next 5 hours before bed. Your body loses significant amounts of fluid during bowel preparation. To prevent dehydration it is important to supplement that fluid loss with clear liquids. Make a conscious effort to drink as much as you can before, during and after the preparation.

• If you experience nausea -- slow down your prep intake, walk around until nausea is relieved.

• Over the counter “anti-gas” drops or pills may help relieve excessive gas. Use baby wipes and/or Balneol cleansing cream or lotion during the prep. Toilet paper can cause irritation.

THE DAY OF YOUR PROCEDURE – 4 HOURS BEFORE YOU LEAVE HOME FOR YOUR APPOINTMENT

• Step One – Fill the dosing cup provided with cold water up to the lower line on the cup (5 ounces).

• Step Two – Pour in the contents of ONE (1) packet – Stir for 2-3 minutes until dissolved. Drink the entire contents.

• Follow with at least THREE (3) – 8 ounce cups of clear liquid. You may drink clear liquids until 3 hours before your appointment time.

• You may take your prescription medications (except those listed in the booklet) with water up to 3 hour before your appointment arrival time.

• Do not use items such as gum, hard candy, breath mints or smokeless tobacco on the day of your procedure.

• If you have any questions or concerns or if you are unable to prep, please call your physician’s office. If the time is after normal office hours the answering service will take your call and contact the physician on call.

OsmoPrep bowel preparation

How should I take OsmoPrep?

Take OsmoPrep exactly as prescribed by your doctor.

It is important for you to drink clear liquids before, during, and after taking OsmoPrep. This may help prevent kidney damage. Examples of clear liquids are water, flavored water, lemonade (no pulp), ginger ale or apple juice. Do not drink any liquids colored purple or red.

You must read, understand, and follow these instructions to take OsmoPrep the right way:

On the evening before your colonoscopy, you will take a total of 20 OsmoPrep tablets, as follows:

1. Take 4 OsmoPrep tablets with 8 ounces of clear liquids.

2. Wait 15 minutes.

3. Take 4 more OsmoPrep tablets with 8 ounces of clear liquids.

4. Repeat steps 2 and 3 above, three more times. Make sure you wait 15 minutes after each time.

On the day of your colonoscopy, you will take a total of 12 OsmoPrep tablets, starting about 3 to 5 hours before your colonoscopy, as follows:

1. Take 4 OsmoPrep tablets with 8 ounces of clear liquids.

2. Wait 15 minutes.

3. Take 4 more OsmoPrep tablets with 8 ounces of clear liquids.

4. Repeat steps 2 and 3 one more time.

If you take too much OsmoPrep, call your doctor or get medical help right

What should I avoid while taking OsmoPrep?

You should not take other laxatives or enemas made with sodium phosphate, while taking OsmoPrep. • You should not use OsmoPrep if you have already used it in the last 7 days

What are the possible side effects of OsmoPrep?

OsmoPrep can cause serious side effects, including:

See “What is the most important information I should know about OsmoPrep?”

Changes in your blood tests. Your doctor may do blood tests after you take OsmoPrep to check your levels of calcium, phosphate, potassium, sodium in your blood. Tell your doctor if you have any symptoms of too much fluid loss, including:

• vomiting
• nausea
• Abnormal heart beat (arrhythmias)
• Seizures or fainting (black-outs). People who take a medicine that contains sodium phosphate, such as OsmoPrep, can have seizures or faint (become unconscious) even if they have not had seizures before. Tell your doctor right away if you have a seizure or faint while taking OsmoPrep.

Inflammatory bowel disease.

The most common side effects of OsmoPrep are:

• bloating
• stomach (abdominal) pain
• nausea
• vomiting

Tell your doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of OsmoPrep. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store OsmoPrep?

Store OsmoPrep at room temperature, between 59ºF to 86°F (15ºC to 30°C). • Throw away any OsmoPrep that is not needed.

Keep OsmoPrep and all medicines out of the reach of children.

Magnesium Citrate bowel prep

** 5-7 days before your procedure have your prescription filled.

** If you routinely have less than 2 bowel movements per week then you will also need to purchase an 8.3oz bottle of Miralax from the pharmacy to provide you with 10 doses of this laxative. Begin taking a dose of Miralax twice a day for the 5 days prior to your procedure. Take the last dose of Miralax the morning before your procedure.

** 3 days prior to your procedure begin following the Pre-colonoscopy diet plan.

Eat exactly what is permitted: do not take liberties.

Purchase the following items from your pharmacy. A written prescription from your physician is not required:

• Two (2) bottles of magnesium citrate (10 ounce). Do not purchase red (cherry flavor).
• One (1) package of Dulcolax tablets (laxative).

Day before the procedure:

1. Upon wakening, take four (4) Dulcolax tablets (laxative), with a large glass of water

2. You need to follow a clear liquid diet ALL DAY – no red or purple liquids. No solid foods, milk or milk products

3. In the evening, at 6 p.m., drink the entire content of the first bottle of magnesium citrate. Drink an 8 oz. glass of water at this time.

4. Continue to follow a clear liquid diet through the evening to prevent dehydration.

Day of the procedure:

1. Five (5) hours before your scheduled arrival time, you need to drink the entire content of the second bottle of magnesium citrate, and one 8 oz. glass of water. You should not have anything else to drink (or eat) until after your procedure (except the approved medications with a small sip of water).

2. You must have a friend or family member available to provide you with transportation to the and from the procedure.