GASTRO ASSOCIATES
Mukul Khandelwal MD and Mahmood Solaiman MD
Gastroenterology & Hepatology
8109 Ritchie Highway Pasadena, MD 21122
&
8186 Lark Brown Road, Ste. 104, Elkridge, MD 21075
Phone: (410) 590-8920
FAX: (410) 553-2345
__________________www.mdgastro.net________________
Understanding Colonoscopy
WE PROVIDE FOUR CHOICES FOR PREPARATIONS.
THE FIRST, THIRD, AND FOURTH CHOICES REQUIRE
PRESCRIPTIONS. PREPARATION #3 SHOULD NOT BE
USED IF YOU HAVE HEART OR KIDNEY DISEASE. IF
YOU WISH TO TAKE THE OSMOPREP PILLS, PLEASE
CALL OUR OFFICE SO THAT WE CAN CALL IN A
PRESCRIPTION. ALL OF THESE PREPARATIONS ARE
EQUALLY EFFECTIVE, BUT THERE COULD BE
INDIVIDUAL DIFFERENCES IN EFFECTIVENESS JUST
AS THERE ARE WITH ANY MEDICATION.
What is a colonoscopy?
Colonoscopy enables your doctor to examine the lining of your colon (large
intestine) for abnormalities by inserting a flexible tube as thick as your
finger into your anus and slowly advancing it into the rectum and colon. If
your doctor has recommended a colonoscopy, this brochure will give you a
basic understanding of the procedure - how it's performed, how it can help,
and what side effects you might experience. It can't answer all of your
questions since much depends on the individual patient and the doctor.
Please ask your doctor about anything you don't understand.
What preparation is required?
Your doctor will tell you what dietary restrictions to follow and what
cleansing routine to use. In general, the preparation consists of either
consuming a large volume of a special cleansing solution and clear liquids
and special oral laxatives. You must drink plenty of Gatorade type liquids on
the day before the test in addition to the preparation. The colon must be
completely clean for the procedure to be accurate and complete, so be sure
to follow your doctor's instructions carefully.
Can I take my current medications?
Most medications can be continued as usual, but some medications can
interfere with the preparation or the examination. Inform your doctor about
medications you're taking, particularly aspirin products, arthritis
medications, anticoagulants (blood thinners), insulin or iron products.
Please take all blood pressure medications on the
morning of the procedure.
Also, be sure to mention allergies you have to medications.
It is not recommended to take antibiotics if you have mitral valve prolapse or
joint replacement.
What happens during colonoscopy?
Colonoscopy is well tolerated and rarely causes much pain. You might feel
pressure, bloating or cramping during the procedure. Your doctor will give
you a sedative to help you relax and better tolerate any discomfort.
You will lie on your side or back while your doctor slowly advances a
colonoscope through your large intestine to examine the lining. Your doctor
will examine the lining again as he or she slowly withdraws the
colonoscope. The procedure itself usually takes 15 to 60 minutes, although
you should plan on two to three hours for waiting, preparation and recovery.
In some cases, the doctor cannot pass the colonoscope through the entire
colon to where it meets the small intestine. Although another examination
might be needed, your doctor might decide that the limited examination is
sufficient.
What if the colonoscopy shows something abnormal?
If your doctor thinks an area needs further evaluation, he or she might pass
an instrument through the colonoscope to obtain a biopsy (a sample of the
colon lining) to be analyzed. Biopsies are used to identify many conditions,
and your doctor might order one even if he or she doesn't suspect cancer. If
colonoscopy is being performed to identify sites of bleeding, your doctor
might control the bleeding through the colonoscope by injecting medications
or by coagulation (sealing off bleeding vessels with heat treatment). Your
doctor might also find polyps during colonoscopy, and he or she will most
likely remove them during the examination. These procedures don't usually
cause any pain.
What are polyps and why are they removed?
Polyps are abnormal growths in the colon lining that are usually benign
(noncancerous). They vary in size from a tiny dot to several inches. Your
doctor can't always tell a benign polyp from a malignant (cancerous) polyp
by its outer appearance, so he or she might send removed polyps for
analysis. Because cancer begins in polyps, removing them is an important
means of preventing colorectal cancer.
How are polyps removed?
Your doctor might destroy tiny polyps by fulguration (burning) or by
removing them with wire loops called snares or with biopsy instruments.
Your doctor might use a technique called "snare polypectomy" to remove
larger polyps. That technique involves passing a wire loop through the
colonoscope and removing the polyp from the intestinal wall using an
electrical current. You should feel no pain during the polypectomy.
What happens after a colonoscopy?
Your physician will explain the results of the examination to you, although
you'll probably have to wait for the results of any biopsies performed.
You must arrange for someone to drive you home and
stay with you. Even if you feel alert after the procedure, your judgment
and reflexes could be impaired for the rest of the day. You might have some
cramping or bloating because of the air introduced into the colon during the
examination. This should disappear quickly when you pass gas.
You should be able to eat after the examination, but your doctor might
restrict your diet and activities, especially after polypectomy.
What are the possible complications of colonoscopy?
Colonoscopy and polypectomy are generally safe when performed by
doctors who have been specially trained and are experienced in these
procedures.
One possible complication is a perforation, or tear, through the bowel wall
that could require surgery. Bleeding might occur at the site of biopsy or
polypectomy, but it's usually minor. Bleeding can stop on its own or be
controlled through the colonoscope; it rarely requires follow-up treatment.
Some patients might have a reaction to the sedatives or complications from
heart or lung disease.
Although complications after colonoscopy are uncommon, it's important to
recognize early signs of possible complications. Contact your doctor if you
notice severe abdominal pain, fever and chills, or rectal bleeding of more
than one-half cup. Note that bleeding can occur several days after
polypectomy.
To The Patient
Because education is an important part of comprehensive medical
care, you have been provided with this information to prepare you for
this procedure. If you have questions about your colonoscopy,
alternative tests, the cost of the procedure, methods of billing, or
insurance coverage, do not hesitate to speak to your doctor or your
office staff. Most endoscopists are highly trained specialists and
welcome your questions regarding their credentials and training. If
you have questions that have not been answered, please discuss
them with the endoscopy nurse or your physician before the
examination begins.
My Colonoscopy is scheduled for:
Place:________________________________________________
Date:_________________________________________________
Arrival Time:____________ Procedure Time:_________________
Colonoscopy Preparation:
All patients drink clear liquids the entire day before the
exam. If you have a procedure scheduled in the morning,
please do not take anything by mouth except for
medications. If your procedure is scheduled from 12 noon
and afterwards, you may have a very light clear liquid
breakfast before 7 AM. Please do not take dairy products or
coffee in the morning.
Please do not drink anything red. It dyes your colon
red and looks like there has been bleeding.
Morning of the exam: You may take your regular medications unless
instructed otherwise by your doctor. If you take insulin, take half your
nighttime dose, the night before the colonoscopy, and do not take
your insulin on the morning of your procedure. If you are taking pills
for your diabetes, do not take that medication on the morning of your
procedure.
Preparation 1: For patients taking TriLyte:
(reduced volume)
Items needed:
1. Small box of Dulcolax/bisacodyl (no prescription needed, store brand
is fine). You will need 2 Dulcolax/bisacodyl.
2. One container of Trilyte (prescription attached)
Follow this schedule:
1.
The day before the exam: Drink Clear liquids the entire day.
2.
At 4 PM, take 2 bisacodyl tablets with water. Do not crush or
chew.
3.
Mix the TriLyte with water. Fill to the “Fill line” or 4-liter mark on
the container. You may add a flavor pack of your choice to the
solution. Refrigerate after mixing.
4.
Between 4 pm and 9 pm, begin drinking TriLyte. ONLY DRINK
HALF OF THE CONTENT IN THE CONTAINER. YOU SHOULD
FINISH AT THE 2 LITER MARK ON THE BOTTLE.
Remember you have 5 hours to drink the solution. If you start feeling
nauseated please stop for one hour, and then try to restart. If you are
unable to restart, please follow the secondary prep enclosed in this
packet. IF YOUR BOWEL MOVEMENT IS NOT COMPLETELY
CLEAR AFTER THE PREPARATION, THEN CONTINUE
DRINKING THE SOLUTION UNTIL YOU ARE CLEAR.
5.
Approximately 9pm: You should be finished with your TriLyte.
Drug interactions: Oral medications taken within one hour of the start
of administration of the TriLyte may be flushed from the
gastrointestinal tract and not absorbed.
Recommend: After you have mixed the TriLyte you may wish to
drink it with ginger ale on ice to help the taste.
Colonoscopy Prep for patients that cannot finish
TriLyte:
(If you have started TriLyte and cannot finish it)
1.
Begin TriLyte at 4 pm the day before the colonoscopy. Stay on clear
liquids the entire day before the procedure.
2.
If you develop nausea or vomiting from TriLyte,
Please go to the pharmacy and take the following:
Magnesium citrate take 1 bottle at 4 p.m., 7 p.m., and
9 p.m. or any time afterward to clean yourself out. You may mix with
ginger ale and keep chilled for improved taste.
Alternative Preparation #2 for patients not taking
TriLyte:
(Instead of TriLyte Preparation)
These can be obtained over the counter from any pharmacy.
1. Clear Liquids the day before the examination.
2. Drink 1 bottle of magnesium citrate each at 4pm, 7pm and at 9pm the
day before the examination. You may mix with ginger ale and keep
chilled for improved taste.
Alternative Preparation #3 for patients taking
Osmoprep tablets
THIS SHOULD NOT BE USED FOR PATIENTS WITH CONGESTIVE
HEART FAILURE OR RENAL FAILURE
1.
Take clear liquids the day before the procedure and drink plenty of
liquids.
2.
Starting at 4 PM the day before the procedure, take 4 tablets of
Osmoprep with at least 8 oz of clear liquids every 15 minutes for a
total of 20 tablets.
3.
Starting at 7 PM, take 4 tablets of Osmoprep with at least 8 oz of clear
liquids every 15 minutes for a total of 12 tablets.
Alternative Preparation #4 using MoviPrep
1.
Take clear liquids the day before the procedure.
2.
The MoviPrep carton contains 4 pouches and a disposable container
for mixing. You must complete the entire prep to ensure the most
effective cleansing. If preferred, mix the MoviPrep solution ahead of
time and refrigerate prior to drinking. (The mixed MoviPrep solution
should be used within 24 hours)
3.
First prepare the MoviPrep solution. Empty 1 pouch A and 1 Pouch B
into the disposable container. Add lukewarm drinking water to the top
line of the container. Mix to dissolve. You may wish to chill the
preparation after dissolving.
4.
At 4 pm begin drinking the solution. YOU may wish to add Ginger
Ale to help with the taste. The MoviPrep container is divided by 4
marks. Every 15 minutes, drink the solution down to the next mark
(approximately 8 oz), until the full liter is complete (at approximately
6 pm). Now drink 16 oz of the clear liquid of your choice.
5.
At 6 pm repeat step # 2, and refrigerate if preferred.
6.
At 7:00 pm begin drinking the solution. Every 15 minutes, drink the
solution down to the next mark (approximately 8 oz.), until the full
liter is complete. You may continue to drink clear liquids until
midnight, then NOTHING AFTER MIDNIGHT except medications if
your procedure is before 12 Noon. If your procedure is scheduled
from 12 noon and afterwards, you may have a very light clear liquid
breakfast before 7 AM. Please do not take coffee or dairy products in
morning.
DRS. KHANDELWAL OR SOLAIMAN WILL WRITE THE FINDINGS ON THE
DISCHARGE SHEET AND DISCUSS THE FINDINGS WITH YOUR
DESIGNATED DRIVER AND YOURSELF. PLEASE UNDERSTAND THAT
YOU MAY NOT REMEMBER THE DISCUSSION WITH THE DOCTOR
BECAUSE OF THE SEDATIVES THAT ARE ADMINISTERED DURING THE
PROCEDURE. IF YOU HAVE QUESTIONS ABOUT THE RESULTS, PLEASE
CALL THE OFFICE.
THE WEEK BEFORE THE PROCEDURE
No aspirin or aspirin like products like naprosyn, motrin, excedrin. You may take
Tylenol or Celebrex or Vioxx. The day before the procedure, please avoid dairy
products and red juices. You may take non-dairy creamer at least 6 hours before
procedure.
THINGS THAT YOU MAY EAT THE DAY BEFORE THE PROCEDURE
Jellos (not red jello)
Popsicle
Freeze Pop
Chicken Broth
Beef Broth
Vegetable Broth
7-UP
Sprite
Ginger Ale
Coke
Tea
Black Coffee
Orange Juice
Gatorade
Apple Juice
All patients drink clear liquids the entire day before the
exam. The list of liquids is at the back of this form. If you have a
procedure scheduled in the morning, you should not eat or drink
after midnight except for medications. If your procedure is
scheduled from 12 noon and afterwards, you may have a very light
clear liquid breakfast before 7 AM. Please do not take coffee or
dairy products in morning.