***YOU MUST BE ACCOMPANIED BY A DESIGNATED DRIVER, 18 YEARS OF AGE OR OLDER ***
It is our desire that you have the best experience possible. Please read these instructions completely and thoroughly; in doing so, you will contribute to a much more satisfying outcome. If you have any questions about these instructions, please contact The Corvallis Clinic, Department of General Surgery at (541) 754-1286 (Monday-Friday, 8 am – 5 pm).
Colonoscopy is the direct visual examination of the interior of the large intestine, or colon. When an abnormal area is identified, a small sample is removed for microscopic evaluation, this is a biopsy. Polyps are also encountered; these are growths and can be removed with the use of an electric wire loop, this is a polypectomy. All tissue samples removed during colonoscopy are submitted for microscopic examination. These results will be sent to your physician.
Colonoscopy is performed with a colonoscope. This is a flexible tube measuring 160 cm (slightly longer than 5 feet) in length. It contains an illuminating apparatus and a camera at the tip of the scope. There is also a channel through the length of the scope allowing passage of instruments for sampling, etc.
To achieve optimal examination of the colon, it is imperative to completely remove all fecal matter before the procedure. Inadequate cleansing of the colon leads to a prolonged and difficult examination, as well as a higher risk of complication. Therefore, please exercise your best effort to adhere to the directions for bowel cleansing.
The preparation we use is the safest and most effective method we have found, and we’ve tried a few. It is important that you make every effort to follow the instructions to the best of your ability. If you have had problems tolerating this type of prep in the past, please let us know as soon as possible before your procedure. Dr. Bombeck will be informed and will arrange the best alternative for you.
With this preparation, diarrhea is to be expected; a mild degree of nausea, vomiting and abdominal cramping can also occur. However, if you develop severe nausea, incessant vomiting or intolerable abdominal pain, please notify us right away. Some patients find that wearing a protective undergarment (i.e. Depends) to and from the procedure provides additional comfort and sense of security during transportation.
INSTRUCTIONS REGARDING YOUR MEDICATIONS
a) Coumadin (Warfarin): should be STOPPED 5 DAYS BEFORE THE PROCEDURE (unless otherwise specified). Please consult your primary Physician to determine the need for supplementing with Fragmin.
b) Lovonox/Fragmin: the LAST DOSE SHOULD BE TAKEN THE DAY BEFORE THE PROCEDURE.
c) Plavix (Clopidogrel Bisulfate) and Aspirin: should be STOPPED 7 DAYS BEFORE THE PROCEDURE.
d) Please clear these instructions with your primary Physician.
a) NSAIDs: such as Ibuprofen (Motrin, Advil), Aleve, Naprosyn, Voltaren, Feldene, etc should be STOPPED 5 DAYS BEFORE THE PROCEDURE.
b) If polyps are removed during the colonoscopy, these medications may have to be held for a few more days after the procedure. Dr. Bombeck will give you instructions in this case.
a) Iron supplements should be STOPPED FOR 7 DAYS BEFORE THE PROCEDURE.
b) Multivitamins that contain iron are OK to take.
Blood Pressure Medications
a) Medications for blood pressure or heart disease should be TAKEN as prescribed every day without interruption.
a) Oral medications for diabetes should be STOPPED THE DAY BEFORE AND THE DAY OF THE PROCEDURE.
b) Insulin doses should be HALVED THE DAY BEFORE THE PROCEDURE AND TAKEN AFTER THE PROCEDURE ON THE DAY OF THE PROCEDURE.
PATIENTS WITH A PACEMAKER OR DEFIBRILLATOR
Please ensure that you have informed our office if you have a pacemaker or defibrillator.
It is possible that you might have electro cautery, which could have an effect on your specific pacemaker. Our office will inform your pacemaker clinic and arrange for a document to be faxed to The Surgery Center (541) 738-2072 before the day of your procedure. The procedure cannot be conducted without this document.
DIETARY AND BOWEL CLEANSING INFORMATION FOR COLONOSCOPY
I. Five days before the colonoscopy
a. Stop taking any medication, as directed under the “Instructions Regarding Your Medications” section.
II. Four days before the colonoscopy
a. Avoid any foods with seeds or nuts (i.e. strawberries, tomatoes, sunflower seeds, peanuts, and corn kernels).
III. The day before the colonoscopy
a. DO NOT EAT ANY SOLID FOODS. DRINK CLEAR LIQUIDS ONLY.
b. Although you are drinking a large quantity of bowel prep, it does not contribute to hydration, so drink plenty of light-colored or clear liquids for breakfast, lunch, and dinner. STAY HYDRATED!!! Clear liquids are liquids you can see through. Examples are water, apple juice, white grape juice, 7-UP, Gatorade (yellow only), tea, yellow Jell-O, fat-free vegetable, chicken or beef broth or bouillon.
c. Avoid any red, orange, purple, green and blue colored drinks.
d. Beginning at 5 pm: First, apply the ointment to your perianal region (optional). This reduces the irritation caused by the frequent watery stools you will be experiencing. You may reapply the ointment as needed.
e. Drink 2 liters (half) of the bowel prep within 2 hours. Drink only light-colored clear liquids afterwards.
IV. The day of the colonoscopy
a. You may take your medication(s) with water (NO COFFEE). This should be done PRIOR to drinking your 2nd dose of prep. If you have a medication that MUST be taken at a specific time, please call our office ahead of time.
b. Starting 4 hours before your scheduled arrival time, please drink the 2nd dose of prep (you have 1 hour to drink all of this).
c. The second dose of prep MUST be finished by at least 3 hours before the scheduled arrival time. You should finish all liquids by this time and have nothing further by mouth 3 hours before your scheduled arrival time.
d. 2 hours prior to your arrival time, use the Fleets Enema.
TIMELINE FOR THE DAY OF COLONOSCOPY
4 hours before arrival time – Drink 2nd dose
3 hours before arrival time – Nothing By Mouth Until After Procedure (Don’t Drink or Eat!!!)
2 hours before arrival time – Enema
Arrival – Preop
1 hour after arrival time – Procedure
NO ORAL TOBACCO, CHEW, OR DIP ON THE DAY OF YOUR COLONOSCOPY.
Please be punctual, presenting yourself to the registration personnel at the scheduled time. Your arrival time is scheduled approximately one-hour prior to the procedure time. This is to allow time for the completion of the necessary paperwork as well as other pre-procedural details. You are encouraged to bring a book to help pass the time.
A small plastic catheter will be inserted into the forearm for IV access. Sedatives are usually given to alleviate anxiety and to reduce discomfort. They may also have an amnesic effect (partially erasing the memory of the procedure). Using the sedative PROPOFOL, most people are in a deep sleep and will not have any recollection except for the last few minutes of the procedure. Nearly everyone tolerates the procedure well. You should expect to drift off to sleep in the procedure room and awaken just as the procedure finishes.
During the colonoscopy, the scope is inserted into the rectum and advanced around the colon with gentle pressure. It may become necessary to turn the patient into different positions in order to facilitate the advancement of the scope. For a complete examination, the scope will be passed from the rectum throughout the entire length of the colon, and sometimes into the last segment of the small intestine.
A colonoscopy usually lasts about 35 minutes. After the exam, you will be transferred to the recovery room for further evaluation. When the nurse determines that you are fully alert and safe to leave, they will recommend you for discharge from the unit. You will be given discharge instructions and the detailed results of your examination.
In general, a light meal is recommended after the procedure. If you do not experience any discomfort after the first light meal, you may resume a normal diet thereafter.
If sedatives are given during the procedure, driving or operating any heavy equipment on the day of the procedure is dangerous and should be avoided under all circumstances.
A letter summarizing the results of the procedure, pathology, and follow up recommendations will be sent to you within two weeks.
Although colonoscopy is considered a very safe procedure, on rare occasions, complications do occur. Complications of sedation would be depressed respiratory drive and aspiration of stomach contents.
Bleeding, should it occur, is usually mild, but occasionally requires intervention. Should you experience bleeding (more than just a little on the toilet tissue), please call our office immediately. The extremely rare cases of perforation may require surgical repair (this would be heralded by worsening abdominal pain). For patients with heart diseases, the risk of cardiac complications, including but not limited to heart attack, irregular heart rhythm, cardiac arrest or even death, though extremely low, cannot be absolutely eliminated. If a complication occurs, steps will be taken immediately to control the effects. On occasion, hospitalization will be recommended. Please call our office if you have any questions or concerns about any symptoms (541) 754- 1286.
Lastly, in spite of being considered the gold standard of examination of the colon, colonoscopy is by no means perfect. Not infrequently, polyps smaller than 1 cm in diameter hiding behind the nooks and crannies of the colon may elude detection. Some polyps are just too small to be seen at this exam. This is why we repeat the procedure in a timely manner.
A nurse will call you the day after the colonoscopy to inquire about your recovery of the procedure. If any unusual event, such as severe pain or significant bleeding, should develop, please contact Dr. Bombeck, the physician on-call or present yourself to the Emergency Department without delay.
Once again, it is our desire that you have the best experience possible. Should you have any questions about these instructions, please contact The Corvallis Clinic, Department of General Surgery at (541) 754-1286.
Christopher A. Bombeck, M.D., F.A.C.S