***You must be accompanied by an adult family member/friend, over the age of 18, who can take responsibility for you and sign your discharge papers.
It is our desire that you have the best experience possible. Please read these instructions completely and thoroughly; in so doing, you will contribute to a much more satisfying outcome. If you have any questions about these instructions, please contact The Corvallis Clinic Gastroenterology department at: (541) 754-1988 during normal business hours. If you have questions or concerns outside of normal business hours, please call: 541-754-1150 for the on-call physician.
INTRODUCTION
A colonoscopy is an examination of the interior of the large intestine, or colon. This procedure employs an instrument called a colonoscope, which is a flexible tube of 160 cm (slightly longer than 5 feet), in length. It contains an illuminating apparatus and an electronic camera at the tip of the scope. There is also a channel through the length of the scope allowing passage of instruments for sampling and other works.
When an abnormal area is identified, a small sample is removed for microscopic examination using forceps; a procedure known as a biopsy. Any abnormal growth is removed by using an electric wire loop, this is known as a polypectomy. All tissue samples removed during a colonoscopy are submitted for pathology.
PREPARATION
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 with ambiguous results, as well as higher risk of complication. Therefore, please exercise your best effort to adhere to the directions for bowel cleansing.
The preparation you are prescribed is a safe and effective method for bowel cleansing. It is important that you make every effort to follow the instructions to the best of your ability. If you have had problems in the past tolerating this type of laxative, please let us know as soon as possible before your procedure. The doctor will be informed and will decide the best alternative method for you.
With this preparation, diarrhea is to be expected; a mild degree of nausea, vomiting, and abdominal cramping may 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 (IE: Depends) to and from the procedure can provide additional comfort and sense of security during transportation.
INSTRUCTIONS REGARDING YOUR MEDICATIONS
Blood Thinners
If you are on Blood thinners (such as Coumadin/warfarin or others), you will receive instructions regarding when they should be stopped prior to the exam. Please confirm these instructions with your Primary Care Physician.
Arthritis Medication
NSAID’s such as: Ibuprofen (Motrin, Advil), Aleve, Naproxen, Voltaren, Feldene etc. should be stopped 5 days prior to the exam.
If polyps are removed during your colonoscopy, these medications may have to be held for a few more days after the procedure. The physician performing your procedure will give you instructions if this is the case.
Iron Supplements
Iron supplements should be stopped 5 days prior to the exam. Multi-vitamins that contain iron are OK to take.
Blood Pressure Medications
Medications for high blood pressure, heart diseases or seizures SHOULD BE TAKEN as prescribed every day without interruption.
Diabetic Medication
Oral medications for diabetes should be skipped the day before, and the day of, the procedure. Insulin dose should be halved on the day prior, and morning of the exam.
IF YOU HAVE 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 electrocautery which could affect your specific pacemaker. Our office will communicate with your pacemaker clinic and arrange for a document to be faxed to the SURGERY CENTER before the day of the procedure. The procedure cannot be conducted without this document.
DIETARY AND BOWEL CLEANSING INFORMATION FOR COLONOSCOPY
Five days before the Colonoscopy
Stop taking any medication, as directed under the Instructions Regarding Your Medications section.
Four Days before the Colonoscopy
Avoid any foods with nuts or seeds — Examples are berries, tomatoes, sunflower seeds, peanuts, corn kernels, cucumbers, etc.
ONE Day before your Colonoscopy — CLEAR LIQUIDS ONLY – NO SOLID FOODS !!!!!!!!!
Clear liquid diet ONLY for the entire day. Clear liquids are those that you can see through. Examples are water, apple juice, 7-up, light colored Jell-O, clear soups/broths or light-colored popsicles, white grape juice, lemon juice with NO pulp, etc. Coffee and tea are OK to drink, but do not add any creamer/milk.
Avoid any red, orange, purple, green, and blue colored drinks; this can cause misleading results (IE: can be mistaken for bleeding). You may drink yellow or clear liquids.
It is VERY important for you to stay hydrated, so please drink all the prescribed water at one-hour intervals as listed below.
Starting at 5:00 pm the evening before the colonoscopy:
a. Open 1 bottle (dose 1) of (12) tablets.
b. Fill the provided container with 16 ounces of water (up to the fill line). Swallow each tablet with a sip of water and drink the entire amount over 15 to 20 minutes (one pill every 2 minutes).
Approximately 1 hour after the last tablet is swallowed, fill the provided container a second time with 16 ounces of water (up to the fill line) and drink the entire amount over 30 minutes.
Approximately 30 minutes after finishing the second container of water, fill the provided container with 16 ounces of water (up to the fill line) and drink the entire amount over 30 minutes.
The Day of your Colonoscopy
Beginning 6 hours before your scheduled arrival time:
a. Open 1 bottle (Dose 2) of (12) tablets.
b. Fill the provided container with 16 ounces of water (up to the fill line). Swallow each tablet with a sip of water and drink the entire amount over 15 to 20 minutes (one pill every 2 min).
Approximately 1 hour after the last tablet is swallowed, fill the provided container a second time with 16 ounces of water (up to the fill line) and drink the entire amount over 30 minutes.
Approximately 30 minutes after finishing the second container of water, fill the provided container with 16 ounce of water (up to the fill line) and drink the entire amount over 30 minutes.
You may take your medication(s) with a small sip of water. Refer to Medications section.
DRINK NOTHING by mouth for 3 HOURS BEFORE YOUR ARRIVAL TIME
PROCEDURE DAY
Please be punctual and present yourself to the registration personnel at the designated location at the scheduled time.
A small plastic catheter will be inserted into the hand or forearm for IV access. Sedatives are usually given to alleviate anxiety and to reduce discomfort. They may also have the amnesic effect (partially erasing the memory of the procedure). Using this sedative, PROPOFOL, most people are in deep sleep and will not have recollection except the last few minutes of the procedure. Nearly everyone tolerates the procedure well.
The colonoscope is then inserted into the rectum and advanced with a combination of gentle pressure and deflection of the tip of the scope. Because of the natural looping of the colon, periodically the nurse may apply hand pressure to your abdomen or turn you to different positions in order to facilitate the advancement of the scope. For complete examination, the scope is advanced from the rectum, by the left colon, transverse colon, to the right colon into the cecum. Whenever possible, the scope is also advanced further into the last segment of the small intestine, called the terminal ileum.
During the exam, when abnormal colonic lining is identified, a small sample is “pinched off” and sent to a pathologist for microscopic examination, a procedure known as biopsy. No discomfort is associated with this. Small amount of bleeding may, or may not be, noticeable in the bowel movement following the exam. If a growth on the colonic lining, known as a polyp, is noted, an electro-cauterizing wire loop is used to lasso, cut and cauterize the cut surface. The polyp is then retrieved for microscopic examination.
POST-PROCEDURE RECOVERY
A colonoscopy will usually last 20 to 30 minutes. After the exam you will be transferred to the recovery room for further observation. When your nurse determines that you are fully alert and safe to leave, they will recommend you for discharge from the unit. Discharge instructions are given to you before you leave the recovery room. In these notes is also the description of the findings and all procedures performed during the examination of your colon.
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 normal diet thereafter.
If sedatives are given during the procedure, driving or operating any heavy equipment on the day of the examination is dangerous and should be avoided under all circumstances, and you should plan for someone you know to remain with you during your recovery following your procedure.
RESULT DISCUSSION
If no tissue is removed during the examination, your take home instruction sheet will contain the final result of the colonoscopy and no further communication will be issued.
On the other hand, if either biopsies are taken or polyps removed, the final pathology result will be communicated to you by phone or a letter, as well as recommendation for follow-up.
COMPLICATIONS
Although a colonoscopy is considered a safe procedure, on rare occasions complications do occur. Over-sedation with depression of respiratory drive may occur. Aspiration of stomach content into the lung can lead to pneumonia.
Bleeding, should it occur, is usually mild, but occasionally requires intervention. Should you experience bleeding (bright red blood) after your procedure, please call us immediately. The extremely rare cases of perforation almost always require surgical repair. 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 may be recommended.
Lastly, despite being considered the gold standard of examination of the colon, a colonoscopy is by no means perfect. Occasionally, polyps smaller than 1 cm in diameter hiding behind the nooks and crannies of the colon may elude detection.
A nurse will call you the day after your colonoscopy to inquire of your recovery after the procedure. If you experience an unusual event such as severe pain, significant bleeding, or other symptoms should develop that are worrisome to you, please request to speak with the gastroenterology nurse in the GI office, or the physician on call to discuss the occurrence. If the situation is urgent and you are unable to reach any of those providers, please present yourself to the Emergency Room of the hospital 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 Gastroenterology department at: (541) 754-1988 during normal business hours (M-F 8am – 5pm). If you have questions or concerns outside of normal business hours, please call: 541-754-1150 for the on-call physician.
Sincerely, The Corvallis Clinic Gastroenterology Team
