» COLONOSCOPY (+/- GASTROSCOPY) INSTRUCTIONSGI Health Clinic

PLEASE READ ALL OF THE FOLLOWING INFORMATION CAREFULLY

For Colonoscopy or Gastroscopy and Colonoscopy together, there will be a bowel preparation involved.
You may need to alter your usual medications.
You need an adult to escort you home afterward.
- You cannot drive yourself home or take public transport home.
Please confirm your level of cover with your health fund. We are no-gap providers with all Australian health funds.
Any pathology specimens taken will be tested by Australian Clinical Labs and the results go to your referring doctor. You will not routinely receive a copy of these.

General hints for colonoscopy

- If you have very troublesome constipation, then use your normal laxative regularly for a few days beforehand to start clearing the bowel.
- If prone to nausea and vomiting, discuss using an anti-emetic (eg Stemetil, Maxolon) with your GP or Pharmacist before you start taking the preparation. “Anagraine” is an over the counter combination of paracetamol/metoclopramide (Maxolon) which can be purchased from the chemist- take a dose 30 minutes before starting the prep.
- Using moist toilet wipes and some soothing cream like Anusol or Vaseline around the anus can make life more comfortable.
- You can keep drinking clear fluids up to 2 hours before your scheduled admission time – then fast.
- Don’t have Colonoscopy too soon after abdominal surgery, appendicitis or diverticulitis unless advised by your doctor. Try to wait 6 weeks if possible.
- If possible, avoid planning international travel for 2 weeks after Colonoscopy as there is a small bleeding risk if polyps are removed. This risk may be much less than 1%. We can discuss any potential risk with you after the once we have the Colonoscopy result.

IMPORTANT MEDICAL INFORMATION

IF YOU:

- - Have severe kidney impairment.
  - Have frequent symptoms from heart or lung disease or have severe diabetes.
  - Live alone at home/have mobility issues.-then the standard preparation and procedures may need to be modified. Please discuss these issues with your referring doctor or contact GI Health. We may occasionally recommend a consultation before the procedure.

WHAT TO DO WITH MEDICATIONS

Aspirin and Clopidogrel: Continue use through to the day of the procedure.
Diabetes pills: Do not take on the morning of the procedure. A lower dose may be needed in the evening before. Please discuss with your usual doctor. time.
**Some newer types of diabetes pills need to be stopped for 2 days before the colonoscopy day due to risks associated with fasting and dehydration. These are Forxiga, Jardiance, Xigduo,Qtern,>Glyxambi and Jardiamet. Seek advice from your usual doctor if necessary**
Insulin: Usually reduce any evening dose by half. Do not take any insulin on the morning of the procedure. Please discuss with your referring doctor. Ask for an early
morning Colonoscopy time.Please bring your insulin with you.
Iron tablets: Please stop these 7 days before procedure.
Heart and blood pressure pills: Continue use and take them with a small amount of water early in the morning of procedure day unless otherwise advised by your usual doctor/specialist.
Blood thinners: warfarin, Pradaxa, Eliquis, Brilinta and Xarelto

- - Option 1: Stop blood-thinners before procedure. Please coordinate with the usual supervising doctor. GI Health cannot fully advise you over the phone what to do with these important medications. If you have a cardiac stent or artificial heart valve, then do not stop medications without your Cardiologist approval. If you are in any doubt, please arrange a consultation to see the Gastroenterologist prior
    to any Colonoscopy.
  - Option 2: Continue blood-thinners. There is about a 10% chance we would need to book a second colonoscopy later off the blood-thinners to deal with a large polyp.

Please bring all medications (including insulin) you would normally take on the day of your procedure with you. The nurses will give you your medications once your procedure has been completed.

Following any procedure with anesthetic, you can not drive until the next day. We strongly recommend you have a responsible person to escort you home and keep an eye on
you in the hours after your hospital discharge.You cannot walk home or take public transport unescorted.

INFORMATION ABOUT COLONOSCOPY

Colonoscopy is an examination of the lining of the colon, or large bowel. The procedure is performed using a telescope-like instrument that is passed into your bowel through the anus and allows the doctor to closely examine the lining. The doctor can also use this instrument to take tissue samples, remove polyps and perform other procedures. The examination can take from 15 to 45 minutes and is performed while you are sedated with short-acting anesthetic. An information sheet detailing colonoscopy can be downloaded from www.gesa.org.au

One common finding is that of polyps. These are wart-like growths that occur in the bowel in about a third of people. These have the potential to become cancerous and will usually be removed during Colonoscopy. The samples will be sent to pathology to assist in determining further treatment requirements.

You can expect to be at the hospital for up to 4 hours. Although you will be essentially back to normal before leaving because of the anesthetic, you will not be able to drive a car until the next day. We strongly recommend that you have a responsible adult to be with you at home after the procedure.

Colonoscopy is a very safe medical procedure.The potential risks mainly relate to:

- - Colonoscopy may not find the cause of your symptoms. Colonoscopy has been reported to miss small polyps and there are reported cases of cancer being diagnosed within a few years of an apparent normal colonoscopy. Colonoscopy and polyp removal have however been clearly shown to significantly reduce the risk of future bowel cancer.
  - Abdominal cramps or altered bowels – occasionally occur for a day or so after Colonoscopy. In rare cases might prevent the return to work the next day.
  - Bleeding after removal of polyps (risk about 1 in 500). Can occur up to 17 days after Colonoscopy. Can require hospitalisation and repeat Colonoscopy to treat.
  - Damage or perforation. The risk of this is about 1 in 3000 for most colonoscopies although the risks may change depending on age, the presence of severe diverticulosis, multiple previous abdominal surgeries or treatment of larger polyps. Symptoms of pain and fever can manifest within 24 hours and usually while you are still at the hospital. Will usually need hospitalisation
    and can need surgery to repair
  - Rare (less than 1 in 3000 risks) cases of diverticulitis, appendicitis or spleen injury have been reported and attributed to colonoscopy

You will have the opportunity to discuss these and other issues with your Gastroenterologist before the procedure starts. After that, you will be asked to sign a consent form to go
ahead with the procedure.
If you are concerned about having a colonoscopy, please call our office to arrange a consultation with the doctor so that we can come up with a plan that suits your needs.

INFORMATION ABOUT GASTROSCOPY

A gastroscopy is an examination of the lining of the oesophagus, stomach and duodenum. The procedure is performed using an endoscope that is passed gently down your oesophagus and allows the doctor to closely examine the insides. You do not have to actively swallow the scope. The doctor can also use this instrument to take tissue samples and perform other minor surgical procedures. The examination will take 15 minutes and is performed while you are under deep sedation.

PREPARING FOR A GASTROSCOPY
No solid food for at least 6 hours before your admission time.You can have water or other clear fluids like apple juice or lemonade, along with any essential medications, up to 2 hours before admission time. After that nothing until after the procedure.

If you are also having a colonoscopy, then follow the instructions for that procedure. If the gastroscopy is to diagnose gluten allergy it is strongly recommended that gluten is consumed for a minimum of two (2) weeks beforehand (consume the equivalent of 2 slices of wheat-based bread per day)

FOLLOWING GASTROSCOPY

You can expect to be at the hospital for up to 4 hours. Although you will be essentially back to normal before leaving because of the anaesthetic, you will not be able to drive a car until the next day. We strongly recommend that you have a responsible adult to be with you at home after the procedure.

Gastroscopy is a very safe medical procedure. In rare cases (about 1 in 10,000 cases) a perforation or tear of the stomach, oesophagus or duodenum can occur. This is a serious but extremely rare complication and usually requires an operation to correct the problem.

Sometimes people notice some throat discomfort for 24-48 hours afterwards. You can use salt water gargles or paracetamol to treat this.

You will get the results of the procedure before you go home and your referring doctor will receive a copy of the report a few days later. Any biopsy results take several days to come through. Consider making an appointment to see your doctor to discuss the results and further management.

You will have the opportunity to discuss these and other issues with your gastroenterologist before the procedure starts. After that, you will be asked to sign a consent form to go ahead with the procedure.

If you are concerned about having a gastroscopy, please call our office to arrange a consultation with the doctor so that we can come up with a plan that suits your needs.

GETTING READY FOR A COLONOSCOPY

Change your food intake two days before
You need to try and change your food intake 2 days before admission day to a “white diet”. The main aim is to avoid seeds, nuts, pips and any high fibre or fibrous material as these can interfere with the camera views. Avoid the following: vegetable skins, seeds and nuts, grapes, peas, beans, tomatoes, seeded breads, pears, parsnip, cauliflower, onion, high fibre white
bread, coconut, porridge, banana, mushrooms, semolina, couscous and popcorn. Avoid fruit with small pips or seeds like passionfruit. Avoid fluids that are very green or red in colour.
Foods that can be consumed include: milk, yoghurt (no added fruit), mayonnaise, cream, sour cream, butter and margarine, white bread/toast, rice bubbles cereal, eggs, white rice, regular pasta, potatoes (peeled), rice noodles, rice crackers (plain), white flour, sugar.
You can also have chicken breast (no skin), white fish fillet (no skin). Cheese: cream cheese/cheddar/ricotta/feta/cottage/mozzarella/parmesan cheese. White chocolate, vanilla ice cream, lemonade ice-block and custard.
There is a bowel preparation involved
You need to go to the chemist to get the bowel preparation material. You will need to buy PICOPREP (3 Sachets) or MOVIPREP >Moviprep kit) – NO SCRIPT REQUIRED
Use PICOPREP (low volume but more vigorous) if you are under 75 years of age and otherwise well.
Anyone can use MOVIPREP (larger volume but >more gentle) but especially if over 75 years age or other health conditions like heart or kidney problems.
The Pharmacist may suggest an alternative if there is a supply issue.
Look at the bowel preparation plan enclosed to determine when to take the preparation.
The split dosing between evening and morning is considered the gold standard approach to preparing the bowel.
You may need to alter your usual medications.
Please read important information page.
If you have been told to take an “extended” preparation because of severe constipation or failed bowel
prep in the past, then:
Buy a pack of Bisacodyl (5mg) tablets and take 2 tablets each night for 3 nights before your preparation day and a further dose at 1pm on the day before Colonoscopy.
Commence clear fluid diet at 8am the day before for a morning procedure and midday for an afternoon procedure. Follow the rest of the instructions as usual.

PREPARATION FOR MORNING COLONOSCOPY

Choose which preparation is most suitable for you:

PICOPREP This prep is suitable as a low volume preparation for those under 75 years of age in good general health	MOVIPREP Anyone can use this prep but especially if you are over 75 years of age or have any kidney or heart problems.
2-3 days before the colonoscopy:	2-3 days before the colonoscopy:
Avoid vegetable skins, seeds and nuts: especially grapes, peas, beans, tomatoes, and seeded breads.	Avoid vegetable skins, seeds and nuts: especially grapes, peas, beans, tomatoes, and seeded breads.
The day before the colonoscopy:	The day before the colonoscopy:
Up to 3pm: have the white diet type foods.Food options can include eggs, chicken, white bread, yoghurt and plain pasta such as macaroni with cheese.	Up to 3pm: have the white diet type foods. Food options can include eggs, chicken, white bread, yoghurt and plain pasta like macaroni with cheese.
After 3pm take clear liquids only (liquid you can see through) with a dash of milk only in tea/coffee.Clear broth soups, Bonox, pulp free fruit juice (egapple juice), water or cordial (not red or green), lemonade, ice blocks or plain jelly (not red or green) are okay. Electrolyte drinks like orange or yellow Gatorade are a good option to maintain hydration.	After 3pm Take clear liquids only (liquid you can see through) with a dash of milk only in tea/coffee.Clear broth soups, Bonox, pulp free fruit juice (eg apple juice), lemonade, water or cordial (not red or green), ice blocks or plain jelly (not red or green) are okay. Electrolyte drinks like orange or yellow Gatorade are a good option to maintain hydration.
At 2pm mix first sachet of PicoPrep in 1 glass (250ml) of warm water then chill in the refrigerator. You can make up the additional two glasses (250ml warm water in each) of PicoPrep (one sachet in each) and chill in the refrigerator at this stage too.	At 3-4pm Prepare your MoviPrep by mixing sachet A+B in 1 litre of water then chill in the refrigerator. You can make up the next 1 litre at this time as well and leave it in the refrigerator for the morning.
At 5pm drink first glass of PicoPrep. Continue to drink clear fluids. You may need to start using your bowels in anhour or two and bowel motions will become watery and loose.	, drink 1L MoviPrep over an hour and follow this by drinking 3-4 glasses of extra clear fluids in the next 30 minutes. Continue to drink clear fluids. You may need to start using your bowels in an hour or two and bowel motions will become watery and loose.
At 8pm Drink second glass of PicoPrep then continue to drink clear fluids.	Before going to bed make up the second lot of MoviPrep ready for the morning and chill in the refrigerator overnight, if you haven’t already done so.
On the day of your colonoscopy:	On the day of your colonoscopy:
At 5am get up and drink final glass of PicoPrep with water as above. Then drink 3-4 glasses of clear fluids. You can take your usual tablets with water before fasting starts.	At 5am drink the next 1 litre of MoviPrep, followed by 3-4 glasses of clear fluid. You can take your usual tablets with water before fasting starts.
Continue to have clear fluids up until two (2) hours before your admission/arrival time to hospital then fast completely.	Continue to have clear fluids up until two (2) hours before your admission/arrival time to hospital then fast completely.

PREPARATION FOR AFTERNOON COLONOSCOPY