- Colonoscopy
- EGD / Upper Endoscopy
- ERCP
- HALO Barretts Ablation
- Bravo Reflux Test
- Capsule Endoscopy
- Liver Biopsy
Procedure Preparation
STEP 1: Three (3) days prior to the procedure:
- Begin a low fiber diet and continue until 12PM the day prior to procedure.
- Avoid fruits and vegetables with peels or leafy greens including salads. Avoid nuts and seeds.
- Discontinue fiber supplements such as Metamucil, Citrucel, Fiberall, etc.
- Drink plenty of fluids to hydrate prior to beginning colonoscopy prep.
STEP 2: One (1) day prior to the procedure:
- Eat only clear liquid diet starting at 12PM.You may only have:
- Clear broth – chicken, beef or vegetable (no noodles)
- Plain Jell-O (no red or purple)
- Tea or coffee (no milk or cream)
- Clear pop such as Sprite, 7-UP and ginger ale
- Clear juices such as white grape, apple, lemonade
- Sports Drinks such as Gatorade or Powerade, Kool-Aid, Crystal Light (no red or purple)
- Popsicles, Italian Ice (no red or purple and no added fruit pieces)
- NO SOLID FOOD
- Be sure to drink plenty of fluids all day (nothing colored red or purple)
- Prepare the bowel prep as instructed on the container. You may refrigerate to make more tolerable.
- At 3:30 pm, take four (4) Dulcolax pills.
- At 4:00 pm start to drink 8 oz from the jug every 10-15 minutes until half of the prep is gone. You may prefer to drink it on ice. Other tips to make the prep easier:
- Drinking through a straw may help avoid contact of the salty fluid with your taste buds.
- Rinse your mouth with water, clear soda or mouthwash after drinking.
- If you feel nauseated, slow down to 8 oz every 30 min for 2-3 cups, sip peppermint tea, or suck on a lemon.
- If you experience abdominal fullness and/or bloating, slow down to 8 oz every 30 min until these symptoms subside. This is normal and will subside when bowel movements start.
- If your pharmacy did not supply you with a flavor packet, you may substitute powdered Gatorade or Crystal Light. Follow the instructions on the Gatorade or Crystal Light Container for reconstituting one (1) gallon. No red or purple.
STEP 3: The day of the procedure:
- At 4:00 am the morning of the procedure begin to drink the remainder of the prep. Again, 1 cup every 10-15 minutes until it is empty. This step must be completed by 6:00 am or 2 hours before your procedure time. To allow optimal results with your colonoscopy, make sure the jug is completely gone.
DIABETIC PATIENTS:
- No insulin or oral diabetes medications the day of your procedure.
- Insulin pump patients – follow the off-pump plan given by your prescribing physician on the day of your procedure.
PATIENTS ON BLOOD THINNERS:
- If you take Coumadin (warfarin) or Pradaxa, please obtain clarification from your prescribing physician to stop taking the medication 5 days prior to your procedure.
- If you take Plavix, Effient or any other similar blood thinning medications, please obtain clarification from your prescribing physician to stop taking the medication 7 days prior to your procedure.
- If you take, Xarelto, please obtain clarification from your prescribing physician to hold medication for 1 day prior to your procedure.
FREQUENTLY ASKED QUESTIONS ABOUT YOUR BOWEL PREP
Is there any way to make the prep taste any better? Try sucking on hard candy. Add the flavor packs that come with the gallon prep or you can add Crystal Light or Gatorade packets to the glass. Don’t eat or drink anything other than the approved liquids while you are drinking your prep. Rinse your mouth with water or mouthwash after drinking the prep.
I feel like vomiting and do not think I can drink any more. What should I do? It is important that you continue to drink the solution if possible. Without a clean bowel, the doctor will not be able to thoroughly see inside of your colon to complete the examination. You can stop drinking for 30 minutes, then resume. If you do vomit, wait 30-60 minutes then begin drinking the solution again. You make drink the prep at a slower rate.
Why avoid red and purple liquids? The color can persist in the colon and make an accurate diagnosis more difficult.
One of the medications I was instructed to take is red. Can I take it? YES
I already have diarrhea before taking the prep. Do I still have to take the colon prep/laxative? Yes, you must take the prep as directed. Your colon is approximately 6 feet long; the entire colon must be emptied for your physician to see the colon clearly.
I am taking the prep and already have loose watery stools; do I still need to take the rest of the prep? Yes, you may have solid stool higher in the colon that needs to be eliminated.
I see yellow color in the toilet bowl and a few flecks; what do I do? If your last bowel movement was clear enough to see the bottom of the toilet; you should be fine. It is OK if you have some flecks of material. The yellow color is bile that normally colors the feces. This should not interfere with the procedure.
Can I drink alcoholic beverages? No.
My bottom is very sore. What should I do? Avoid rubbing when cleaning the area. Gently pat with a wet washcloth or wet wipes. Apply Vaseline, Preparation H, or Desitin liberally.
Can I drink alcoholic beverages? No.
Can I chew gum or suck candy? NOT on the day of the procedure.
What if I am still passing stool the morning of my test? Take a tap water enema until you run clear. If this does not work, call the office.
Can I brush my teeth? Yes. Do not swallow any water.
Can I wear my dentures? Yes, you may wear dentures to the Endoscopy Center. However, you may be asked to remove them prior to the procedure.
If you have been instructed not to take anti-inflammatory or blood thinner medicine several days before the procedure. What can you take for headaches and pain relief? You may take Tylenol (acetaminophen) as directed.
I have a headache and/or feel dizzy. Dizziness and headache could be signs of low blood pressure or dehydration. Drinking a regular carbonated beverage (not diet), Gatorade or apple juice may alleviate these symptoms. Drink plenty of fluids!
Can I have the colonoscopy done if I am having my menstrual period? Yes, the procedure can still be performed. We ask that you use a tampon if possible (not absolutely necessary).
What should I do if I believe that I am pregnant? It is very important for us to be aware of this possibility. If there is any doubt, please contact us immediately.
May I drive home? Any patient receiving sedation should not drive until the next day. A patient receiving sedation for a procedure needs a ride home with a responsible adult. Patients will not be allowed to drive, walk or take public transportation after sedation or anesthesia. Please make the appropriate arrangements.
What must I bring with me on the day of the procedure?
- Bring insurance identification cards, driver's license
- Bring your completed medication list, including over-the counter, herbals and vitamins and a list of any medications to which you are allergic
- Make sure you have a ride home and someone to care for you at home
- Wear comfortable, loose fitting clothing
- Bring case for eyeglasses or contacts
- Leave all jewelry and valuables at home
EGD / Upper Endoscopy
DAY OF YOUR PROCEDURE
- DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE DAY OF PROCEDURE. THIS INCLUDES NO WATER!
- NO INSULIN or oral DIABETES MEDICATION the morning of the procedure. You may take your other scheduled medications as prescribed by your primary care physician.
- Please bring your insurance cards.
- Please bring a list of your medications and allergies.
- SOMEONE MUST ACCOMPANY YOU TO DRIVE YOU HOME. If you do not have someone to drive you home, your procedure will be rescheduled. You will receive medications which will make it dangerous for you to drive or work for the following 24 hours.
Please note: Although the actual procedure may take a short time, the time spent in the Endoscopy Lab could be longer. Time is spent on interviews with nursing personnel, preparation with medications, and recovery after the procedure. We appreciate your patience and understanding.
ERCP
Day Of Your Prpcedure
- DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE DAY OF PROCEDURE. THIS INCLUDES NO WATER!
- NO INSULIN or oral DIABETES MEDICATION the morning of the procedure. You may take your other scheduled medications as prescribed by your primary care physician.
- Please bring your insurance cards.
- Please bring a list of your medications and allergies.
- SOMEONE MUST ACCOMPANY YOU TO DRIVE YOU HOME. If you do not have someone to drive you home, your procedure will be rescheduled. You will receive medications which will make it dangerous for you to drive or work for the following 24 hours.
Please note: Although the actual procedure may take a short time, the time spent in the Endoscopy Lab could be longer. Time is spent on interviews with nursing personnel, preparation with medications, and recovery after the procedure. We appreciate your patience and understanding.
Halo Barretts Ablation
DAY OF YOUR PROCEDURE
- DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE DAY OF PROCEDURE. THIS INCLUDES NO WATER!
- NO INSULIN or oral DIABETES MEDICATION the morning of the procedure. You may take your other scheduled medications as prescribed by your primary care physician.
- Please bring your insurance cards.
- Please bring a list of your medications and allergies.
- SOMEONE MUST ACCOMPANY YOU TO DRIVE YOU HOME. If you do not have someone to drive you home, your procedure will be rescheduled. You will receive medications which will make it dangerous for you to drive or work for the following 24 hours.
Please note: Although the actual procedure may take a short time, the time spent in the Endoscopy Lab could be longer. Time is spent on interviews with nursing personnel, preparation with medications, and recovery after the procedure. We appreciate your patience and understanding.
Bravo Reflux Test
DAY OF THE PROCEDURE
- DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT THE DAY OF PROCEDURE. THIS INCLUDES NO WATER!
- NO INSULIN or oral DIABETES MEDICATION the morning of the procedure. You may take your other scheduled medications as prescribed by your primary care physician.
- Please bring your insurance cards.
- Please bring a list of your medications and allergies.
- SOMEONE MUST ACCOMPANY YOU TO DRIVE YOU HOME. If you do not have someone to drive you home, your procedure will be rescheduled. You will receive medications which will make it dangerous for you to drive or work for the following 24 hours.
Please note: Although the actual procedure may take a short time, the time spent in the Endoscopy Lab could be longer. Time is spent on interviews with nursing personnel, preparation with medications, and recovery after the procedure. We appreciate your patience and understanding.
AFTER PLACEMENT OF THE BRAVO PH CAPSULE
1. The purpose of pH monitoring is to monitor the frequency and duration on gastroesophageal reflux during a normal day. It is important that you eat, drink, work and exercise as you normally would. Without carrying out your normal day, the test results may not reflect an accurate picture of your esophageal pH exposure. DO NOT take antacids (drugs such as Maalox, Mylanta, Tums and Rolaids) during your study. You will be instruct4ed by your physician regarding other medications. This is a 48 hour study.
2. You may resume to your normal diet. Eat whatever you normally do.
3. DO NOT have MRI for 30 days following the placement of the pH capsule. Keep the capsule identification card from your patient booklet in your wallet. DO NOT have other diagnostic tests such as: CT scans, Nuclear medicine tests or X-Rays during the 48 hours the pH test is in progress.
4. Record your symptoms by pressing the buttons on the receiver. A green light on top of the receiver will light up, and a beep will be heard when a symptom button is pressed.
5. Record in your diary the start and stop times of meals or anytime you have something to eat. Use the time on the top of the receiver.
6. Record events (meals, snacks, sleep or lying down) in the patient diary using the time on the top of the receiver. Record regurgitation, chest pain, cough, etc… in this diary and this will automatically record by pressing the appropriate symptom button also. To confirm that the button has been pressed, a green indicator light remains lit for 3 seconds and a beep is heard.
7. Record in your diary start and stop time when you are lying down. If you sleep in a recliner, note in your diary that you were in a recliner.
8. If the receiver is too far from the Bravo capsule, a beep will be heard for 30 seconds and the display will flash P1 or C1. Move the receiver to your breastbone until the beep stops and the P1 or C1 is no longer visible. If P1 or C1 is still visible, you may be getting interference from another electrical device, and you need to move away from the area. The receiver must be with you at all times. You should be no further that 5 to 10 feet away from receiver at all times.
9. You may shower or bathe. Place the receiver in a zip lock plastic bag and place it outside the shower or tub. DO NOT GET RECEIVER WET!
10. The receiver will automatically shut off after 48 hours.
11. The capsule will fall off after 5 to 7 days and pass normally through the GI tract, being expelled in a bowel movement and flushed down the toilet.
12. At the completion of your pH study, return the Bravo pH receiver and your diary to the hospital, Day Surgery Department where your procedure was performed.
13. If you have any problems during the study, please notify the Day Surgery Unit Supervisor at the hospital where the procedure was performed.
Capsule Endoscopy
Things To Avoid Before Your Capsule Endoscopy:
- IRON PILL, ANTACID AND CARAFATE FOR 3 DAYS PRIOR TO TEST
- SMOKING 24 HOURS PRIOR TO TEST
Day Before The Test
Eat a Clear Liquid Diet All Day. You may Only have:
- Clear broth (no noodles)
- Plain Jello (no red or purple)
- Tea or coffee (no milk or cream)
- Clear pop like Sprite, 7-UP and ginger ale, or drink apple juice
- NO SOLID FOOD (BE SURE TO DRINK PLENTY OF FLUIDS (NOTHING COLORED RED OR PURPLE)
- If you are a diabetic, please ask us about taking your medication.
- At 6:00 p.m., mix three 17 gram packages of Glycolax/Miralax (sold over the counter) in 12 ounces of liquid.
- DO NOT EAT or DRINK ANYTHING (INCLUDING WATER) after 10 p.m. except for necessary medications with a small sip of water.
- Male patients need to shave their abdomen 6 inches above and below the navel (belly button). This enable the sensors to adhere to the skin.
Day Of The Test
- Do not take any medication 2 hours before the test.
- Arrive at the office at scheduled time, wear loose fitting, two piece clothing. Please no dresses.
After Ingesting The Capsule
- After ingesting the capsule, do not eat or drink for 2 hours. You may have a small snack after four hours. You may resume a normal diet at teh conclustion of the test.
- Avoid any powerful; electromagnetic fields, such as MRI machines, until you have passed the capsule.
- Capsule Endoscopy lasts approximately 8 hours. Please DO NOT manipulate the equipment in any way. Please also avoid any sudden movement or banging of the data recorder.
- Please also try to verify every 15 minutes that the red light at the top of the data recorder is blinking twice a second. This ensures the machine is working. Contact us immediately if it stops.
- Record the time and nature of any event such as eating, drinking, activity other than normal daily activity, or any strenuous activity.
- It is recommended that you walk throughout the day. Increase in activity helps to increase motility of the intestines and pass the capsule through more quickly. However, avoid any strenuous activity that may cause you to sweat.
After Finishing Capsule Endoscopy
- After 8 hours, you will return to the office where the equipment was placed earlier in the morning. At this time, the office staff will remove the equipment. Please DO NOT attempt to remove the equipment on your own.
- You can now resume all activities and regular eating habits.
Liver Biopsy
- A liver biopsy is a procedure to remove a small piece of the liver so it can be examined with a microscope for signs of damage or disease.
- A liver biopsy is used to diagnose liver problems or to estimate the degree of liver damage.
- Patients prepare for a liver biopsy by stopping medications that might interfere with blood clotting and by having blood drawn to make sure clotting is normal.
- Patients should not eat or drink for 8 hours before the liver biopsy and should arrange a ride home.
- Results from a liver biopsy take a few days to come back.
- Most patients fully recover from a liver biopsy in 1 to 2 days.
- The major risk of liver biopsy is excessive bleeding, called hemorrhage.