Colonoscopy

PROCEDURE INSTRUCTIONS:

AREAS EXAMINED & TREATED

RIGHT COLON
TRANSVERSE COLON
LEFT COLON
RECTUM

THE PROCEDURE

COLONOSCOPY
- DIAGNOSTIC
  - This is an internal examination of the entire length of the colon
  - It is performed using an instrument called a colonoscope
  - The colonoscope has a small camera attached to a flexible tube
  - It may provide a visual diagnosis
  - Biopsies may be taken

- THERAPEUTIC
  - Various therapeutic maneuvers can be performed
  - Benign or precancerous polyps may be removed

BEFORE YOUR PROCEDURE

SCHEDULE YOUR PROCEDURE [GASTRO DOXS]
- APPOINTMENT
  - Schedule your procedure appointment with GastroDoxs by phone or in the office
- LOCATION
  - A procedure location will be suggested based on your insurance & geographic area
  - Please refer to the locations page on our website
- INSURANCE
  - Our team will obtain the required insurance prior authorization, if needed
- FINANCIAL
  - GastroDoxs provider fees will be collected upon scheduling your procedure
- ORDERS
  - Our team will send your procedure orders to the surgery center
- TRANSPORTATION
  - Do not plan to drive after your procedure
  - You must have someone 18 years old or above to drive you home
  - NO Uber | Lyft | Cab
- CHANGES
  - To cancel or reschedule, call GastroDoxs @ 832-632-4070
REGISTER [SURGERY CENTER]
- GENERAL
  - A representative from the hospital or surgery center will call you to discuss the registration process, time & location of your procedure
- CLINICAL
  - The pre-assessment testing team will discuss the following:
    - Clearance if necessary
    - Medical History
    - Medications
    - Pre-anesthesia questionnaire
    - Surgical history
- FINANCIAL
  - Hospital, anesthesia & pathology fees are independent from GastroDoxs
  - The other fees not related to GastroDoxs are to be discussed directly with the other providers, hospital or surgery center
  - If you have not heard from the financial representative 24 hours before your procedure, call them at that time
CLEARANCE
- Cardiac | Pulmonary | Hematology | Neurology Clearance
  - You may need a clearance if you
    - Have high risk conditions requiring clearance
    - Are on blood thinners or these medications
      - Coumadin [Warfarin] | Pradaxa [Dabigatran] | Plavix [Clopidogrel] | Xarelto [Rivaroxaban] | Eliquis [Apixaban] | Brilinta [Ticagrelor] | Savaysa [Edoxaban] | Effient [Prasugrel]
- You may need a follow up with your Doctor or Provider before they can issue a clearance
- Our team will send your Doctor or Provider a clearance request from our office
- Once our team has your clearance on file, we will call you to schedule your procedure
MEDICATIONS
- 2 WEEKS BEFORE
  - Hold > GLP-1 Agonist Medication: Ozempic | Mounjaro | Victoza | Trulicity | Wejovy, etc
- 1 WEEK BEFORE
  - Hold > Anti-Diarrheal Medication: Imodium, Kaopectate [Pepto-Bismol]
  - Hold > Iron Tablets
  - Hold > Multivitamins
- 1 DAY BEFORE
  - Hold > Oral Diabetes Medication
  - Insulin > Take ½ the dose
- PROCEDURE DAY
  - Blood Pressure Medication > as instructed by the pre-assessment team
  - Insulin > Hold
  - Others > Hold
- OTHER
  - Continue to take your medications unless specified below
  - Blood thinners will require a clearance on file before scheduling
  - The pre-assessment team (PAT) will review your medications & may make other recommendations also
DIET INSTRUCTIONS
- 2 WEEKS BEFORE THE PROCEDURE
  - FOODS
    - No change
  - LIQUIDS
    - Drink plenty of water
- 1 WEEK BEFORE THE PROCEDURE
  - FOODS
    - No Nuts or Seeds [berries, cashews, corn nuts, peanuts, pecans, popcorn, walnuts]
    - Low Fiber Diet
      - Foods - white bread, cheese, eggs, yogurt
      - Soups - clear vegetable, chicken or beef broth
      - Vegetables - cooked without skin like mashed potato
      - Fruits - pureed fruits without skin like applesauce
  - LIQUIDS
    - Drink plenty of water
- 1 DAY BEFORE THE PROCEDURE
  - FOODS
    - Clear Liquid Diet
    - Soups - clear vegetable, chicken or beef broth
    - Juices - clear only without pulp
    - Stop - All food after 12 am [midnight]
  - LIQUIDS
    - Drink plenty of water
    - No alcohol
    - No red or purple colored drinks
    - Stop - All liquids after 12am [midnight]
- PROCEDURE DAY
  - NO - food or liquids on the procedure day
  - Blood Pressure Medication > as instructed by the pre-assessment team
  - Insulin > Hold
  - Others > Hold
BOWEL PREPARATION INSTRUCTIONS
- All Preparations
- Clenpiq
- Colyte
- Gavilyte C|G|N
- Golytely
- Magnesium Citrate
- Nulytely
- Moviprep
- PEG 3350
- Plenvu
- Suflav
- Suprep
- Sutab

PROCEDURE DAY

DIET
- NO - food or liquids on the procedure day
ARRIVAL
- Please ensure you arrive 1-1.5 hours before your procedure
- You will check in at registration when you arrive
PRE-PROCEDURE
- The clinical team will go through the clinical assessment as well as risks & benefits of the procedure
- The anesthesia team will explain all aspects before the procedure
- Consent forms the procedure will need to be signed
SEDATION
- An intravenous line will be inserted into your arm to administer medication
- You will be given intravenous sedation medication during the procedure
POSITION
- You will be instructed to lie on the left side with your knees up to your chest
VISUALIZATION
- After sedation, the colonoscope is inserted through the anus & gently advanced to visualize the colon.
- Since better views are obtained during withdrawal than during insertion, a more careful examination is done during withdrawal of the scope
POST-PROCEDURE
- It will take approximately 30 minutes to 1 hour to recover from the anesthesia
- The clinical team will observe for any symptoms or signs of abdominal pain, vomiting, dizziness, blood pressure issues, heart rate issue, fever
- If you are doing well & have woken up from the anesthesia you will likely be discharged to go home 1 hour after the procedure
DIAGNOSTIC
- If any diagnostic tissue samples or biopsies are required it can be obtained through the endoscope during the procedure
THERAPEUTIC
- If intervention is required, it will be done during the procedure.
- Polyps may be removed with electrocautery snares, & photographs may be taken.
- Biopsies may be taken
PATHOLOGIST
- Biopsies are tissue samples that are reviewed by a Pathologist under the microscope
- The Pathologist will determine the nature of the tissue samples
- The Pathologist will send the reports to our office
FOLLOW UP
- Our providers will review the report in detail
- The findings will be reviewed with you in detail upon follow up

AFTER YOUR PROCEDURE

RECOVERY
- You will be under observation for 30 minutes to monitor for any symptoms
- You will be awake within 30 min but may still be groggy for 12-24hrs
- Do not plan to drive the remainder of the day after your procedure
TRANSPORTATION
- Do not plan to drive after your procedure
- You must have someone 18 years old or above to drive you home
- NO Uber | Lyft | Cab
SYMPTOMS
- Normal post procedure symptoms:
  - Bloating
  - Gas
  - Slight abdominal pain
  - Some diarrhea
  - Weakness
- Abnormal post procedure symptoms:
  - Bleeding
  - Excessive vomiting
  - Fever >100
  - Severe abdominal pain
  - Any other severe or unusual symptoms
  - Please call 911 & go to the nearest emergency room
APPOINTMENT
- Ensure that you have a followup 2-3 weeks after the procedure
RESULTS
- Your results will be discussed in detail
- Treatment recommendations will be given
QUESTIONS
- Call GastroDoxs @ 832-632-4070