Many of our patients need some type of endoscopic procedure to examine the digestive system. Here you can download copies of the instructions that we use for our patients and also find the answers to frequently asked questions (FAQs, see below).
Note: these are PDF files. If you do not already have Adobe Reader, you may need to download it here: Adobe Reader
Colonoscopy
EGD
Sigmoidoscopy, morning exam
Sigmoidoscopy, afternoon exam
Other instruction sheets and forms can be found on Patient
Forms
Colonoscopy Index
EGD Index
Sigmoidoscopy Index
Questions about the preparation for your colonoscopy:
What is a colonoscopy?
What preparation is required?
What about eating fiber for three days prior to the examination?
I'm having a really hard time with this low-fiber diet in the
three days prior to my procedure. Fresh fruits and vegetables are all that
I eat! What exactly is allowed?
May I use Metamucil or something similar before the exam?
May I still take my regular medications before my colonoscopy?
May I have my morning cup of coffee the day of the exam?
Isn't alcohol a clear liquid? Is it permitted before the exam?
What happens if I need to cancel my appointment?
What happens if I change my insurance company before my examination?
Questions about the day of the examination:
How early do I need to arrive for my colonoscopy?
May I come alone or does someone need to drive me home?
What medication will I receive during the procedure?
What happens during the examination?
What if I have a polyp?
What are the risks of the procedure?
Questions about what happens after the examination:
What happens after the procedure?
What happens if I have pain or lose blood after I leave?
When will I get my results?
Do I need to see the doctor in the office to discuss the findings at the colonoscopy?
Will my primary/referring physician receive the results of the exam?
Questions about preparation for your EGD:
What is an EGD or EsophaGogastroDuoenoscopy?
What preparation is necessary for an EGD?
May I still take my regular medications before my EGD?
What happens if I need to cancel my appointment?
What happens if I change my insurance company before my examination?
Questions about the day of the examination:
How early do I need to arrive for my EGD?
May I come alone or does someone need to drive me home?
What medications are given during the EGD?
What happens during the examination
What are the risks of EGD?
Questions about what happens after the examination:
What happens after the examination?
When will I get my results?
Do I need to see the doctor in the office to discuss the findings at the EGD?
Will my primary/referring physician receive the results of the exam?
What is a sigmoidoscopy? How is it different from a colonoscopy?
What preparation is required?
May I continue my regular medications prior to my sigmoidoscopy?
May I come alone or does someone need to drive me home?
Will I be medicated during the procedure?
What happens during the examination?
When will I get the results?
Colonoscopy:
Questions about the preparation for your colonoscopy:
A colonoscopy is a medical procedure. A long flexible tube (colonoscope) is used to inspect your colon (large intestine) so that diseases, if present, may be identified. Sometimes the examination is carried out to locate and remove polyps. They are usually benign, but occasionally may contain a focus of cancer. They can usually be removed at the time of the exam. The only other means for their removal would be surgical intervention.
Proper preparation is extremely important for this examination. The colon must be clean and empty for the doctor to perform an adequate exam. An inadequate preparation usually means that the exam must be stopped and rescheduled at a later date. Your physician will give you detailed instructions regarding diet and the cleansing routine. Please follow these instructions carefully. Copies of the instructions can be found by clicking here.
What about eating fiber for three days prior to the examination?
For three days prior to the exam, large amounts of fiber in the diet should be avoided (for example, fresh fruits and vegetables, the skin of potatoes, brown bread).
Also, do not eat corn or beans for three days prior to the procedure.
I’m having a really hard time with this low-fiber diet in the three days prior to my procedure. Fresh fruits and vegetables are all that I eat! What exactly is allowed?
There are many acceptable foods, including:
• very low fiber cereals, such as rice krispies or cream of wheat
• bananas
• eggs, cheese, yogurt, milk
• plain spaghetti, white rice
• chicken, fish, well-cooked beef
• canned fruits and vegetables (but no corn or beans)
• white bread and rolls
• ice cream
May I use Metamucil or something similar before the exam?
Because these items make it more difficult to clear out the colon, drugs, such as iron and bulking agents (Metamucil, Citrucel, Benefiber, etc.) should not be taken for five days prior to the exam.
May I still take my regular medications before my colonoscopy?
Please follow these guidelines and remember to mark on your calendar the day you must stop taking certain medications.
• Avoid aspirin, coumadin, Plavix, and anti-inflammatory pills, such as Aleve, Advil, Motrin, and ibuprofen and multivitamins, vitamin E, calcium and iron pills for 5 days prior to the colonoscopy.
If you have had bypass surgery or a coronary artery stent, stop the aspirin and Plavix only 3 days before the colonoscopy. If joint pain is a particularly bad problem you can continue anti-inflammatory medication until 3 days before the colonoscopy.
• Please alert the doctor if you are taking Plavix or coumadin.
• You may take Tylenol (acetaminophen).
Most of these items are blood thinners that may increase the risk of bleeding following polyp removal. Calcium and iron may impair optimal cleansing of the bowel.
Please alert the doctor if you have an artificial heart valve or previous bacterial endocarditis. You will then need pre-operative antibiotics. For mitral valve prolapse or most artificial joints, current guidelines suggest pre-treatment with antibiotics is unnecessary for colonoscopy. However, we would prescribe pre-operative antibiotics for artificial joints placed less than 6 months ago.
If there is any question about medications you are taking, discuss it with your doctor well before the procedure.
May I have my morning cup of coffee the day of the exam?
Coffee is considered a clear liquid. Follow the instructions for drinking clear liquids before the exam. The answer depends on what time your exam is and what type of anesthesia you are having.
Isn’t alcohol a clear liquid? Is it permitted before the exam?
Alcohol is not permitted for 24 hours before the examination.
What happens if I need to cancel my appointment?
There is a huge demand for colonoscopic procedures and we have difficulty scheduling patients as early as they would like because of the limited number of time slots available at the hospital. In addition, this procedure reserves up to one hour of the doctor’s time. Every effort must be made to inform the office of cancellations at least one week in advance. Even with this notice it is very difficult to substitute another patient because of the requirements of the prep and disruption of their schedules. These procedures are scheduled with hospitals or Woodburn Endoscopy Center, often requiring insurance company pre-approval and therefore consume up to 30 minutes of our scheduler’s time to reschedule procedure dates. Procedure slots that are not utilized further impair our ability to schedule our patients in a timely manner. Late cancellations should be for true emergencies only.
What happens if I change my insurance company before my examination?
You must notify our office if you change your insurance company before the date of the procedure.
Questions about the day of the examination:
How early do I need to arrive for my colonoscopy?
If your Procedure is at Fairfax Hospital you must be at the Outpatient Registration Department (Blue entrance – Women’s and Children’s Hospital lobby) 30 minutes before the scheduled time of your procedure, unless otherwise specified.
If your procedure is at the Woodburn Endoscopy Center, you must arrive 30 minutes before the scheduled time of your procedure.
May I come alone or does someone need to drive me home?
You must bring a driver with you the day of the exam. You will be medicated during the procedure and the effects of the medication make driving dangerous and illegal until the next day. If you absolutely cannot find a driver, a ride service is available--please see the notice in our waiting room in the Prosperity Palza office. You may not take a taxi unless accompanied by a friend or family member.
What medication will I receive during the procedure?
You will be medicated for your procedure with either:
- Deep intravenous sedation
This is administered by an anesthesiologist. A medication called propotol is administered through an IV in your arm. It is not general anesthesia but is deeper sedation than conscious sedation. For this sedation, you will infrequently need an anesthesia form. If so, you will be notified during your office visit before the procedure.
- Conscious sedation
For conscious sedation, a sedative called versed and a narcotic (almost always fentanyl) are given intravenously to relax the patient and make the exam more comfortable. The patient may sleep, but will remain arousable. If you have had any unfavorable reaction to these drugs (especially nausea/vomiting), tell the doctor before the injection is given. The effects of the medication make driving and operating dangerous machinery or tools hazardous until the next day.
What happens during the examination?
The patient will lie on their left side for the exam. A lubricant is applied around the anus and the colonscope is passed into the rectum. It is necessary to pass some air through the scope to aid in the exam. This may cause you to feel distended and full. The large intestine is quite tortuous. As the instrument passes around some of these turns, it may cause a transient cramping or a pressure sensation. This is usually relieved as the instrument is straightened. The sedatives help minimize any discomfort.
The exam generally lasts between 20 and 30 minutes. A nurse is present to help the doctor and to monitor the patient.
Polyps are removed by either grabbing them with a small forceps or by placing a wire loop around the base of the polyp through which an electric current is passed to cauterize blood vessels while the polyp is removed. You will not feel this current. The polyp is retrieved and examined by a pathologist.
What are the risks of the procedure?
The frequency of complications with a colonoscopy is extremely small. The removal of large colon polyps represents the greatest potential for complications. The only other means of removing these pre-cancerous polyps would be abdominal surgery. Despite the complications that can rarely be seen with polypectomy (removal of a polyp), surgery represents a greater risk for complications than a colonoscopy with polyp removal, making colonoscopy the procedure of choice in dealing with colon polyps.
Perforation of the colon occurs in approximately 1 and 2,000 exams. This would likely require a major surgical procedure on the same day to close the perforation. Bleeding from a polyp removal site or biopsy site is another potential complication. It is also unusual, occurring in 0.1% to 1% of patients undergoing polypectomy. Should significant bleeding occur, hospitalization may be necessary. Although most of this bleeding stops spontaneously, transfusions may be necessary before its cessation. If the bleeding does not stop, other measures, including repeat colonoscopy, angiography with therapeutic intervention, and even surgery may be necessary.
The alternatives to colonoscopy for identifying polyps, cancer or other abnormalities are barium enema x-ray or virtual colonoscopy (CT colonography). These other exams are less likely to identify existing polyps and do not permit biopsy, removal or treatment of lesions, so if any abnormalities are identified, colonoscopy will then be needed. They require similar bowel preparation and have similar discomfort levels. However, the very low complication rate with colonoscopy is even lower with these procedures. Polyps are found in about 30-40% of patients at colonoscopy. Sigmoidoscopy is another alternative but utilizes a shorter scope that only reaches about one-third of the colon.
The vast majority of patients tolerate colonoscopy very well. The above information is provided only to increase your medical awareness and enable us to deliver the best medical service to you.
Some degree of apprehension is normal, but the endoscopy staff will try to make your exam as comfortable as possible. Most patients find that the exam is much less unpleasant than they anticipated. If you have any further questions, your doctor will have an opportunity to talk with you before the procedure.
Questions about what happens after the examination:
What happens after the procedure?
After the exam you will rest for a while in a recovery area until the effects of the medications have subsided and until you have passed much of the air that was pumped in to aid in the exam. You will be observed for 30 – 45 minutes after completion of the colonoscopy. There may be some crampy abdominal discomfort immediately following the exam, although this usually diminishes as you pass the excess air. It is also not unusual to see a small amount of blood in your stool following polyp removal or biopsy.
What happens if I have pain or lose blood after I leave?
If substantial pain develops after you leave the endoscopy unit, or if you begin to experience substantial blood loss per rectum, contact your doctor at 703-560-3510 or go to a nearby emergency facility immediately.
If biopsies are taken you will be called with the results within 2 weeks after your exam, and often within a week. However, if you have not gotten you results within three weeks of your exam, please call the office Monday through Friday between 1:30 and 4:00 pm.
If no biopsies were taken and no polyps were removed, you will not be contacted.
Do I need to see the doctor in the office to discuss the findings at the colonoscopy?
Usually not. Your doctor will tell you if you need to follow up in the office.
Will my primary/referring physician receive the results of the exam?
Yes. We will send your primary/referring physician a report. He or she will generally receive a dictated report within 1-2 weeks after the procedure, often within a few days.
EGD – (ESOPHAGOGASTRODUODENOSCOPY)
Questions about the preparation for your EGD:
What is an EGD or EsophaGogastroDuoenoscopy?
An EGD is examination of your esophagus, stomach, duodenum, and upper few inches of the small intestine which is performed to locate and understand any abnormalities that are present. It is used to help diagnose and treat certain upper gastrointestinal symptoms and other problems including diarrhea and bleeding.
What preparation is necessary for an EGD?
The examination requires that you have an empty stomach; that is, you should not take any food after midnight the night before the exam, or any liquid for six hours before the exam. Essential medications, such as blood pressure or heart pills, may be taken with a small amount of water up to 3 hours before the exam.
May I still take my regular medications before my EGD?
Please follow these guidelines and remember to mark on your calendar the day you must stop taking certain medications.
• Do not take aspirin, coumadin, Plavix, or vitamin E pills for 4 days prior to the EGD.
• If you have had bypass surgery or a coronary artery stent, stop the aspirin only 3 days before the EGD.
If there is any question about medications you are taking, discuss it with your doctor well before the procedure.
What happens if I need to cancel my appointment?
There is a huge demand for endoscopic procedures and we have difficulty scheduling patients as early as they would like because of the limited number of time slots available at the hospital. In addition, this procedure reserves up to 45 minutes of the doctor’s time. Every effort must be made to inform the office of cancellations at least one week in advance. Even with this notice it is very difficult to substitute another patient because of the disruption of their schedules. These procedures are scheduled with hospitals and Woodburn Endoscopy Center, often requiring insurance company pre-approval and therefore consume up to 30 minutes of our scheduler’s time to reschedule procedure dates. Procedure slots that are not utilized further impair our ability to schedule our patients in a timely manner. Late cancellations should be for true emergencies only.
What happens if I change my insurance company before my examination?
You must notify our office if you change your insurance company before the date of the procedure.
Questions about the day of the examination:
How early do I need to arrive for my EGD?
If your Procedure is at Fairfax Hospital you must be at the Outpatient Registration Department (Blue entrance – Women’s and Children’s Hospital lobby) 30 minutes before the scheduled time of your procedure unless otherwise specified.
If your procedure is at the Woodburn Endoscopy Center, you must arrive 30 minutes before the scheduled time of your procedure.
May I come alone or does someone need to drive me home?
You must bring a driver with you the day of the exam. You will be medicated during the procedure and the effects of the medication make driving dangerous and illegal until the next day. If you absolutely cannot find a driver, a ride service is available--please see the notice in our waiting room in the Prosperity Palza office. You may not take a taxi unless accompanied by a friend or family member.
What medications are given during the EGD?
You will be medicated for your procedure with either:
- Deep intravenous sedation
This is administered by an anesthesiologist. A medication called propotol is administered through an IV in your arm. It is not general anesthesia but is deeper sedation than conscious sedation. For this sedation, you will infrequently need an anesthesia form. If so, you will be notified during your office visit before the procedure.
- Conscious sedation
Because many patients are nervous and apprehensive about the examination, we usually administer a small dose of sedative medication through an IV line (into a vein). The drugs usually used are a narcotic (almost always fentanyl) and a sedative called Versed. The drugs will either put you to sleep or strongly relax you. Your throat will also be sprayed with benzocaine or cetacaine to numb your gag reflex. If you have had an unfavorable reaction to any of these drugs you should tell your physician before the medication is given.
What happens during the examination?
The examination is conducted with the patient lying on the left side. A long flexible tube is placed in the mouth as the patient swallows; the doctor advances the tube into the esophagus. You will be able to breath normally throughout the examination. A mouth guard on which the patient rests his teeth is used to protect the instrument from accidental bite injury. As the examination is conducted the doctor pumps a small amount of air into the esophagus and stomach to provide a good look at the stomach lining. The doctor will also remove air and secretions by suction to prevent distention, but you may feel some fullness during the test. Tiny bits of tissue may be removed with the biopsy forceps for examination by a pathologist. You will not feel the sampling process.
There is some risk to any procedure, but the frequency of complications with upper gastrointestinal endoscopy is exceptionally small. In a national survey of the results of 211,410 examinations there were 70 tears through the lining (perforation), 62 instances of bleeding, 129 heartbeat and breathing problems, 17 infections, and 228 miscellaneous reactions, primarily to medication (hives, blood clots, etc.). Perforation is a major complication requiring emergency surgery but occurs in less than 1 in 2,000 exams. Cardiac and pulmonary irregularities are exceedingly uncommon, but may be life-threatening. Bleeding complications may necessitate hospitalization and transfusions. Because removal of stomach polyps is sometimes associated with bleeding, on rare occasion your doctor may hospitalize you after the procedure. The vast majority of patients tolerate the procedure very well. The above information is provided only to increase your medical awareness and enable us to deliver the best medical service to you.
Some degree of apprehension is normal, but the endoscopy staff will try to make your examination as comfortable as possible. Most patients find that the exam is much less unpleasant that they anticipated. If you have any questions, please call our office at your convenience.
Questions about the day of the examination:
What happens after the examination?
The examination usually lasts 10-20 minutes. The physician will discuss the results with you in the recovery room following the examination. Most patients will be able to leave 30 minutes after the examination is completed. Until then, you will be asked to rest in the recovery room for a short time until the effects of the sedation have subsided. You should rest at home for the remainder of the day. You may resume most normal activities including driving and operating hazardous machinery the next day. The examining doctor will send a report to your physician reviewing all the details of the examination.
If biopsies are taken you will be called with the results within 2 weeks after your exam and often within a week. However, if you have not gotten you results within three weeks after your exam, please call the office Monday through Friday between 1:30 and 4:00 pm.
If no biopsies were taken and no polyps were removed, you will not be contacted.
Do I need to see the doctor in the office to discuss the findings at the EGD?
Usually not. Your doctor will tell you if you need to follow up in the office.
Will my primary/referring physician receive the results of the exam?
Yes. We will send your primary/referring physician a report. He or she will generally receive a dictated report within 1-2 weeks after the procedure, often within a few days.
Flexible Sigmoidoscopy
What is a sigmoidoscopy? How is it different from a colonoscopy?
A sigmoidoscopy is a medical procedure. A long flexible tube (flexible sigmoidoscope) is used to inspect your rectum and lower colon so that diseases, if present, may be identified. Sometimes the examination is carried out to locate and remove polyps. These are usually benign, but occasionally may have a focus of cancer on the surface. These can often be removed at the time of the exam. The only other means for their removal would be surgical intervention. A sigmoidoscopy is different from a colonoscopy because only the rectum and lower colon are examined. In a colonoscopy, the entire large intestine is examined. A sigmoidoscopy only really reaches about one-third of the colon. We usually perform sigmoidoscopies in the office. A colonoscopy is done at the hospital.
Before the exam, you will need to take specific steps at home so that your bowel is completely emptied. The goal of the following instructions is to adequately cleanse the bowel to allow good visualization of the rectum and lower colon with the sigmoidoscope. An inadequate preparation usually means that the exam must be stopped and rescheduled at a later date. Your physician will give you detailed instructions regarding diet and the cleansing routine. Please follow these instructions carefully. Copies of the instructions for the morning examination can be found by clicking here and copies of the instructions for the afternoon examination can be found by clicking here.
May I continue my regular medications prior to my sigmoidoscopy?
Do not take iron tablets or vitamins with iron or fiber supplements (i.e. Metamucil, Citrucel), or calcium supplements for 72 hours prior to the exam. For morning or afternoon exams, other medications that you may be taking may be ingested with water. If you are on Plavix or Coumadin or have questions about other medications you are taking, please consult your doctor prior to the exam.
May I come alone or does someone need to drive me home?
You are not medicated during the examination so there are no prohibitions on driving after the sigmoidoscopy.
Will I be medicated during the procedure?
No.
What happens during the examination?
During the exam, you will be asked to lie on your left side. This way, the doctor can gently insert the sigmoidoscope through the anus and rectum and pass it into the bowel. The doctor will then draw it out slowly while carefully examining the inside surface. The exam generally lasts 10 minutes.
The doctor will discuss the results with you after the examination.
If biopsies are taken you will be called with the results within 2 weeks
after your exam, and often within a week. However, if you have not gotten
your results within three weeks, please call the office, Monday through Friday between
1:30 and 4:00 pm.
W3C HTML 4.01 Validated
W3C CSS Validated
© 2005 Daniel Ranard and Ben Ranard
The information on this website is not intended to replace the advice of a
doctor. If you have medical questions please contact your doctor. If it is
a true emergency please call 911 or proceed to the nearest emergency room.
Email webmaster@novagidoc.com for technical issues ONLY. This email does not go to medical personnel.
| |
|||||||
|
|
|
|
|||||
|
|
|||||||
|
|
|
||||||
|
|
|||||||
|
|
|
||||||
|
|
|||||||
|
|
|
||||||
|
|
|||||||
|
|
|
||||||
|
|
|||||||
|
|
|||||||
|
|
|||||||
|
|
|
||||||
|
|
|||||||
|
|
|||||||
|
|
|||||||
|
|
|
|
|
|
|
|
|