Welcome to medicine with Doctor Moran. I am Doctor Keith Moran. In this video I will
review the importance of preparing for a colonoscopy with one day of clear fluids
and 4 liters of PEG solution. if you have not already I would recommend that
you watch my video titled everything that you wanted to know about
colonoscopy but were afraid to ask. It's on the screen right now just click
the link. This reviews all aspects of the colonoscopy and is a must watch. This
video specifically is about the one day of clear fluids and four liters of PEG
solution preparation. This is from Carla Barrett. Colonoscopy preparation. The
preparation is always the worst part of the procedure. For patients going on
clear fluids the day before and the laxatives that will trigger the back
there and diarrhea can cause apprehension. It is worth this minor
hassle to have a good look at the colon to assess for abnormalities which might
include colonic polyps which are gross on the colon.
These can be benign as well as precancerous and the other purpose of
course is to search for colon cancer. There are many other abnormalities
though that could be seen. The preparation is a very important part of
the procedure to ensure that the bowel is clear of feculent matter and that all
the walls of the colon can be well seen. How effective the prep is a critical
factor for colonoscopy. It's very important to read the prep
sheet in detail at least one week pre procedure. There may be medications that
need to be held and it's important to avoid nuts, seeds, popcorn, as I will
describe pre procedure. You will need to purchase the medication for preparation
as well. and An inadequate bowel preparation as a number of consequences.
It takes the colonoscopist longer to pass the scope from the rectum to the
end of the colon where the cecum is. It also takes longer
to withdraw the scope as areas which may be partially soiled need to be
washed and suctioned. It is harder to find polyps when the colon is not clear.
As I always tell my patients it is much easier to find something in a room that
is tidy rather than looking for something in a room that is messy. A
suboptimal bowel preparation sometimes means that the interval between
colonoscopies needs to be shortened. or if the preparation is truly suboptimal the
procedure simply needs to be repeated at the next available time slot. In other
words you have to have another colonoscopy. Suboptimal bowel
preparations lead to a lower likelihood of the scope being advanced all the way
to the cecum so a lower completion rate.Tthey also lead to a lower polyp
detection rate. There is much higher risk of adverse events when the bowel is not
optimally prepared as it may be difficult to see which way the lumen is
going on insertion. Sometimes large diverticula which are thin walled can be
difficult to tell the difference between the colonic lumen and a diverticulum in
a suboptimal preparation. Pushing the colonoscope into a diverticulum could
cause a perforation. Medications prior to colonoscopy. It is important that your
medications are reviewed prior to a colonoscopy. Some medications such as
iron need to be held beforehand. Typically iron is held for five days
pre-procedure. Blood thinners otherwise known as anticoagulants or antiplatelet
medications may or may not need to be held. This is done on an individualized
basis. If an anticoagulant is discontinued there is obviously a risk
of a blood clot developing around the time of the colonoscopy but this has to
be balanced by the risk of bleeding from the procedure itself. Aspirin and
non-steroidal anti-inflammatory drug like Ibuprofen or Naprosyn or Motrin may
be continued safely in patients having a colonoscopy. Diabetic patients on
medications will need adjustments. Typically for diabetics in general the
medications are reduced by 50% with close blood glucose monitoring during
the preparation days or day as well as the day of the colonoscopy. Even with a
significant reduction in diabetic medications some of my diabetic patients
attend for colonoscopy with glucose readings in the normal range which they
tell me they never get. I always point out to them in this instance that
typically patients consume less carbohydrates during the preparation
than in their normal diet. So their blood glucose levels would be much lower
as carbohydrates are broken down into glucose by the intestine. This is why we
reduce diabetic medications. I tell diabetics that it shows them if
they want to do a lower carbohydrate diet when they transition back to solid
food after their colonoscopy they could have much better diabetic control going
forward with much less medication for diabetes. This is an excellent
opportunity to explain to diabetics the importance of a lower carbohydrate diet.
In order to reduce their dependence on their diabetic medication many diabetic
patients on a low-carb diet can in fact reverse their diabetes lose weight and
subsequently develop normal glucose control. Colonoscopies do have risks.
There have been multiple studies looking at complications over the last 20 years.
Serious harm is approximately 0.2% which is two and one thousand. This was seen in
one meta-analysis. A meta-analysis is a technique of synthesizing research
results by using different statistical methods to put together results from
previous separate but related studies to drove draw an overall conclusion. Serious
harm in this meta-analysis was realated to post-procedure bleeding or
perforation. In the vast majority of instances this was seen only when a
polyp was removed. Commonly quoted risk for colonoscopy is one in 2,000 and
perforation two in 1,000. Risk of post-operative bleeding. Which is
typically secondary to polypectomy as I've just mentioned. Death is three in
100,000. While these risks are infrequent they may require urgent treatment or
even an operation. Risks are obviously much higher in older patients who would
have other medical conditions such as heart failure, chronic lung disease, heart
rhythm abnormalities, stroke, or cancer. Risks related to sedation are very
uncommon. The bowel preparation itself can cause side effects including nausea,
vomiting, bloating, and rarely fluid, or electrolyte abnormalities. Sedation is
given through an intravenous for the majority of patients having a
colonoscopy. Approximately 10 or 20% of my patients will have the test carried
out with no sedative medications. If they do they are able to talk with me
throughout the procedure and watch the findings. Some patients have discomfort
during the test and so conscious sedation is what is given to alleviate
anxiety and discomfort in the majority of patients. Conscious sedation which we
give for colonoscopy is not general anesthesia. General anesthesia is where a
coma is induced and you're temporarily put on life support ventilation while a
surgeon is performing an operation such as an appendectomy or cholecystectomy.
Conscious sedation is a much lighter level of sedation to keep you
comfortable and relieve discomfort that you might have. You will breathe on your
own and if we need you to change your position during the colonoscopy you will
be able to with mine and the nursing staff assistance. We sometimes
need to change a patient's position in order to facilitate the passage of the
scope through certain areas of the colon. Most consciously sedated patients have
no memory of the test even though you may
have some vague awareness at the end of the procedure. Next is the consent before
the procedure. I will speak to you outlining the procedure in detail I will
review the nature of the procedure, the benefits, the risks, and any relevant
limitations. Please do not hesitate to ask any questions that you might have. If
there is any change in your health, new medications, or if you might be pregnant
this must be brought to my attention.
Some general points. Arrive for your colonoscopy one hour pre procedure. You
need to bring your health card and a list of your medications. Leave your
valuables at home. It takes time for you to be assessed by the nursing staff and
prepare for the procedure with an intravenous and appropriate attire. It is
important if there's residual fluid in the colon that you go to the bathroom to
evacuate the fluid. Once we take you into the endoscopy suite and we are ready to
start we position you right up on your left-hand side and you will be facing
the screen. If you are having this done without sedation you will be able to watch and
talk to me throughout the procedure. If you are not we will give you sedative
medication at this point. Colonoscopies typically take 15 to 25 minutes if
there's no significant pathology found.
It can take much longer or even up to an hour if there is significant pathology.
This can occur if there are multiple polyps, a large polyp, or other complex
interventions needed to be done. While we make every effort to be on time elective
cases can take longer than expected and sometimes emergent cases take
priority. I always recommend that patients bring something to read and be prepared
to wait. Patients typically are discharged 20 to 60 minutes post
procedure. If needed blood work will be done post procedure, additional imaging
if needed for further workup of your symptoms will be
arranged at that time. I will speak to you post procedure. If you would like me to
speak to a family member as well I am happy to. Please let the nursing staff know.
I will give you a discharge sheet when you leave and circle the relevant
findings of the colonoscopy and the follow-up plan. If you did not receive
sedation you can go home immediately after the procedure once you have
changed and you can drive and go about your day as you normally would.
If you received sedation you must have a family member or friend take you home
and remain with you. You cannot drive, operate machinery, or make any major
decisions for the rest of the day. if you received sedation. Most patients have no
discomfort after the colonoscopy. Very few may feel some bloating due to
residual gas. We use co2 carbon dioxide which gets absorbed very quickly and so
the bloating should subside with the passage of gas. Usually within an hour or
two at the most. Most patients can resume a normal diet after the procedure. If you
have any abdominal pain or bleeding such as more than 2 tablespoons per rectum.
nausea, vomiting, shoulder pain, or fever do not eat or drink and please attend
the emergency room. In the unlikely event that you do attend the emergency room
please let my office staff know. This is from Lynch.
Four days before the colonoscopy avoid nuts, popcorn, seeds which would
also include multigrain bread, fruit, or vegetables with seeds. Seeds can stay in
the colon for several days and can make it difficult to suction puddles as the
seeds will get caught up in the suction channel and prevent me from sucking
fluid. Avoid iron pills if you take them. Iron can make the stool black and thick.
It is difficult to purge. If there is any residual feculent material it can
make visualization difficult. After all we are looking inside the dark tunnel
called the colon with a light to see puddles that are dark or walls that are
partially coated with black feculent material and this obviously makes it
visually more difficult to see abnormalities such as polyps. Consume
clear fluids only with no solid food from this point on up to two hours
pre-procedure. Studies show the drinking liquid up to
two hours pre procedure is safe and that there are no significant residual
liquids in the stomach two hours before the procedure. Make sure you drink plenty
of fluids approximately three liters for the day fruit juices without pulp such
as apple, sports drinks such as Gatorade, clear soup, chicken broth, or consomme
also popsicles, jello, honey, pop, black coffee, and black tea are acceptable. Do
not drink milk, or any red, or blue, or purple colored drinks because the dyes can
discolor the lining of the colon and make it harder to see
abnormalities. Medications can be taken with a sip of water the day before a
colonoscopy as well as the day of the colonoscopy.
During the preparation review your preparation instructions well to ensure
a clean bowel. Purchase a wide variety of clear fluids to drink after a bowel
movement. Use medicated wipes such as baby wipes or wipes with a aloe or
vitamin E. Use a barrier cream to prevent perianal skin chafing.
Set up shop in the bathroom. Bring in books, magazines, a laptop, tablet, or cell
phone, play music. Remember that you're drinking chilled liquid and so your body
can get cold from it so dress appropriately. To lessen nausea
that you might get from the preparation drink it chilled with a straw. Place the
straw as far back in your mouth as possible and swallow it quickly. You can
hold your nose and drink it as quickly as possible. Some patients find that
sucking on a lime or lemon slice after you finish can be very helpful. A lime or
lemon under your nose while you drink can also be helpful. Sugar-free menthol
candy drops to suck on also can be helpful. If you're having trouble you can
temporarily interrupt the regimen for 30 to 60 minutes. Wear loose clothing and
stay near the bathroom. Now for the preparation instructions. The day before
the test in the morning take BIsacodyl 10 milligrams by mouth. This is a very
mild laxative and will not induce diarrhea. You can go to work this day.
Starting around 5 p.m. or as late as 7 p.m. during 2 liters of the chill
Peg solution over 2 hours. You will need to go to the bathroom typically 30 minutes
after starting to drink the peg solution. After drinking this chew 2 tablets of
Simethicone these are usually 125 milligrams tablets. The Simethicone will
reduce bubbles within the colon which allows for better visualization during
the colonoscopy. The day of the test 4 to 5 hours before the tests chew 2 more
tablets of simethicone and drink the remaining 2 litres of chilled Peg
solution. Then you can clear take clear fluids up to two hours before your
colonoscopy as I previously mentioned. Please follow the instructions carefully.
Remember that adherence to the instructions improve the quality of the
examination both for you as well as for me. You can pause the video here and take
a picture of the screen with your phone camera if you want to look at the
instructions later. I hope this video was very helpful in your colonoscopy
preparation. Please click like if it was. Click subscribe and hit the bell for
notifications. I produce many new medical videos on different topics
I am Doctor Keith Moran. You have watched Medicine with Doctor Moran. Get healthy
and Stay healthy