Prepopik and Colonoscopy Preparation

What is a colonoscopy?

A colonoscopy is the most accurate test for detecting colon polyps and colon cancer, and the only test where polyps can be removed. During this procedure, a doctor examines the lining of your large intestine and rectum through a flexible tube called a colonoscope. The colonoscope is inserted into the anus and advanced slowly through the colon. If polyps or other abnormalities are found, the doctor may remove them for further examination or biopsy.

The bowel prep is the most important factor in ensuring you get the most thorough and complete exam during your colonoscopy. Small polyps can be missed if they are covered with retained stool. If your bowel prep is incomplete, your exam may need to be repeated on another day or you may need to return sooner for your next colonoscopy. Studies have clearly shown that the best preps are obtained when half of the prep is taken the night before your colonoscopy and the other half is taken the morning of the colonoscopy. This is called a split dose prep. The American College of Gastroenterology recommends a split dose prep for all patients. This regimen allows you to drink roughly half the total volume of liquid as compared to the 4 liter preps like Golytely that are completed the night before.

The preps used for split dose preps are Moviprep, Osmoprep Tablets, Prepopik, and Suprep. Osmoprep tablets and Suprep should not be used if you have heart or kidney problems. The Moviprep is safe for all patients. Please ignore the instructions on the back of the Moviprep box which states you can take all of the prep the night before the procedure. It simply does not work well enough if taken the night before. Please see the attached sheet with specific information. If you don’t think you can get up early to do the second half of the prep, please be sure to schedule your colonoscopy for later in the day. The liquid usually passes through the bowel much faster in the morning than in the evening so don’t panic if it takes awhile for the prep to start working in the evening.

Instructions

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PRE-PROCEDURE CHECKLIST

If you have diabetes, ask your regular doctor for diet and medication restrictions. Do not take your oral diabetes medicine on the day of your procedure. If you take metformin, stop taking it the day before your colonoscopy. Also, please bring your Insulin and Insulin syringes with you to your procedure; we will check your blood sugar before and after the procedure.

If you take a medication to thin your blood

  • Do NOT stop taking your daily Aspirin or NSAIDs. If you are taking a daily Aspirin or NSAIDS we want you to continue to take your medication. On the day of your procedure you can make your gastroenterologist aware of the medication you are taking and the amount you are taking.
  • If you take a medication to thin your blood (such as Coumadin, Plavix, Pradaxa, Lovenox, Xarelto, Eliquis, Brilinta, Effient, Ticlid, Disgren, Pletal…) you must be seen in our office (can be seen by nurse practitioner or physician assistant) prior to your procedure. At the time of your office visit a plan will be made in conjunction with your prescribing physician about use of your blood thinner.

If you currently are taking other prescription medications, you may continue to take all other medications as instructed by the prescribing physician.

If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.

You MUST arrange for a ride for the day of your exam. If you fail to arrange transportation with a responsible adult, your procedure will need to be cancelled and rescheduled. Your driver must check in with you and stay in our office the entire time that you are there. We cannot start your procedure if you do not have a driver present. In addition to this, you may not take a taxi or ride the bus by yourself. This is for your safety.

If you must cancel or reschedule your appointment, please call 404-355-3200 for Atlanta or 706-253-7340 for Jasper at least three days prior to your procedure to avoid any late cancellation fees.

If you have any special needs, such as a pacemaker, internal defibrillator, latex allergy, need for an interpreter, or if you are allergic to eggs, nuts or soy, please contact our office immediately. Your procedure may need to be rescheduled.

Remember your prep is a split dose. You will be taking the prep the day before the procedure as well as the day of the procedure. You can start your split prep 5 hours before the procedure.

Remember even while taking split prep you cannot have any liquids, ice chips, water or food two hours before your procedure. If you do, the procedure may be delayed.

STOP AND READ:

  • If you do not follow these instructions your procedure may be delayed or cancelled.
  • Please note that you cannot have any solid foods starting the day before your procedure.
  • The day of the procedure you may not have gum, mints, ice chips, hard candies or cigarettes.
  • You may have clear liquids up to two and a half hours before your procedure. This includes the prep solution.
  • You cannot have anything in your mouth (gum, mint, cough drop, ice chips etc.) two and a half hours before your procedure.

PREPARATION

To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

The day before your exam:

The day of your exam:

  • You may take your usual medications with up to 4 oz. of water at least 2.5 hours prior to your procedure. Be sure to wear comfortable clothes and shoes that will remain on your feet (preferably tennis shoes) to your procedure. Please do NOT wear flip flops, sandals, or backless shoes.
  • Please remove ALL jewelry including earrings, rings, bracelets, anklets, necklaces, and watches prior to the procedure, and be sure to leave any and all valuables at home. DHEC will not be responsible for any lost valuables (including eyeglasses and dentures).
  • Plan to spend up to two hours at the endoscopy center the day of your procedure. The exam itself takes about 25 minutes to complete.

Before the exam:

  • You will change into a gown and robe.
  • Your medical history will be reviewed with you and you will be given a consent form to sign.
  • A nurse will insert an intravenous (IV) line into your hand or arm.

During the exam:

  • Medicine will be given through the IV line to sedate you.
  • Your heart rate and oxygen levels will be monitored. If your blood pressure is low, you may be given fluids through the IV line.
  • The doctor will insert a flexible tube – called a colonoscope – into your anus and will advance it slowly through the rectum and colon, looking for abnormal tissue or polyps.
  • If abnormal tissue or polyps are found, the doctor may remove them through the colonoscope for closer examination or biopsy. Tissue removal is painless.

What happens after the exam?

  • The doctor will talk with you about the initial results of your exam.
  • The doctor will prepare a full report for the physician who referred you for the colonoscopy.
  • You may feel bloated after the procedure. This is normal.
  • Medication given during the exam will prohibit you from driving for the rest of the day.
  • Following the exam, you may resume your normal diet. Avoid alcohol until the next day.
  • You may resume your regular activities the day after the procedure.
  • A nurse will provide you with complete discharge instructions before you leave the endoscopy center. Be sure to ask the nurse for specific instructions if you take blood thinners such as aspirin, Coumadin or Plavix.
  • Any tissue samples or polyps removed during the exam will be sent to a lab for evaluation. It may take 5-7 working days for you to be notified of the results.

Are there possible complications from a colonoscopy?

Although serious complications are rare, any medical procedure has the potential for risks. A nurse will review all potential warning signs with you before you leave the endoscopy center. Risks include:

  • Perforation, or a tear, of the lining of the colon.
  • Bleeding from the biopsy or polypectomy site if tissue was removed.
  • Reaction to medications used during the procedure.

Additional information:

Your procedure has been scheduled at one of the GI labs listed below. Please check your paperwork to make sure you arrive on time to the correct location:

DIGESTIVE HEALTHCARE ENDOSCOPY LAB is located at 95 Collier Road NW, Suite 4075. Enter the Piedmont Hospital complex at the Collier Road entrance. Park in the “South” parking deck. Take the elevator to the “Orange Level”. Cross over the glassed in covered bridge. You are now in the 95 building. You do not have to check in at the hospital. Go up to the 4th floor and look for Suite 4075. You and your driver may sign in at the window. If someone is sitting at the window, let them know you have arrived.

THE PIEDMONT HOSPITAL ENDSCOPY LAB is located on the first floor of the 77 building. It is most convenient to park in the North parking deck. Take the elevator to the bridge level (BR). You will need to go to the 77 building registration office to register for your procedure. After getting off at the bridge level you will walk through a glassed-in bridge and go straight. You will pass the 77 building (D) elevator, which will be located on your left. The registration office is located in the next hallway on your left. Once inside, a member of the registration staff will help you complete some additional paperwork, and then escort you to the GI Lab for your procedure. This should take approximately 15 minutes.

  • Bring a list of all of your current medications, including any allergy or over-the-counter medications.
  • Bring a photo ID as well as up-to-date insurance information, such as your insurance card and any referral forms that might be required by your payer.
  • If you have any special needs please notify the staff prior to your procedure (pacemaker, internal defibrillator, latex allergy, need interpreter).
  • Wear comfortable clothes to your procedure. Please wear shoes that will remain on your feet (i.e. no flip flops, sandals or backless shoes).
  • Attention: Your driver must check in and wait for you in the Endoscopy waiting room. It generally takes 1 ½ – 2 hours for a procedure to be completed.

Co-pays are required on the day of your appointment. If you have any questions about pre-certification, please call our business office at 404-603-3543.

If your insurance does not cover this procedure, for example you are a self-paying patient or you have been notified by our office that you owe a copay or coinsurance, please bring a credit card (Visa, MasterCard and AMEX), check or cash.

You may receive several statements from this procedure; your physician’s fee, a facility fee for the Endoscopy Center (supplies and nursing care), a statement for anesthesia (Propofol) and for pathology if tissue is removed during the procedure.

Digestive Healthcare of Georgia Endoscopy Center is co-owned and operated by the Physicians of Digestive Healthcare and Piedmont Hospital.