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Colonoscopy with SUPREP Preparation
We would like to take this opportunity to thank you for choosing the Atherton Endoscopy Center. Our goal is to provide you with the highest quality of care in a friendly environment. We always welcome your feedback regarding your experience at our facility.

About the Procedure
Your doctor has recommended that you have a colonoscopy. A colonoscopy is a test that allows your doctor to examine the lining of your colon for any abnormalities. The colonoscope, which is a thin, flexible, fiber optic instrument, is passed from your rectum to your cecum (the end of your colon). Colonoscopy is considered the “gold standard” for colon cancer prevention. It is also possible to evaluate for intestinal inflammation, ulceration, bleeding, diverticulosis and tumors in this manner. It is possible to remove most colon polyps during a colonoscopy; there is no pain or any sensation as the polyp is removed. A colonoscopy is a safe and highly effective procedure. The procedure is quick (usually between 20 – 40 minutes) and generally quite painless. You will be given sedation to make you relaxed and sleepy. Usually patients remember very little, and are pleasantly surprised by how easy the procedure was.

Five Days before the Procedure:
Please discontinue any of the following medications :

• Blood thinning medications – such as Coumadin, Plavix, Ticlid, Aspirin, Ibuprofen (Advil, Motrin, Excedrin IB), Naproxen (Naprosyn, Anaprox, Aleve). Please discuss stopping these medications with your doctor.
• Anti-arthritis medications (Voltaren, Lodine, Indocin, Orudis, Daypro, Feldene)

It is fine to take Acetaminophen (Tylenol).

Please avoid foods with many small seeds and foods that contain the artificial fat ‘Olestra’ prior to your procedure. They can clog our scopes.

Two Days Prior To Your Procedure

• Pick up your prescription of SUPREP at the pharmacy.

One of our nurses will be contacting you two days prior to your procedure to obtain your medical history and review your preparation instructions. We will be happy to answer any questions you may have at that time. Please make sure you tell the nurse if you have any of the following:

• Allergies to any medications or latex products
• Heart problems or related surgeries, Heart valve replacement
• Joint replacement
• A tendency to bleed during surgical or dental procedures
• Sleep apnea or breathing difficulties
• Kidney problems

The nurse will ask you about the medications you take. Please let her/him know if you are taking, or have recently taken, any of the following medications:

• Blood thinning medications – as above
• Anti-arthritis medications – as above
• Anti-seizure medications
• Chemotherapy treatments
• Iron
• Diabetes medications such as Insulin or oral diabetes medications
• Herbal remedies

If you are taking medications for your heart, lungs or blood pressure the nurse will let you know if you should take them in the morning with sips of water.

The Day Before Your Procedure

Important: Please be aware that the time you take your preparation may vary depending on the time of your procedure.

Please follow the instruction times given to you by your physician.

SUPREP Preparation (Split Dose Regimen)
You may only have clear liquids all day, no solid foods. It is very important that you drink frequently throughout the day to avoid dehydration and to enhance the laxative response.

Acceptable clear liquids include:

• Water
• Gatorade or other sports drink
• Apple juice, white grape or white cranberry juice
• Chicken, Beef or Vegetable broth
• Jello (No red or purple colors)
• Popsicles (No red or purple colors)
• Coffee or Tea (No milk; sugar is fine)
• Soda Pop

The Evening Before the Procedure

On the evening before your procedure (or when your doctor tell you to begin) complete steps 1 through 4 using (1) 6 ounce bottle of SUPREP before going to bed:

Step 1: Pour ONE (1) 6 ounce bottle of SUPREP liquid into the mixing container.

Step 2: Add cool drinking water to the 16 ounce line on the container and mix.

Step3: Drink ALL the liquid in the container.

Step4: IMPORTANT You must drink two (2) more 16 ounce containers of water over the next 1 hour.

The Morning of Your Procedure

Repeat steps 1 through 4 using the other 6 ounce bottle of SUPREP.
Note: You must finish the final glass of water at least 2 hours before your colonoscopy.

Transportation
Because you will be receiving sedation (which may alter your reflexes, judgment and reaction time), you must make arrangements for a responsible adult to drive you home after your procedure. Taxis and buses are not permitted unless you are accompanied by a responsible adult. If you do not make the above arrangements, your appointment will need to be rescheduled for a time when a driver is available. This is for your safety and protection, as well as the safety and protection of others. Please contact us several days in advance if you are having difficulty finding a ride; we may be able to provide you with some resources for transportation assistance.

What to Wear
Please wear loose, comfortable clothing that is easily removed. Avoid tight fitting garments such as pantyhose. Please leave your valuables at home. You will be changing into a patient gown; you may usually leave on a small T-shirt and your socks. Wear comfortable, stable shoes since you may be a little unsteady when you leave.

Bring the following items with you:

• Your insurance cards and driver's license or suitable ID card
• A list of all medications you are taking (or bring the bottles with you)
• Respiratory inhalers or insulin, if you use them
• Your consent form

Please arrive at our center 30 minutes prior to your scheduled procedure time unless otherwise instructed. Expect to be at the Center for 1½ to 2 hours. Your ride may wait in our waiting room or they may return to pick you up at the specified time. We will also be happy to call your ride when you are ready if they don’t want to wait. When you arrive our receptionist will review your insurance and contact information with you. Please let her know of any changes.

The nurse will bring you back to the admission area to get you ready for your procedure.

• She/he will review your medical history if this has not already been done.
• The nurse will be starting an intravenous (which is used to administer the sedation) in your arm.
• You will be signing a consent to have your physician perform the colonoscopy as well as possibly taking biopsies, removing polyps and controlling any bleeding that your doctor may see. On this consent you will also be agreeing that:
  1. You are not to drive or operate machinery until the next day.
  2. You should not work until the next day.
  3. You should not sign any important documents or make important decisions until the next day.
  4. You should not exercise strenuously until the next day.

During Your Procedure
You will be brought into one of the private procedure rooms where you will be cared for by your doctor and a Registered Nurse. The nurse will obtain your blood pressure, pulse, oxygen saturation and cardiac rhythm, which will be monitored continuously throughout the procedure. You will be lying on your left side for the procedure, and may be asked to roll onto your back during the exam. Once you have had a chance to talk to your doctor, the nurse will begin administering the sedation. Your nurse may administer oxygen through a small tubing that rests under your nose. Once your doctor feels you are adequately relaxed, he/she will gently insert the colonoscope. As the doctor maneuvers from your rectum to your cecum, he/she will be filling your colon with air, so it is normal to feel gassy, or like you have the urge to move your bowels. But don’t worry, it is only air and we encourage you to pass it. Your doctor may take a biopsy, which you will not feel. Most patients doze throughout the procedure and, because of the sedation, do not remember much.

After Your Procedure
After your procedure is complete you will be taken to the recovery area. The nurses there will continue to monitor your blood pressure, pulse and oxygen saturation.

You will be able to drink liquids as soon as you are in recovery and will be able to eat as soon as you leave the Center. There is no pain after the procedure, but you may be a little bloated; you must pass any residual air prior to going home. Please don’t be embarrassed; you will not be the only one! When you are feeling awake and are steady on your feet you will be able to go home; this is usually after about 30 minutes. The doctor will talk to you (and your family/friend if desired) about the results of your procedure before you leave, but because of the sedation you may not remember this. We will give you all of your discharge instructions in writing.

Discharge Instructions

• You may resume a normal diet as soon as you leave the Center unless otherwise instructed by your doctor.
• Because you may still feel a little bloated it is best not to eat a lot of gas producing foods for the rest of the day (beans, cabbage, broccoli, carbonated beverages).
• Drink plenty of fluids.
• Do not drink alcohol until the following day, it may interact with the sedatives you were given.
• Expect to sleep for several hours after you get home. Remember no driving or strenuous exercise for the remainder of the day. You may resume normal activity the following day.
• Your doctor may ask you to avoid aspirin and ibuprofen-like products for a period of time.
• Your doctor will recommend when to follow up with him/her.

You should call your doctor if you develop any of the following after your procedure:

• Severe abdominal or chest pain
• Inability to pass air, accompanied by abdominal distention
• Persistent nausea and/or vomiting
• Signs of bleeding (coughing up blood or black tarry stools)
• Fever over 101 degrees and/or chills

A nurse will call you the following business day to see how you are. Please let her/him know if you have any concerns. You are welcome to call us anytime during our open business hours as well.

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Atherton Endoscopy Center
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