Having a Gastroscopy and Colonoscopy with Moviprep

By performing a Gastroscopy examination the cause of your symptoms may be found. Images and biopsies (samples) of the lining of your upper gastrointestinal tract may be taken.

A Gastroscopy is a safe examination but there are risks you need to be aware of. Common risks include, sore throat and bloating. Rarely, patients may experience dental damage, chest infection, bleeding or perforation. If a perforation (a tear in your oesophagus, stomach or duodenum) occurs you may be required to stay in hospital for close observation and in some cases may require a stent or surgery to repair it. If you have a sedative rarely you may experience nausea and vomiting or heart and breathing problems.

There may be alternatives to this procedure and sometimes a Barium swallow/meal is done instead. This test does not provide very detailed images of the upper gastrointestinal tract and does not allow biopsies or treatment to be carried out at the same time. Your referring clinician has advised that Gastroscopy is the most appropriate test for you. If you would like to discuss alternatives further please speak to your referring clinician.

By examining your bowel the cause of your symptoms may be found. Images and biopsies (samples) may be taken and sometimes polyps (small growths in the bowel) can be removed or other treatments performed.

A Colonoscopy is a safe examination but rarely, a complication such as bleeding or perforation may occur (1 in 1500, or if polyps removed 1 in 200). Other risks are discomfort, bloating and pain. Entonox® (gas and air) may cause nausea, dizziness and euphoria. Sedation may cause nausea and vomiting, and rarely you may become over sedated which can reduce your breathing rate.

There may be alternatives to this procedure and sometimes a dedicated bowel CT scan is done instead. Your referring clinician has advised that this is the most appropriate test for you. If you would like to discuss alternatives further please speak to your referring clinician.

Please make sure you follow the instructions in this leaflet and on your appointment letter. If you are unable to make your appointment or need to change your appointment time, please telephone using the numbers listed on the back page of this leaflet.

Your appointment time takes into account the time required to admit you onto the unit. You should therefore not expect to immediately go through for the test when called. You will be assigned to a Morning or Afternoon Endoscopy session and will be in the department for up to 4 hours. Please note we usually have 6 different lists running consecutively, which may mean some people will have to wait longer than others, even with the same appointment time.

Please note that the time of day that you will need to start taking the Moviprep® solution differs between a morning and an afternoon appointment. Please follow the instructions carefully.

Please be aware we are a Teaching Hospital and may have trainees in any areas of your pathway. They will always be supervised and they will always be working at an appropriate level for their training stage. If you would rather not have a trainee involved in your care please let the staff know your wishes. This will not affect your care.

Please bring a list of all your medications on the day.

Please leave valuables and jewellery at home where possible as we unfortunately are unable to look after these.

Before the procedure a nurse will take you into an admission room and explain the test and ask you some health questions. They will answer any questions or concerns you may have.

You will be asked to sign a consent form and change your underwear to some procedural dignity shorts that we supply.

A cannula will be inserted in preparation for your procedure (a small plastic tube).

We will transfer you to the waiting area and from here you will be called into the procedure room for your test.

In the endoscopy room you will have both procedures whilst lying on your left side on a trolley. You may be asked to change position during the Colonoscopy procedure.

Many patients are concerned about the thought of swallowing the Gastroscope, but we would like to reassure you that most patients manage this well and you will be able to breathe normally during the test. The Gastroscopy will be made more comfortable with throat spray to numb your throat and/or conscious sedation. If you have only had throat spray, Entonox® (gas and air) is available to relieve any pain or discomfort during the Colonoscopy.

Prior to the Gastroscopy you will be given a throat spray to numb the back of your throat. This reduces the sensation of the scope in your mouth and throat and helps to reduce ‘gagging’.

You will need a cannula (small plastic tube) in your hand or arm through which a mild sedation and analgesia (pain relief) is given.

The Endoscopist and Nurses will explain things to you during the tests.

You will be able to breathe and swallow normally during the Gastroscopy but it will feel strange.

Sedation will relax you but will not put you to sleep. It is not a general anaesthetic. You will be awake and aware during both procedures with sedation.

Sedation may cause loss of memory and judgement for 24 hours after the test. You must not:

• Drive

• Drink alcohol

• Operate machinery

• Sign legal documents

If your job involves any of the above you will need to take the day off work following the sedation.

After your procedure you will be transferred to our recovery area for approximately 30 minutes. The nurse will prepare your results and discharge advice.

You should not eat or drink for 60 minutes following throat spray administration to allow the numbness to wear off.

You may experience a sore throat and/or have some bloating with wind-like discomfort after your procedures. This is normal and usually settles quickly. If you have a biopsy taken or a polyp removed it is common to pass small spots of blood from your bottom for a day or two following the Colonoscopy procedure.

You will need a responsible adult to accompany you from the unit because of the effects of the sedation and also have someone at home overnight after having sedation.

Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.

In order to examine the whole of the bowel it must be clear of all waste materials. This is achieved by using a combination of changing what you eat and taking laxative medicines.

Moviprep® works by loosening your stools. This is unpleasant but necessary and may last up until the time of your appointment. Easy access to your toilet will be required for most of the day.

You might like to use a barrier cream to prevent a ‘sore bottom’. A product such as petroleum jelly can be effective.

7 days before your Colonoscopy appointment please stop taking iron tablets. Please also stop taking any laxatives that will cause bulk in your bowels (such as Fybogel®).

4 days before your Colonoscopy appointment please stop taking medication that might constipate you for example Codeine, Cophenotrope (Lomotil®), Loperamide (Imodium®) or Kaolin and Morphine mixture, Cholestyramine or Colesevelam.

Taking other medication

If you are taking other medication, please take it at least one hour before or at least one hour after taking Moviprep®, otherwise they may be flushed through your digestive system and not work so well.

Take any medication you are on up to 2 hours before your appointment with water. If you are taking medication for DIABETES please refer to the specific diabetic instructions towards the end of this leaflet.

Oral Contraception

If you are taking an oral contraceptive pill, diarrhoea can make it less effective. Continue taking the pill but use other precautions for the rest of that cycle.

Important: No alcohol should be consumed on the day before and on the day of the procedure.

DO NOT TAKE MOVIPREP® IF:

• You are allergic to any of the ingredients.

• You are pregnant.

• You are on dialysis.

• You are taking medication for an organ transplant.

• You have not passed wind or opened your bowels in the last five days leading up to your bowel preparation time.

Please contact the Endoscopy Booking Assessment Nurse via the phone number on the back of this leaflet if any of the above cautions apply to you.

Some Possible side effects of Moviprep®

Abdominal pain, abdominal distension, sleep disturbances, dehydration, dizziness, tiredness, feeling generally unwell, soreness of the anus, nausea, vomiting, headache and indigestion. If you experience any of these symptoms try taking the Moviprep® more slowly. There is a small possibility that the medication can cause low blood pressure or kidney problems. Rarely are people allergic to Moviprep®.

They may experience a rash or itching, swelling of the face or ankles, palpitations or shortness of breath. If any of the side effects become serious, stop taking Moviprep® and seek medical advice.

Three days before your test please follow a low residue diet, which consists of the following:

Fats (use sparingly) – Butter or margarine.

Rice – Plain boiled white rice.

Eggs – Boiled or poached.

Meat / Fish – Chicken (skinless) or white fish.

Cheese – Cream, cottage cheese, tofu or cheese sauce.

Bread – White bread or toast.

Cereals – Crisped rice cereal, cornflakes (no bran).

Pasta – Plain macaroni, spaghetti, noodles.

Potatoes – Boiled, creamed, mashed or baked (no skins).

Dessert – Clear jelly (not red jelly) natural plain yogurt, ice cream or custard.

Foods to avoid:

Red meat, sausage, pies, any fruit or salads, most vegetables, potato skins, chips, wholemeal or brown bread, nuts, pulses, baked beans, wholemeal pasta, brown rice, puddings containing fruit and nuts, cakes, biscuits and yoghurts.

The Day before your Procedure

Eat your breakfast before 9am.

Do not eat anything after 9am. Do not eat food again until after your examination even if you feel hungry. Your bowel must be completely empty for the examination to be successful.

You may drink clear soup, Oxo, Bovril, soft drinks (not red coloured), black tea or coffee (no milk). You may add sugar if you like. You may drink as much as you like of these fluids.

Senna tablets and Moviprep® bowel preparation are provided. Each sealed plastic bag of Moviprep® contains two sachets, one marked A and the other sachet marked B. Please follow the instructions carefully to make sure your bowel is empty. This is essential for a proper examination.

2pm

Take 6 Senna 7.5mg tablets with plenty of water.

During the day drink at least a glass of water (about 250ml) or other clear fluid every hour whilst the effects of the medication persist.

5pm

Open one sealed plastic bag of Moviprep®. Open and empty the contents of Moviprep® sachet A and B into a container that will take at least 1 litre of liquid.

Add water (not chilled) to make up to 1 litre and stir until the powder has completely dissolved. Once dissolved (this may take up to 8 minutes) the solution can be refrigerated. You may add cordial to taste (not blackcurrant) if you require.

Drink one glassful (250mls) of the Moviprep® drink every 15 to 30 minutes until you have taken the full litre. This may take 1 to 2 hours.

Take your time, there is no need to rush. You must drink a minimum additional 500ml water or clear fluids with each litre of Moviprep®. This will prevent you from becoming dehydrated.

When you start taking Moviprep® it is important that you stay close to a toilet. At some point you will start having very watery bowel movements. This is normal and indicates that the Moviprep® is working.

8-9pm

Open the second sealed plastic bag of Moviprep®. Open and empty the contents of Moviprep® sachet A and B into a container that will take at least 1 litre of liquid.

Add water (not chilled) to make up to 1 litre and stir until the powder has completely dissolved. Once dissolved (this may take up to 8 minutes) the solution can be refrigerated. You may add cordial to taste (not blackcurrant) if you require.

Drink one glassful (250mls) of the Moviprep® drink every 15 to 30 minutes until you have taken the full litre. This may take 1 to 2 hours. Take your time, there is no need to rush.

You must drink a minimum additional 500ml water or clear fluids with each litre of Moviprep®. This will prevent you from becoming dehydrated.

When you start taking Moviprep® solution it is important that you stay close to a toilet. At some point you will start to experience watery bowel movements. This is normal and indicates that the Moviprep® solution is working.

You can go to bed when you have stopped going to the toilet.

If you follow these instructions your bowel should be clear to enable a successful examination.

You may continue to drink water up to 2 hours before your procedure

The Day before your Procedure

Eat your lunch before 12 Noon (midday). Do not eat anything after 12 Noon.

Have a light lunch of foods permitted within the low residue diet. Do not eat food again until after your examination even if you feel hungry. Your bowel must be completely empty for your examination to be successful.

You may drink clear soup, Oxo, Bovril, Soft drinks (not red coloured), black tea or coffee (no milk). You may add sugar if you like. You may drink as much as you like of these fluids.

Senna tablets and Moviprep® bowel preparation are provided. Each sealed plastic bag of Moviprep® contains two sachets, one marked A and the other sachet marked B. Please follow the instructions carefully to make sure your bowel is empty. This is essential for a proper examination.

2pm

Take 6 Senna 7.5mg tablets with plenty of water.

During the day drink at least a glass of water (about 250ml) or other clear fluid every hour whilst the effects of the medication persist.

7pm

Open one sealed plastic bag of Moviprep®. Open and empty the contents of Moviprep® sachet A and B into a container that will take at least 1 litre of liquid.

Add water (not chilled) to make up to 1 litre and stir until the powder has completely dissolved. Once dissolved (this may take up to 8 minutes) the solution can be refrigerated. You may add cordial to taste (not blackcurrant) if you require.

Drink one glassful (250mls) of the Moviprep® drink every 15 to 30 minutes until you have taken the full litre. This may take 1 to 2 hours. Take your time, there is no need to rush.

You must drink a minimum additional 500ml water or clear fluids with each litre of Moviprep®. This will prevent you from becoming dehydrated.

When you start taking Moviprep® solution it is important that you stay close to a toilet. At some point you will start to experience watery bowel movements. This is normal and indicates that the Moviprep® solution is working.

You can go to bed when you have stopped going to the toilet.

On the Day of your Procedure

6am

Remember do not eat anything.

Open the second sealed plastic bag of Moviprep®. Open and empty the contents of Moviprep® sachet A and B into a container that will take at least 1 litre of liquid.

Add water (not chilled) to make up to 1 litre and stir until the powder has completely dissolved. Once dissolved (this may take up to 8 minutes) the solution can be refrigerated. You may add cordial to taste (not blackcurrant) if you require.

Drink one glassful (250mls) of the Moviprep® drink every 15 to 30 minutes until you have taken the full litre. This may take 1 to 2 hours. Take your time, there is no need to rush.

You must drink a minimum additional 500ml water or clear fluids with each litre of Moviprep®. This will prevent you from becoming dehydrated.

When you start taking Moviprep® solution it is important that you stay close to a toilet. At some point you will start to experience watery bowel movements. This is normal and indicates that the Moviprep® solution is working.

If you follow these instructions your bowel should be clear to enable a successful examination.

You may continue to drink water up to 2 hours before your procedure.

If you have diabetes, please read the ‘extra’ leaflet sent alongside this leaflet.

• This leaflet is specific to controlling your diabetes through the various procedures available within our unit and you will have been sent the one that corresponds with your specific procedure:

Guidance for Managing Diabetes for Gastroscopy & Sigmoidoscopy or Gastroscopy & Colonoscopy (known as Dual Procedures)

This will give you clear instructions on what to do with your medication (including insulin) during the preparation for your test.

If you have not received a copy of this leaflet, please contact the Gastroenterology & Endoscopy Unit, via the phone numbers listed on the back of this leaflet and request a copy.

How long will the procedures take?

A Gastroscopy lasts 10-20 minutes whereas a Colonoscopy lasts 30-60 minutes. You will be in the department for up to 4 hours.

Does it hurt?

Gastroscopy is not painful but patients usually have some retching and bloating type discomfort. Sometimes patients find Colonoscopy painful but gas and air (Entonox®) or sedation is available to use for pain relief if needed.

Do I have to have the tests?

No. The choice is yours, please refer to pages 3 and 4 for alternatives and the reason why these tests are appropriate.

Can I take my tablets as normal?

Yes unless instructed otherwise. Please take the tablets at least one hour before or at least one hour after taking Moviprep®. Diabetic patients please read page 17 for diabetic medication instructions.

Will I be asleep for these procedures?

No. Gas and air (Entonox®) or sedation is available (if your circumstances permit), but you will be awake for the procedures.

How can I make the Moviprep® more palatable?

It is important to sip the Moviprep® and not gulp it down to reduce nausea. A straw is sometimes helpful to drink the Moviprep® with and you can add cordial (not blackcurrant) to taste if you prefer.

What shall I wear to attend the procedure?

Please wear loose comfortable clothing. You will be asked to wear dignity shorts under your own clothing before the procedure. On entering the procedure room you will be asked to remove your lower clothing (keeping your dignity shorts and your top clothes on).

Details of your results and discharge advice will be given before leaving the unit. Biopsy results will be communicated by the referring clinician at a later date.

If you have any issues or need advice after your procedure please contact the Gastroenterology & Endoscopy Unit within working hours (7.45am to 6pm) and ask to speak to the nurse in charge. See contact phone numbers on the back of this leaflet.

If urgent out of hours advice is required please contact Ward 2 on 01253 953402.