Having a Gastroscopy and Colonoscopy with Moviprep

By performing a Gastroscopy examination the cause of your symptoms may be found and sometimes we are able to treat them there and then. Images (for your medical notes) and samples of the lining of your upper gastrointestinal tract (biopsies) may be taken with instruments passed down a channel in the endoscope.

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 surgery to repair it. If you have a sedative rarely you may experience nausea and vomiting or heart and breathing problems.

An alternative to a Gastroscopy is a barium meal / swallow. This is an X-ray based test. It does not provide very detailed images of your oesophagus, stomach and duodenum. It does not allow biopsies or treatment to be carried out at the same time therefore you may still require a Gastroscopy examination.

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 but your physician has advised that this is the most appropriate procedure available to you. If you would like to discuss alternatives further please speak to your referring physician

If you are unable to make your appointment or need to change your appointment time, please do telephone via the numbers on the back 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 in the department for upto 4 hours. Please note we usually have 6 different lists running consecutively, this 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 make sure you follow the instructions in this leaflet and on your appointment letter.

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.

Please bring a list of your medication with you on the day.

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

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 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.

2 days before your Colonoscopy appointment please stop taking medication that might constipate you for example Co-Codamol, Codeine, Co-phenotrope (Lomotil®), Loperamide (Imodium®) or Kaolin & Morphine mixture.

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.

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 if any of these cautions apply to you via the phone number on the back of this leaflet.

Important notes on Moviprep

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. 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.

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 the day of the procedure

Two 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 Well cooked meat, beef, lamb, ham, veal, pork, poultry, fish, shellfish.

Cheese Cream, cottage 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).

Foods to avoid: Red/rare 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 Examination

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 water, clear soup, Oxo, Bovril, Soft drinks (not red coloured), black tea or coffee (no milk). You may add sugar if you like. All your drinks must be clear because then you will know that there is no fibre in them. You may drink as much as you like of these fluids.

5pm

Open one sealed plastic bag of Moviprep. Each of the two sealed plastic bags contain two sachets. One sachet marked A and the other sachet marked B.

Empty the contents of sachet A and sachet B into a jug. Add water (not chilled) to make up to one litre and stir until the powder has completely dissolved. You may add cordial to taste (not blackcurrant) if you require.

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

You should also drink an additional 500 mls at least of water or clear fluids with each litre of the Moviprep that you take. This will prevent you from becoming dehydrated.

 8 – 9pm

At about 8 - 9pm make up the second litre of Moviprep as you did the first one. Again drink it over 1 - 2 hours.

Again it is important that you drink an additional 500mls at least of water or clear fluids along with the Moviprep during the course of the evening. 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 quite normal and indicates that the Moviprep solution is working.

The bowel movements will stop soon after you have finished drinking.

Allow 2 hours for the second litre of Moviprep to work. You can go to bed when you stop going to the toilet (for example 11pm).

If you follow these instructions your bowel should be clear and this will help you have a successful examination.

You may continue to drink water until 2 hours before your appointment. 

The Day Before Your Examination

Do NOT eat anything after your 1pm lunch.

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 water, clear soup, Oxo, Bovril, Soft drinks (not red coloured), black tea or coffee (no milk). You may add sugar if you like. All your drinks must be clear because then you will know that there is no fibre in them. You may drink as much as you like of these fluids.

7pm

Open one sealed plastic bag of Moviprep. Each of the two sealed plastic bags contain two sachets. One sachet marked A and the other sachet marked B.

Empty the contents of sachet A and sachet B into a jug. Add water (not chilled) to make up to one litre and stir until the powder has completely dissolved. You may add cordial to taste (not blackcurrant) if you require.

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

You should also drink an additional 500mls at least of water or clear fluids with each litre of the Moviprep that you take. This will prevent you from becoming dehydrated.

After you have finished the first litre of Moviprep and your 500mls of additional fluids, allow 2 hours for Moviprep to work. You can go to bed when you have finished going to the toilet (for example 10pm).

The Day Of Your Examination

6am: Remember, do not eat anything.

Mix the sachets as before: Empty the contents of sachet A and sachet B into a jug. Add water (not chilled) to make up to one litre and stir until the powder has completely dissolved. You may add cordial to taste (not blackcurrant) if you require.

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

You should also drink an additional 500mls at least of water or clear fluids during the course of the morning. This will prevent you from becoming dehydrated.

Once again you will experience watery bowel movements which will slow down after 1 - 2 hours. This will allow you to leave home in good time for your hospital appointment. If you are going to the toilet up to your test, please don’t worry, this is just the Moviprep.

When you start taking the 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 quite normal and indicates that the Moviprep solution is working. The bowel movements will stop soon after you have finished drinking.

If you follow these instructions your bowel should be clear and this will help you have a successful examination.

You may continue to drink water until 2 hours before your appointment.

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 following leaflet:

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

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, could you please contact us and request a copy.

• Many patients are concerned about the thought of swallowing the endoscope. We would like to reassure you that the Gastroscopy is not painful but you may experience some discomfort. You will be able to breathe normally. A Colonoscopy can be uncomfortable and Entonox (gas and air) or mild sedation are available to relieve pain.

• Before the Gastroscopy and Colonoscopy the nursing staff will admit you to the unit and fully explain the tests to you whilst answering any questions or concerns you may have. You will be given paper dignity shorts to wear.

• You will need to sign a consent form for the Gastroscopy and Colonoscopy.

• You will then be taken to another area where you will wait to be called into the room for your procedures. Please note we usually have 6 different lists running consecutively this may mean some people will have to wait longer than others, even with the same appointment time.

• You may have a cannula inserted into your hand or arm.

• In the endoscopy room you will have both procedures whilst lying on your left side on a trolley. The Gastroscopy will be made more comfortable with throat spray to numb your throat or conscious sedation. If you have the throat spray Entonox (gas and air) is available to relieve any pain or discomfort during the Colonoscopy.

• A Gastroscopy lasts approximately 10-20 minutes and a Colonoscopy lasts between 30-45 minutes depending on the position of your colon and the procedures that need to be done (for example removal of polyps will take longer).

A cannula (small plastic tube) will be inserted just in case any medication is needed during your 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’.

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.

Entonox (gas and air) instructions will be given on how to self-administer this before your colonoscopy starts. It is inhaled through a mouthpiece to relieve pain.

After the procedure you will be transferred to our recovery area. You will be able to leave the department and drive after 30 minutes following Entonox providing you have had a satisfactory recovery.

You should not eat and 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.

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 your colonoscopy.

You do not need an escort with you if you have throat spray and Entonox but you may wish to have someone accompany you on the day.

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

This should relax you but will not put you to sleep, it is not a general anaesthetic nor will it numb the throat like the throat spray.

You will be awake and aware during the procedure 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 the Gastroscopy and Colonoscopy you will have a rest for about half an hour and will then be offered a drink and biscuits.

After about an hour you will be discharged with your Gastroscopy and Colonoscopy results.

You may experience a sore throat and some bloating following the tests but this will soon settle.

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.

Following the procedures you will be transferred to our recovery area for a rest before being discharged home.

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 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 required please contact Ward 2 on 01253 953402.