Hôpital Général Juif- SMBD
The Sir Mortimer B. Davis Jewish General Hospital
INFORMATION AND CONSENT FORM:
Your colonoscopy will take place on ______________________at __________ in the endoscopy laboratory located in room G-304 of the Sir Mortimer B. Davis Jewish General Hospital.
A colonoscopy is a test in which a colonoscope (long flexible tube) is inserted through the rectum into the large intestine. It allows the physician to examine the lining of the large intestine and evaluate small abnormalities that may have not been detected by X-ray. If the doctor feels a suspicious area needs greater evaluation, a small piece of tissue (a biopsy) can be taken for examination in the laboratory. During the colonoscopy, abnormal growths (polyps) may be detected. These are usually removed because they can bleed or contain cancerous cells. To remove a polyp, your doctor may insert a wire loop (snare) through the colonoscope, and remove the polyp using an electrical device. This procedure is generally painless. The majority of polyps are benign, but some may evolve into cancer over time, so polyp removal is an important way to prevent colon cancer.
You may receive medication through a vein to make you relaxed and comfortable. The procedure is usually well tolerated, and many patients fall asleep during or after the examination. In some cases, it is impossible to examine the entire colon. If that were to occur, your doctor will discuss other alternatives with you. After the colonoscopy, if you have received medication, you will remain in the endoscopy area until the effects of the medications have sufficiently worn off. You may also feel bloated from the air that was introduced in your intestine during the examination.
When you leave the department, you will be able to resume your usual diet, unless your physician instructs you to do otherwise. Because your reflexes and judgment may be impaired by the medication you receive, it is strongly recommended that you be accompanied.
You will not be able to drive for 24 hours following the procedure. Your colon must be COMPLETELY EMPTY in order for the colonoscopy to be successful. You must follow these steps:
- 1. Purchase 2 sachets of Pico-Salax and 2 Dulcolax tablets (5mg each) at the pharmacy
- 2. The day before the colonoscopy, drink only CLEAR FLUIDS for the entire day (see examples below). No solid foods or dairy are allowed.
- 3. Take the first sachet of Pico-Salax at 4pm the day before your examination. Empty the contents of the packet into a cup and add 150mL (5oz) of cold water. Stir until the powder is dissolved, and let it cool before you drink it. Take the second sachet of Pico-Salax at 8pm the night before your colonoscopy. Follow the same instructions as above.
- 4. you must drink 4-6 large glasses of clear liquids, including at least one bottle of light-colored Gatorade, following each sachet of Pico-Salax. You must be fasting as of midnight (no solids or liquids).
- 5. Take 2 Dulcolax 5mg tablets at 10 pm.
- 6. All cancellations must be made at least 24 HOURS IN ADVANCE
Please remove all jewelry before the procedure. It is advisable to leave it at home, in order to avoid theft or loss.
It is important to inform the doctor in advance if you have any of the following medical conditions: a. If you are taking Coumadin, Aspirin, Plavix or diuretics. It is usually necessary to stop these medications ____days prior to the procedure. Please discuss in advance with your treating physician to see if these can be stopped safely. b. If you have diabetes: your diabetic medication will need to be adjusted prior to starting the preparation for the gastroscopy. Do not take your diabetic pills on the morning of the procedure. If you are on insulin, discuss what you should do with your diabetes doctor prior to the procedure. c. If you are taking iron pills, you must stop them 1 week prior to the examination. d. If you are allergic to any medications, soy or eggs, notify the nurse and doctor
COMPLICATIONS: Colonoscopy and polypectomy are associated with a very low risk of complications when performed by specialized physicians. One possible complication is a perforation (a tear in the wall of your intestine) that can occur in less than 0.1% of cases. If that were to occur, bowel rest, in conjunction with antibiotics and intravenous solutions are often sufficient to resolve the problem. Rarely does it require a surgical intervention. Bleeding may occur at the site of biopsy or polyp removal. It is usually minor and stops on its own, or can be controlled by cauterization (application of electrical current), or injecting medication into the bleeding site, using a needle through the colonoscope. It is extremely rare to require transfusions or surgery to stop the bleeding. Localized irritation of the vein or small bruise may occur at the site of injection of medication. This will resolve in a few days or rarely a few weeks. We rarely see reactions to the medication administered during the procedure. These reactions would resolve by themselves rapidly. Other extremely rare complications can occur in predisposed patients, including a heart attack or stroke. As for any other medical intervention, cases of death have been reported, but this is extremely rare.