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Endoscopy Centre - Philip Bull md, Consultant Surgeon

Endoscopy Centre

The Endoscopy Centre

The Endoscopy Center is designed to provide gastrointestinal procedure and health care excellence in a personalised, comfortable and state-of-the-art facility.  Our facility uses the latest generation of video endoscopes produced by the leading manufacturer of precision endoscopic equipment. The Fujifilm video endoscope incorporates high definition video technology.  We also use CO2 (carbon dioxide) rather than air for distending the colon during colonoscopies. The use of CO2 has been shown to reduce the incidence of gas, bloating and abdominal discomfort following a colonoscopy. Furthermore, we proudly service patients experiencing issues related to ulcers and colon cancer.

State-of-the-art monitoring equipment is utilised throughout the centre and all emergency and safety equipment as would be found in a hospital operating room or emergency room is available.

The physicians and staff at The Endoscopy Centre are committed to meeting the gastrointestinal health care needs of our community by providing care regardless of a patient’s race, religion, national origin, age, sexual orientation or disability.

To fulfill our mission, we are committed to:

  • Listening to our patients and their families
  • Earning the trust and respect of our patients
  • Exceeding the expectations of those we serve
  • Ensuring a safe and compassionate professional environment
  • Striving for continuous improvement at all levels

Colonoscopy

What is a colonoscopy?

Colonoscopy is a lower endoscopy, we look at the lining of your large bowel to see if there are any growths or disease. This is done by putting a bendable tube (colonoscope) with a video camera attached to the tip for viewing.

The tube is then slowly passed into the rectum and large bowel (colon). Pictures of the inside of your bowel are then seen on a video screen. You will lie on your side or back while your doctor slowly passes a colonoscope along your large intestine to look at the lining. Your doctor will examine the lining again as the colonoscope is taken out.

If you wish not to be sedated, you might feel some pressure, bloating or cramping during the procedure. You should plan on two to three hours for waiting, preparation and recovery. The procedure itself usually takes anywhere from 15 to 30 minutes.

What do I need to do before my colonoscopy?

Before colonoscopy, your doctor/nurse will tell you what you can and cannot eat and drink. They will also tell you what bowel cleansing routine to use.

The preparation is usually made up of drinking 2 sets of a special cleansing drink or clear liquids and special oral laxatives.

The colon must be completely clean for the procedure to be accurate and complete, so be sure to follow the instructions carefully.

Why is lower endoscopy done?

It is done on a precaution or as treatment so that the doctor can indentify ans remove a growth at an early stage. Your doctor can pass instruments down the endoscope and treat many problems with little or no discomfort. Your doctor may stretch a narrowed area, remove small non- cancerous growths, or treat bleeding.

Your doctor can also treat bleeding by • injecting drugs, • sealing off bleeding vessels using heat
OR • other methods such as small clips.

Your doctor may take pieces of tissue to have investigated. This is known as biopsy. These can identify many
conditions such as chronic inflammation or mucous growth.

How to prepare for the procedure?

3 days before your colonoscopy: Stop eating nuts, fruits with small seeds, tomatoes popcorn, corn, beans, and celery.

Do not drink red or purple colored liquids or foods the days before your procedure. Avoid fruits and vegetables, bulk-forming agents , seeds, popcorn, multigrain bread, salad or high fiber foods for 2 days prior to your procedure. These may make the inside of the colon difficult to see.

Start cleaning out your colon 24 hours before your colonoscopy. Drink only clear liquids the day before your colonoscopy. Do not eat or drink solid food, milk, alcoholic beverages or dairy products. The following are examples of clear liquids: water, tea, soft drinks, sport drinks (Red Bull®) clear sodas, clear broth or bouillon juices without pulp, coffee (no milk or cream)

The day before your colonoscopy begin cleaning out the bowel with Moviprep or a similar prescribde laxative. You can have a small breakfast (e.g. eggs and toast) after no solid food from now until your procedure is done.

Begin a clear liquid diet (below). Drink at least 8 glasses of water or clear liquids during the day to avoid dehydration.•

  • Mix first dose of Moviprep by emptying one Pouch A and one Pouch B into the container. Add lukewarm drinking water to the top line of the container and mix to dissolve. If you prefer, mix solution ahead of time and refrigerate prior to drinking. The mixed solution must be used within 24 hours.
  • Between 5 and 6 pm, begin drinking the prep. The Moviprep container is divided by 4 marks. Every 15 minutes drink the solution down to the next mark (about 8 ounces), until the full liter (32 ounces) has been consumed. This process will take on hour. It takes about thirty (30) minutes for the bowel cleanser to start working. It may continue to cause loose, liquid stools for 2 – 3 hours after you have finished drinking it. Over the course of the evening, drink an additional ½ liter of clear liquids from the table below.
  • Stay near a toilet, as you will have diarrhea

Follow the schedule on the last page. Stay close to a toilet. It is important to get the colon as clean as possible. If the bowel is not well cleaned out colonoscopy and bowel preparation may need to be repeated.

In the Morning

Take only the medicines you were instructed to take the morning of you appointment with sips of water. Be sure to ask your doctors which of your routine, home medicines you can take the morning of your coloscopy. If your have diabetes, high blood sugars, hypertension or high blood pressure you should ask your doctors which medicines you should take.

5 hours before leaving home for your colonoscopy, you may have to wake up early.

  • Mix second dose of MoviPrep by emptying the second Pouch A and second Pouch B into the container. Add lukewarm drinking water to the top line of the container and mix to dissolve. If you prefer, mix solution ahead of time and refrigerate prior to drinking.
  • 5 hours before you need to leave for your procedure drink the second dose of the Moviprep solution in the container divided by 4 marks. Every 15 minutes drink the solution down to the next mark (approximately 8 ounces), until the full liter (32 ounces) has been consumed. This process will take 1 hour. Next drink an additional 32 ounces of clear liquids within 30 minutes.
  • Take your morning medications with a small amount of water 4 hours before your appointment time (unless you have been told otherwise). If you take Diabetes medications follow your doctor’s instructions.

2 hours before your colonoscopy

  • Stop everything by mouth, including all liquids, smoking and chewing gum. Important!If you followed all of the instructions, your stool will be a clear or yellow liquid and you are ready for your colonoscopy.
  • If your stool is formed or your preparation is not going as expected call our clinic at + 43 1 328 8777.

Colon cleansing tips:

  1. Stay near a toilet! You will have diarrhea, which can be quite sudden. This is normal.
  2. Try drinking the solution with a straw. It may be easier to tolerate.
  3. Rarely, people may have nausea or vomiting with the prep. If this occurs, give yourself a 30 -minute break, rinse your mouth or brush your teeth, then continue drinking the prep solution.
  4. You may have bowel cramps until the stool has flushed from your colon (this may take 2 to 4 hours and sometimes much longer).
  5. Anal skin irritation or a flare of hemorrhoid inflammation may occur. If this happens, treat it with over-the-counter-remedies, such as baby wipes, Vaseline, or Penaten . Avoid products containing alcohol. If you have a prescription for hemorrhoid cream, you may use it. Do not use suppositories.
  6. When should I call the call center? If you have been ill and have had any of the following symptoms within 48 hours of your appointment

Bring all of the medications you take and medication lists to the hospital with you the morning of colonoscopy. Keep the medicines in the original bottles.

If you have diabetes or take insulin, please inform your doctor or nurse. You may need to adjust your insulin dose the morning of your procedure. Bring your diabetes medications with you so you can take them immediately after your procedure.

Special Conditions And Instructions

Do not take routine medications the day of your procedure unless you discuss it with your doctor or nurse. Inform your physician or nurse if you are taking Multi-vitamins, iron pills, NOAK’s (Pradaxa, Xarelto), Coumadin (Warfarin), ibuprofen or aspirin, Ticlid (ticlopidine), Plavix (clopidrogrel) or any blood thinner. These may need to be stopped 5 days before your colonoscopy.

Due to the sedation medications given during the procedure, you will not be permitted to drive yourself home. Please bring a responsible adult, age 18 years or older, who can drive you home or escort you home. You must have some one stay with you at home until you are fully awake and can care for yourself. You may resume all normal activities the morning after you procedure.

Nausea, vomiting or bloating can occur when cleansing the bowel. If this occurs, stop drinking the bowel cleanser for about 30 minutes then resume drinking it. Walking helps the colon wash the cleanser through. If the nausea or vomiting persist, you should call the clinic.

These written instructions do not replace a discussion with your physician or nurse. They may give you other instructions. Feel free to ask questions, come back for a visit or call if you are unclear about your diagnosis, treatment plan or these directions. The office number is 1 328 8777

Can I carry on taking my usual drugs?

You should be able to carry on taking your usual drugs, but some drugs may cause problems with the examination.

You must tell your doctor what you are
taking, particularly:

• Aspirin products
• Arthritis drugs
• Blood thinners eg. Warfarin (anticoagulants)
• Insulin
• Diabetic tablets
• Iron supplements
• Any herbal remedies
And if you have:
• any allergies to any drugs
• a pacemaker
• a joint replacement
• a heart valve replacement

Tell your doctor if you have to take antibiotics before dental treatment. If so, you may also need antibiotics before a colonoscopy.

Just before the procedure, you will be given a light anaesthetic and a pain killer. This is usually given by injection into a vein. You will be able to breathe for yourself so it is not like a general anaesthetic and you may have difficulty remembering what happened after the procedure.

  1. What if the doctor finds something wrong?

Your doctor may pass an instrument through the colonoscope and take a biopsy (a very small piece of the bowel lining) to be examined under a microscope. Biopsies are used to identify many conditions, and your doctor may take a biopsy, even if cancer is not thought to be the problem.

If colonoscopy is being done to find sites of bleeding, your doctor may stop the bleeding through the colonoscope by
• injecting drugs,
• sealing off bleeding vessels with heat treatment or
• other methods such as small clips.

Your doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination. These procedures don’t usually cause any pain

What are polyps and why are they removed?

Polyps are growths in the bowel lining, and they can be as small as a tiny dot or up to several centimetres big.

They are not usually cancer but can grow into cancer over time. Taking polyps out is an important means of preventing bowel cancer. The doctor usually removes a polyp along the colonoscope, using a wire loop to remove the polyp from the bowel wall. An electric current is sometimes also used. This is not painful.

What are risks of a colonoscopy?

There are some risks and complications, which can happen. These include:
(a) The bowel may be punctured. This can cause leakage of bowel contents into the abdomen. The risk is higher when polyps are removed, depending how large the polyp is. This is treated by keeping the bowel empty using suction and a tube into the stomach or bowel via the nose. Fluids and antibiotics are given via a drip, and further surgery may be needed. This may require a longer stay in hospital.

(b) Bleeding from the bowel following biopsy and/or removal of a polyp/polyps. This may be oozing from where the polyps were removed or damage of large blood vessels. The risk may be greater the larger the polyp. Sometimes bleeding can happen up to 12 days afterwards. This usually settles withou t further treatment.

(c) Another colonoscopy may be done to stop the bleeding. Rarely, a blood transfusion and further surgery may be needed if there is a lot of bleeding. The procedure may not be able to be completed due to bowel disease or other problems. Polyps or cancer can be missed. The risks are higher if your bowel is not cleaned properly. It is important that you follow the instructions to clear your bowel before the procedure.

(d) Mild pain and discomfort in the abdomen for one or two days after the procedure. This is treated with pain relief. It usually settles without further treatment.

(e) Very rarely, heart and lung problems such as:
• low oxygen levels
• lowered blood pressure
• higher pulse rate
• pneumonia (caused by vomit going down the lungs)

(f) People with ill health are more at risk. Healthy people may feel very drowsy for a few days afterwards. The procedure is immediately stopped if anything happens. Rarely, drugs may be given to take away the effects of the sedation and at worse life saving procedures may be needed. Death due to complications of colonoscopy is extremely rare.

If you do not wish to have a coloniscopy, there are a number of tests that can be done, such as:

  • Flexible sigmoidoscopy
  • Double contrast barium enema
  • MRI- and CT-Colonoscopy

Usually both would be needed for your doctor to consider that your bowel has been thoroughly investigated.

  1. What can I expect after a Colonoscopy?

You might have some cramping or bloating because of the air entering the colon during the examination. This should go away quickly when you pass gas.

You may get some bleeding from the back passage for a few days after the procedure. You must tell your doctor if this is more than half a cup.

Your doctor will tell you what was found during the examination or you may need to come back for a follow up appointment to discuss the results, and to find out the results of any biopsies

  1. What are the safety issues?

For your safety you must:

  • Be taken home by a responsible person
  • Have a responsible adult care for you that day/night or be on hand in case of any problems
  • Not drive a car or motorcycle (this is against the law) or operate machinery, until the following day or for as long as your doctor or anaesthetist advises.
  • Not make any important decisions or sign any contracts within 24 hours of the procedure (the medication used may impair judgement)
  • Not drink any alcohol for 24 hours after your procedure

Tell your Doctor if you:

• Generally feel ill with or without headache, chills or muscle aches

• Have a high temperature/fever

• Begin to have bright red bleeding from your back passage – more than half a cup.

• Have feelings of dizziness, shortness of breath or feel faint

• Start to get sharp pains in the stomach or begin vomiting

• Get discomfort/irritation in your back passage

Philip Bull, MD FEBVS
Consultant Surgeon

Sieveringer St. 9
1190 Vienna

Tel: 328 8777 Fax: DW28
e-mail: info@dr-bull.com