Colonoscopy information

DATE of COLONOSCOPY:________________________

GASTROENTEROLOGIST:
Dr.Bassily
Dr.Glance
Dr.Nguyen Dr.Lachal

PROCEDURE LOCATION:
- Cnr Kingsbury Dve & Plenty Rd, Bundoora - Cnr. Plenty Rd & Greenhills Rds Bundoora COLONOSCOPY INFORMATION
A colonoscopy is a procedure that enables your doctor to examine the lining of the colon (large bowel). Under sedation, a flexible tube is gently passed via the rectum (back passage) into the colon. A tissue sample (biopsy) may be taken, or polyps (growths) removed and sent to the pathologist. Colonoscopy is the best test to assess for bowel polyps or cancers, although no test is 100% accurate. The procedure usually takes approximately 30 minutes, and most patients will not remember the procedure at all.
Is Colonoscopy safe?
Colonoscopy is a safe and well tolerated procedure, although it is recommended that you seek advice prior to the
procedure if you have significant heart, lung or kidney problems. It is normal to feel temporary bloating following the
procedure due to inflation of the bowel during the procedure. Occasionally there may be nausea or lightheadedness following the anaesthetic. Serious complications are rare, but may include: - Perforation (a hole in the bowel wall) which may require surgery – this is uncommon, 1:3000 cases
Aspiration (inhaling of stomach contents into the lung whilst sedated) which may require antibiotic treatment or
Bleeding if a polyp is removed – this may occur up to 2 weeks following the procedure and rarely requires
hospitalization or further procedures to stop the bleeding Death is extremely rare, although this is a possible consequence of any medical procedure.
If you wish to discuss the details of all possible rare complications, you should inform your doctor and/or anaesthetist prior to the procedure.

What Bowel Preparation is required?
For the procedure to be accurate, the colon must be completely clean. This is achieved using a “BOWEL PREPARATION
KIT” (see next page for further instructions), which causes mild-moderate diarrhoea. This is available at the GastroNorth main rooms or at your local pharmacy without a prescription for a small fee.
What do I need to bring?
You will need to bring your doctor’s referral if available, health fund card and medicare card. You will need to change into a patient gown for the procedure, and so please bring loose fitting clothing that can be easily removed and folded. Any jewellery and valuables should be left at home.
What happens afterwards?
You may be drowsy for several hours following the colonoscopy due to the sedation administered. A friend or family
member needs to drive you home your procedure may be cancelled if this has not been organized. You must not
drive or operate any machinery for 24 hours afterwards. You can continue taking all of your prescription medications as
directed.
Please contact your doctor if you experience any severe abdominal pain, heavy bleeding, fevers/chills, breathing difficulty, or any other symptoms you are concerned about. Alternatively, contact the closest emergency department e.g. The Northern Hospital (9405 8000), The Austin Hospital (9496 5000) IF YOU DO NOT UNDERSTAND ANY OF THE ABOVE INFORMATION, OR HAVE FURTHER
QUESTIONS OR CONCERNS, PLEASE CONTACT GASTRONORTH 9473 8865.

I have read and understood the above information regarding Colonoscopy. I understand the reason for my doctor to
recommend that I undergo a Colonoscopy and understand the risks associated with this procedure as outlined above. I have been given an opportunity to discuss any concerns or queries.
Signed: ________________________________________
Date: ____________________________
Witness (Doctor) ________________________________
Date: ____________________________
COLONOSCOPY INSTRUCTIONS

GENERAL INFORMATION
 Dietary Modification – For 2-3 days prior to the colonoscopy avoid foods with grains or seeds.
 Medications – You can usually take all of your regular medication with a sip of water. If you take
warfarin/coumadin, clopidogrel (Plavix/Iscover), insulin please seek advice at least 10 days prior to the colonoscopy. Oral diabetic medications can be withheld on the day of the procedure. In general, please cease the following drugs 7 days prior to the colonoscopy: anti-inflammatories (nurofen, indocid, voltaren etc), iron tablets (including multivitamins containing iron), and drugs to stop diarrhoea. If you take the Oral Contraceptive Pill you should use alternative contraception for 7 days after the bowel preparation is commenced as the pill’s absorption may be Bowel Preparation Kit
You will need to obtain THREE Picolax OR Picoprep sachets.
This is available at the GastroNorth main rooms or at your local pharmacy without a prescription. Each sachet of Picolax/Picoprep should be dissolved in a glass of warm water (approximately 250ml). This can be chilled beforehand if preferred.
FOR A MORNING COLONOSCOPY
 STEP 1: Diet
Only CLEAR FLUIDS are allowed. This includes: water, coffee or tea (without milk),
clear fruit juice (no pulp), clear soups (e.g. clear chicken broth), cordial or sports
drinks (avoid red/purple colourings), lucozade, Jelly.
 STEP 2: 4 pm
One Picolax or Picoprep. Follow with two glasses of CLEAR FLUIDS
 STEP 3: 6 pm
One Picolax or Picoprep. Follow with two glasses of CLEAR FLUIDS
 STEP 4: 8 pm
One Picolax or Picoprep. Follow with two glasses of CLEAR FLUIDS
 STEP 5: READY
Take regular medications (except diabetic medications) with a sip of water
Nothing to eat or drink for 6 hours prior to the procedure, except for medications.
Arrive at scheduled time. Please note that the appointment time is not the time of the endoscopic procedure ________________________________________________________________
FOR AN AFTERNOON COLONOSCOPY
 STEP 1: Diet
You may have a light low fibre breakfast, but NOTHING to eat thereafter.
Only CLEAR FLUIDS are allowed after breakfast. This includes: water, coffee or tea (without
milk), clear fruit juice (no pulp), clear soups (e.g. clear chicken broth), cordial or sports drinks
(avoid red/purple colourings), lucozade, Jelly.  STEP 2: 6 pm
One Picolax or Picoprep. Follow with two glasses of CLEAR FLUIDS
 STEP 3: 8 pm
One Picolax or Picoprep. Follow with two glasses of CLEAR FLUIDS
 STEP 4: 7am
One Picolax or Picoprep. Follow with two glasses of CLEAR FLUIDS
 STEP 5: READY
Take regular medications (except diabetic medications) with a sip of water
Nothing to eat or drink for 6 hours prior to the procedure.
Arrive at scheduled time. Please note that the appointment time is not the time of the endoscopic

Please note: You will NOT be able to drive home, someone must pick you up. You cannot operate a vehicle
or machinery on the day of the procedure.

IF YOU DO NOT UNDERSTAND ANY OF THE ABOVE INFORMATION, OR HAVE FURTHER
QUESTIONS OR CONCERNS, PLEASE CONTACT GASTRONORTH ON 9473 8865.

Source: http://gastronorth.com.au/pdf_form/ColonConsentGN.pdf