7th june 2010

CENTRAL MELBOURNE GASTROENTEROLOGY
Suite 6-7, Level 2, 55 Victoria Parade, Fitzroy Vic 3065 Email: [email protected] Instructions for Colonoscopy Preparation with PICO-SALAX for Afternoon Test

Colonoscopy Date . Admission Time .

The success of your examination depends on the bowel being as clear as possible. Otherwise the
examination may need to be postponed and the preparation repeated. Please carefully follow the
instructions below.
The week before the colonoscopy:
You will need to obtain PICO-SALAX from your chemist. This comes in a box containing two
packets (sachets). You will not need a prescription
Notify your doctor if you are pregnant, allergic to medication or latex, have a cardiac pacemaker or heart valve disease. If you are on medication for diabetes (tablets or insulin), or if you are on blood thinning medication such as Aspirin, Plavix, Iscover or Warfarin/Coumadin, you must discuss this with your doctor at least one week prior to the colonoscopy. Stop taking iron tablets or anti-diarrhoeal medications 7 days prior to your colonoscopy. All other regular medications can be continued.
Two days before the colonoscopy:
Maintain a low fibre diet. Avoid brown or wholegrain breads, cereals, and any foods containing seeds, nuts or yellow cheese. Limit your intake of vegetables and fruit. You may have egg, steamed white fish, boiled chicken, white bread, white pasta, white rice.
On the day before the colonoscopy:
You may have a normal breakfast and lunch. After that you may only have clear fluids for the
rest of the day. Approved clear fluids include water, clear fruit juices (eg. apple juice),
clear cordials, soft drinks, black tea & coffee (no milk), plain jelly, bonox, lucozade,
clear broth, barley sugar. You must have no solid food or milk products after lunch.
First Dose - 6.00 PM: Empty the first sachet of PICO-SALAX into glass of 150 ml of water
and stir for 2-3 minutes until dissolved. The solution can be refrigerated if required. Drink this
first glass of PICO-SALAX and ensure that you drink approximately 250ml (one glass) of
water or approved clear fluids each hour for the next 3 – 4 hours. The laxative bowel
preparation usually causes frequent, loose bowel movements within one to three hours of
taking the first dose. It is best to stay at home within easy reach of the toilet.

On the day of the colonoscopy:
Second Dose - 7.00 AM: Empty the second sachet of PICO-SALAX into glass of 150 ml of
water and stir for 2-3 minutes until dissolved. The solution can be refrigerated if required.
Drink this second glass of PICO-SALAX. Then drink approximately 250ml (one glass) of water
or approved clear fluids each hour for the next 3 hours.
Take your usual medicines (excluding those listed above) with some water. You should have nothing to eat or drink after 10.00 AM. You can have small sips of
water if needed..
General Information About Colonoscopy
What is a colonoscopy and how is it performed?
Colonoscopy is a procedure to inspect the inside of the bowel using a thin, flexible, tube introduced via the back passage. An intravenous sedative is given prior to the procedure so that you will be sleepy and comfortable during the examination. The entire procedure usually takes between 20 and 40 minutes. Several procedures can be carried out during the colonoscopy including taking biopsies (small tissue samples) of the colon and removing polyps. What are polyps?
Polyps are small growths attached to the lining of the bowel. Some polyps can develop into cancer later in life. Therefore, if polyps are detected during a colonoscopy, they are usually removed at the time of examination. As you will be sedated, it will not be possible to discuss the removal of polyps with you during the procedure. If you have any questions regarding removal of polyps, please ask your doctor before the colonoscopy. What happens after the colonoscopy?
Following the colonoscopy, you will remain in the hospital recovery area for approximately two hours
until the effect of the medication wears off. You may experience slight discomfort or bloating which
usually eases with the passage of wind. If you have a biopsy or polyp removed, you may notice a
small amount of blood passed in the toilet. If you develop severe or persistent abdominal pain,
bleeding from the back passage or any other symptoms of concern, you should contact your
doctor immediately or go to the nearest hospital’s Emergency Department.
Because the sedation given may interfere with your judgement or ability to concentrate, you
should not drive a motor vehicle, travel on public transport alone, operate dangerous
machinery or sign important documents for the remainder of the day. It is necessary to
arrange for a relative or friend to take you home from the hospital and stay with you.
What are the risks of colonoscopy?
Any medical procedure carries some risk but colonoscopy is generally considered a safe procedure and complications are rare. Potential complications may include: Intolerance to the laxative bowel preparation (headaches, nausea, vomiting, dehydration) Bowel perforation (estimated risk is approximately 1 in 1000). Major bleeding (estimated risk is 1 in 3300 for biopsies and 1 in 500 for removal of polyps). Although rare, perforation or major bleeding are potentially serious and may require urgent surgery.

If you wish to have a more detailed discussion about potential risks, please ask your doctor
prior to the procedure.

What are the limitations of colonoscopy

While colonoscopy is the best test for excluding bowel polyps or cancer, it is not perfect and a small
proportion of polyps or cancers may escape detection. In about 5% of patients, the entire colon
cannot be accurately assessed. This may be due to variations in the structure of the bowel, pathology
within the bowel or because of inadequate bowel preparation. If this occurs you may need to have the
colonoscopy repeated another time or you may need a CT scan or X-ray.
Are there any alternatives to colonoscopy?
The established alternative to colonoscopy is a barium enema x -ray. CT colonography is not yet in routine use in Australia. Colonoscopy is usually recommended over the other two tests because it is more accurate and allows biopsies to be taken and polyps to be removed.

Source: http://centralmelbournegastro.com.au/downloads/PICO-SALAX%20afternoon.pdf