Microsoft word - capsuleendoscopyinstructionswithprep

Capsule Endoscopy Instructions (with prep)

You have been scheduled for Capsule Endoscopy on __________________________. You should arrive at
Gastroenterology Associates at Five Irongate Center at 7:45AM.
Patients failing to cancel their Capsule Endoscopy appointment at least 48 hours in advance will be
billed an administrative fee of $100 by Gastroenterology Associates of Northern N.Y., PC. This fee
must be paid in full prior to scheduling future appointments with our practice. If you must cancel or
reschedule the examination, please call 793-5034 at the earliest possible time. There are often
significant delays in rescheduling and if there are any questions regarding the need to cancel due to
sickness or other health issues, it is essential that you contact our office or our physician on call (after
hours or on weekends).

Your physician has determined that as part of your medical evaluation you should undergo an examination known as
Capsule Endoscopy. This procedure involves ingesting a small (the size of a large vitamin pill) GivenR Imaging M2AR
Capsule which will pass naturally through your digestive system while taking pictures of the intestine. The images are
transmitted to the Sensor ArrayTM which is placed on your abdomen. The Sensor Array is attached to a Walkman-like
GivenR Data RecorderTM which saves all the images. It is located in the Recorder BeltTM, which is worn around your
waist. After 8 hours, you will return to our office where we will remove the Recorder Belt. The M2A Capsule is
disposable and will be excreted naturally in your bowel movement. In the rare case that it will not be excreted naturally,
it will need to be removed endoscopically or surgically. In order for your physician to get the most accurate information
from this examination, you will need to follow the instructions below:
If you are a diabetic and on a diabetic medication, please discuss this with our office at least seven (7) days
prior to your capsule endoscopy.

One Week Prior to Exam
1. Do not take iron (including multivitamins that contain iron) for seven (7) days prior to your capsule endoscopy. 2. Do not take any coating meds (including antacids, Tums, Carafate, etc.) for seven (7) days prior to your capsule endoscopy.
The Day Before Capsule Endoscopy

1. Consume your usual diet for breakfast and lunch. Begin a clear liquid diet after lunch until 12:00 midnight. Do not have anything to drink after 12:00 midnight the evening before your exam. 2. At 5:00 p.m. mix one 119 gram bottle of MiraLax in 32 oz. of Gatorade, G2 or Powerade. Shake the solution 3. Drink 1(one) 8 oz. glass of the MiraLax/Gatorade solution every 15 minutes until the solution is gone. (Four 4. Continue drinking clear fluids until bedtime. 5. Do not take any oral medication after midnight the evening before your procedure. Day of Capsule Endoscopy

1. Do not have anything to eat or drink the morning of your capsule endoscopy. 2. Take 1 Reglan 10 mg. tablet with water at 6:30 AM the day of your capsule endoscopy. You will be given a prescription for this. Reglan is a medication which improves the transit of the capsule through the small intestine. Do not have anything to drink after you take the Reglan. 3. Arrive at GI Associates at Five Irongate Center at 7:45AM for your Capsule endoscopy dressed in loose fitting, two-piece clothing. The manufacturer recommends you wear a 100% cotton shirt to allow for proper functioning of the equipment. 4. At this time you will have a pre-procedure interview. You will be checked-in and asked to give your informed consent. 5. The Sensor Array will be applied to your abdomen with adhesive pads and will be connected to the Data Recorder which you will wear in a belt around your waist. After that you will be instructed to ingest the M2A Capsule.
After Ingesting the M2AR Capsule
1. After ingesting the M2A Capsule, do not eat or drink for at least 4 hours. After 4 hours you may have a light snack and take your usual daily medications. After the examination is completed, you may return to your normal diet. The above instructions related to eating apply, unless your physician specifies otherwise. Contact your physician immediately if you suffer from any abdominal pain, nausea or vomiting during Capsule Endoscopy. 2. After ingesting the M2A Capsule and until it is excreted, you should not be near any source of powerful electromagnetic fields such as one created near an MRI device or amateur (ham) radio, metal detectors at airports, courthouses, etc. 3. Capsule Endoscopy lasts approximately 8 hours. Do not disconnect the equipment or remove the belt at any time during this period. Since the Data Recorder is actually a small computer, it should be treated with utmost care and protection. Avoid sudden movement and banging of the Data Recorder. 4. During Capsule Endoscopy, you will need to verify every 15 minutes that the small light on top of the Data Recorder is blinking twice per second. If for some reason it stops blinking at this rate, record the time and contact your physician. You should also record the time and nature of any event such as eating, drinking, your activity and unusual sensations. Return the Event Form with these notes to your physician at the time you return the equipment. 5. Avoid any strenuous physical activity especially if it involves sweating and do not bend over or 6. The Data Recorder is sensitive to heat and thus please avoid covering the Data Recorder with blankets or clothing.
After Completing Capsule Endoscopy

1. You should return to Gastroenterology Associates at 3:45 p.m. to have the equipment 2. If you did not positively verify the excretion of the M2A Capsule from your body, and you develop unexplained post procedure nausea, abdominal pain or vomiting, contact your physician for evaluation and possible abdominal X-ray examination. 3. Undergoing an MRI while the capsule is inside your body may result in serious damage to your intestinal tract or abdominal cavity. If you did not positively verify the excretion of the M2AR Capsule from your body, you should contact your physician for evaluation and possible Abdominal X-ray before undergoing an MRI examination.

Source: http://giassociatespc.com/assets/pdf_files/capsuleendoscopyinstructionswithprep.pdf