Dr. ALEXANDROS

MRCP(UK), FEBGH, AGAF

YOUR VISIT

What will you need ?

1. Your greek or EU social security number (AMKA) if you have one. Check that social security fees are not overdue so as to have medication or investigations prescribed by using the National Health Service scheme. If you are using private insurance please check with our secretary.

2. A list of current medications and known allergies

3. All the relevant investigations ie blood results, endoscopy reports and photographs, CT/ MRI report and CDs etc.

Preparation for endoscopies

Upper GI endoscopy - Gastroscopy

 

Preparation for gastroscopy is a 6 hour fast. You can have sips of water up to 1 hour before the procedure. If the endoscopy is diagnostic (includes taking biopsies), you do not have to stop taking your medication.


However, if you take medication for high blood pressure, it is advisable that you refrain from it the morning of the procedure, since the sedatives used may lower your blood pressure.

In case you will be having a therapeutic procedure (polypectomy, stricture dilatation etc) and you take antiplatelet - anticoagulant drugs (for example Aspirin, Plavix, Iscover, Sintrom , Pradaxa, Xarelto, Eliquis) which are prescribed post angioplasties, by pass surgery, strokes, heart attacks or arrhythmias you will need to call in advance because these drugs may have to be stopped or substituted.

If you are diabetic on oral medication, you should avoid taking them the morning of the procedure. If you take insulin consult your diabetologist - you may have to lower the dose.

 

In case of doubt, give us a phone call.

You should remove your jewellery and any loose fitting dentures. We recommend that you wear comfortable, loose fitting clothes and avoid high heels.

 

Once the procedure is performed, you will remain in the recovery area for about 30 minutes prior to being informed of the findings. In case you experience dizziness or nausea you will remain for a longer period in a short stay ward.

 

Since you will have received intravenous sedation, it is recommended that you are accompanied by another person and refrain from driving for 4-6 hours.

Colonoscopy

 

Bowel preparation is paramount for colonoscopy. This will allow complete visualisation of the entire colon, thus minimising the possibility of a lesion being missed. If your colon is not properly cleansed, you will be asked to repeat the procedure sooner.

 

However if you take medication for high blood pressure, it is advisable that you refrain from it the morning of the procedure, since the sedatives used, may lower your blood pressure. If you take antiplatelet - anticoagulant drugs (for example Aspirin, Plavix, Iscover, Sintrom , Pradaxa, Xarelto, Eliquis) which are prescribed post angioplasties, by pass surgery, strokes, heart attacks or arrhythmias you will need to call in advance because these drugs may have to be stopped or substituted.

 

If you are diabetic on oral medication, you should avoid taking them the morning of the procedure. If you take insulin consult your diabetologist - you may have to lower the dose.

If you take iron supplements, these should be stopped 5 days prior to the procedure. In case of doubt, give us a phone call.

 

We recommend that you wear comfortable, loose fitting clothes, avoid high heels and jewellery.

Bowel preparation :

Two days prior to the procedure

  • Low residue diet (avoid salads, legumes, fibres)

 

The day before the procedure

  • Clear fluid diet ie water, tea, coffee, clear soup, clear juices (not red), popsicles, hard candies, Jell-O, beverages.

  • In the afternoon 4-10 pm:  4 litres of PEG 3350 solution (Effecol Prep, Fortans, Klean Prep) if you have an early morning appointment or 2 litres in case of a lunchtime appointment. You can have clear fluids up to 6 hours before the procedure.

       Medications should be taken at least 2 hours before              starting or finishing the bowel prep, or they will be                  washed away.

On the day of the procedure

  • You can drink sips of water/ fluids in case of an early morning appointment. If you have a lunchtime appointment take 2 litres of PEG 3350 solution (Effecol Prep, Fortans, Klean Prep) completing the bowel prep at least 4 hours prior to your colonoscopy.

Once the procedure is performed, you will remain in the recovery area for about 30 minutes prior to being informed of the findings.

 

In case you experience dizziness or nausea you will remain for a longer period in a short stay ward.

 

Since you will have received intravenous sedation, it is recommended that you are accompanied by another person and refrain from driving for 4-6 hours.

Helpful tips for taking the bowel prep

If you vomit :

  • Slow down till you feel less nauseous.

  • Keep the solution in the fridge or drink over ice.

    Drink it using a straw.

    Dissolve it in lemonade or add lemon juice.

  • Use hard candy.

  • Wash your teeth or use mouth wash.

If you don’t go to the toilet :

  • Drink more fluids.

  • Walk a bit.

ERCP

ERCP preparation is the same as for gastroscopy with a few important additions.

 

ERCP is a therapeutic procedure and as such several investigations will have to be performed in advance: a full blood count, prothrombin time - INR and your blood group should be ascertained. If you take anti platelet  or anticoagulant drugs such as but not exclusively Sintrom, Pradaxa, Eliquis, Xarelto, Plavix, Iscover we will have to stop or substitute them a few days earlier. How many days before depends on the specific drug and your cardiac and renal function. If you take Aspirin - Salospir you do not have to stop it.

 

Women of child bearing age should ensure they are not expecting, since the procedure is performed under combined endoscopic and Xray guidance. You should remove your jewellery.

The procedure is performed under intravenous sedation or general anaesthesia should this be deemed appropriate. It is performed in the angiography lab or the Xray department. Contrast medium and possibly intravenous antibiotics will be administered, so please inform us should you have any known allergies in advance.

 

The procedure usually lasts between 15-45 minutes. Most patients will be discharged after a 6-8 hour stay in a short stay ward. However some patients will need admission. Only clear fluids can be administered orally for the first 24 hours after the ERCP.

Capsule endoscopy

Capsule endoscopy preparation is easy. Refrain from iron supplements for 5 days prior to the procedure. Arrive having fasted overnight. You will be given 1 litre of PEG 3350 solution (Effecol Prep, Fortans, Klean Prep) to clear up small bowel secretions.

 

After that a belt or adhesive sensors will be attached to your abdomen which connect to the storage device (size of a large mobile phone) which you carry with you for the duration of the procedure. Once you swallow the capsule, you are free to go.

 

For the first 4 hours you can drink clear fluids (water, tea). It may help chewing a gum for the first 2 hours. After 4 hours you can have a light meal and take your medication.

 

The procedure lasts 12-15 hours (pending on the capsule type). The next morning either you or somebody else return the belt and the storage device to us.

 

You will be informed of the results the same afternoon or the next day.

Double balloon enteroscopy

 

The preparation is like that of a gastroscopy for per oral approach or that of colonoscopy for a per rectum approach.

 

Due to the longer duration of the procedure,  you will remain in a short stay ward for 1-2 hours after the end of the procedure.

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