An endoscopy is a medical procedure that allows healthcare providers to visualize the internal organs of the digestive system using a flexible tube with a camera, known as an endoscope. This procedure is crucial for diagnosing and sometimes treating conditions affecting the upper part of the digestive system. Proper preparation, including dietary adjustments, is essential for a successful endoscopy. This article provides a detailed guide on how to prepare for an endoscopy, ensuring the procedure goes smoothly and yields accurate results.
Understanding Endoscopy
An endoscopy involves inserting an endoscope into the digestive tract to visualize internal organs such as the esophagus, stomach, and intestines. Depending on the type of endoscopy, the procedure can be performed through the mouth (upper endoscopy) or the rectum (colonoscopy or sigmoidoscopy).
Types of Endoscopy
- Upper Endoscopy (Esophagogastroduodenoscopy or EGD): Examines the esophagus, stomach, and upper portion of the small intestine.
- Colonoscopy: Examines the lining of the large intestine and sometimes part of the small intestine.
- Sigmoidoscopy: Examines the lining of the rectum and part of the large intestine.
- Enteroscopy: Examines the small intestine using methods like balloon enteroscopy or capsule enteroscopy.
Why Endoscopy is Performed
Endoscopies are generally conducted to:
- Investigate symptoms such as stomach pain, difficulty swallowing, digestive tract bleeding, changes in bowel habits, abdominal pain, nausea, and vomiting.
- Diagnose conditions and diseases, including cancer, ulcers, gastroesophageal reflux disease (GERD), inflammation, celiac disease, blockages, pancreatitis, internal bleeding, and precancerous abnormalities.
- Collect tissue samples (biopsy) to test for diseases and conditions that may be causing anemia, bleeding, inflammation, or diarrhea.
- Treat problems in the digestive system using special tools passed through the endoscope.
- Monitor existing conditions to assess their progression or response to treatment.
The Importance of Preparation
Proper preparation is crucial for a successful endoscopy. It helps clear the digestive tract, providing a clear view for the physician to examine the lining of the gastrointestinal tract. Inadequate preparation can obscure the view, leading to missed diagnoses or the need for repeat procedures. Moreover, it reduces the risk of complications such as aspiration, where stomach contents might enter the lungs during the procedure.
Dietary Changes Before an Endoscopy
Dietary protocols are an essential component of preparing for an endoscopy. Several days before the procedure, it is important to follow specific dietary guidelines to ensure the digestive tract is clear.
Read also: Comprehensive Guide to Endoscopic Weight Loss
3 Days Before the Procedure: Low-Residue Diet
Three days before your procedure, you should begin a "low-residue diet" to limit high-fiber foods, which your colon takes longer to clear. This diet helps reduce the amount of undigested material in the colon, making it easier to visualize the intestinal lining during the procedure.
High-fiber foods to avoid:
- Whole-grain breads, oatmeal/cereals, granola
- Nuts, seeds, raw/dried vegetables or fruit (NO salads)
- Beverages with pulp
- Nutritional supplements that contain fiber
- Pepper, beans, corn/popcorn
Foods you may eat:
- Cream of wheat/grits, white rice, refined pastas/noodles
- Cooked fresh/canned vegetables and vegetables without seeds including asparagus, beets, carrots, mushrooms, green beans, potatoes without skin
- Bananas, soft cantaloupe, honeydew, avocado
- Chicken, fish, beef, pork, tofu, eggs
- Margarine, butters/oils, smooth sauces and dressings
- Cakes, cookies, pudding, ice cream without nuts or seeds, hard candy, popsicles, yogurt, and cheese
Avoid foods with nuts or seeds as they can plug up the scope.
1 Day Before the Procedure: Clear Liquid Diet
Beginning one full day before your procedure, you must begin a clear liquid diet, which means that you should NOT eat any solid foods and should ONLY drink clear liquids. For example, if your procedure is on Thursday morning, you should not eat any solid foods for Wednesday breakfast, lunch, and dinner and should only drink liquids that are clear. Aim to drink at least 12 tall glasses (about 8-10 ounces each) of clear liquids throughout the day in addition to what you drink with your bowel prep solution/medication.
A clear liquid diet consists of drinking only "clear" liquids, such as:
- Water
- Mineral water
- Clear fruit juices without pulp (apple, white grape, white cranberry, lemonade, etc)
- Clear soft drinks
- Clear sports drinks
- Broth (chicken, beef, vegetable, or bone broth)
- Popsicles or gelatin (such as Jell-O)
- Coffee or tea (without milk)
- Ensure clear or other clear meal-replacement drinks
Avoid juices that you cannot see through, like tomato or orange juice, kombucha, milk, coffee, or tea with cream, ice cream, cream soups, or protein drinks. No red or purple colored items.
Read also: The Hoxsey Diet
4 Hours Before the Procedure: Stop Drinking Clear Liquids
Beginning four hours before your procedure, you should STOP drinking clear liquids. This means that you should not have anything to eat or drink beginning four hours before your procedure. Avoid drinking or chewing anything (including water, gum, mint, etc.) for at least 4 hours prior to your scheduled appointment time.
After the Procedure
After your procedure, you will be able to resume a normal diet, unless otherwise instructed by your doctor. Clear liquids such as water, broth, and unsweetened juice. You shouldn’t eat or drink after an upper endoscopy until you can comfortably swallow. This is because it may hurt to swallow comfortably immediately after the procedure. Once you give it enough time, like say after a few hours, you can then start eating. Go for light food options, and give your gastrointestinal system time to recover from the probing. Stay away from food that’s too heavy or puts undue pressure on your gastrointestinal tract.
Medication Adjustments
You can take most prescription and non-prescription medications right up to the day of the colonoscopy. However, certain medications need to be temporarily discontinued prior to the procedure. Inform your doctor about all medications you are taking.
- Stop medications that are for diarrhea (Imodium, Kaopectate) or contain iron 7 days prior to your procedure.
- Blood thinners may need to be temporarily discontinued prior to procedure. The length of time you will need to stop your medication depends upon which drug you are taking. If you are on a blood thinner, you should consult with your prescribing doctor about whether you should continue or discontinue these medications. Do not stop these medications without first talking to your doctor. You will restart these medicines after the procedure, unless otherwise directed by your doctor.
- Low-dose aspirin can be continued and does not need to be stopped prior to your colonoscopy.
- Insulin/diabetes medication doses may need to be adjusted. Consult your prescribing doctor.
- Blood-pressure medicines should be continued while preparing for the test. On the day of your test, you should take your blood-pressure medicine with water at least four hours before your test.
- You will need to temporarily discontinue GLP-1 medications (such as Ozempic or Trulicity) prior to your procedure.
Take your usual morning medicines, especially those for blood pressure, at least four hours prior to your procedure with a small amount of water.
Bowel Preparation Instructions
Bowel preparation is crucial, especially for colonoscopies, to ensure a clear view of the colon walls. Researchers have found that the best way to clean your colon is with two doses of an oral liquid laxative. The first dose is taken the evening before your colonoscopy. The second dose is taken the morning of your scheduled colonoscopy. It may appear that your colon is clean after drinking the first dose, but your stomach is still making fluids that can make it difficult for your doctor to see the walls of your colon. The second dose removes the fluids your body produced overnight to completely clear all material from your colon. It's very important you don't miss the second dose. Many patients who don't drink the second dose of the liquid laxative have to be rescheduled because their colon is not clean enough.
Read also: Walnut Keto Guide
Using PEG 3350/MiraLAX
- Buy two 32-ounce size bottles of Gatorade, but NO purple, red or orange colored flavors.
- The day before your colonoscopy, mix one half of the bottle of PEG 3350/MiraLAX (about 119 grams) in one bottle of Gatorade and shake it well to dissolve. You may use warm, cold or room-temperature Gatorade. Some patients find drinking the prep through a straw helpful.
- Finish this solution WITHIN 1 HOUR by drinking an 8-ounce glass every 10 to 15 minutes until you finish the bottle.
- You may drink other clear liquids after you finish the PEG 3350/MiraLAX and Gatorade, up until midnight.
- Five hours before leaving for your colonoscopy, mix the other 1/2 (one half) of the bottle of PEG 3350/MiraLAX (about 119 grams) in the other bottle of Gatorade and shake it well to dissolve.
- Drink an 8-ounce glass of the solution every 10 to 15 minutes until you finish it.
PEG 3350/MiraLAX will give you diarrhea! This is normal. You may want to buy flushable baby wipes and Vaseline to use during your prep due to skin irritation.
Other Important Instructions
Transportation
You must have someone accompany you home the day of your procedure, even if you take a cab. You will not be able to drive yourself home. You can also use public transportation (taxi or bus), but only if you have an adult who can escort you home. Medical transport may be arranged for safe transportation home. The medical procedure staff must be able to contact whoever will accompany you. If this person cannot be confirmed prior to the procedure, your procedure will be rescheduled for your safety.
For all procedures involving Sedation/Anesthesia: For your safety, an adult should accompany you home after procedures with sedation. The adult can drive you home or accompany you on public transportation. No Uber/Lyft, taxi, bus or any other form of public transportation can be used if you are alone after sedation. There are a few options that can be arranged prior to your procedure if you do not have an adult to assist you. If there are safety concerns, your procedure will be canceled.
Diabetes Management
If you have diabetes, take special care while only drinking clear liquids! Monitor your blood sugar every 4 hours during your prep time before your colonoscopy.
- If you have an insulin pump: Maintain pump as usual and bring all pump equipment and supplies as well as continuous glucose monitor on the day of the procedure.
- Oral diabetic medications: Please hold all oral diabetic agents the morning of the procedure.
- Metformin: Hold the night before and the day of the procedure.
- GSLT2i: (Canagliflozin,Dapagliflozin,Empagliflozin): hold 3 days prior to the procedure.
- GLP1R: agonists (Ozempic, Wegovy): Hold oral dose the morning of surgery. Hold weekly injections 1 week(7 days) prior to the procedure.
- Insulin: Hold all short acting insulin when on the liquid diet (1- or 2-day colon prep). Decrease the long-acting Insulin 50% the days you are doing the prep/liquid diet. Take 50% of the normal long-acting dose of insulin on the day of the procedure IF YOU TAKE A MORNING DOSE. Do Not Take short acting insulin on the days of prepping/liquid diet or day of the procedure.
Taking any of the following GLP-1 medications for Diabetes, weight loss, or any other reason? If taking once daily, stop taking 2 days before procedure. If taking once weekly, stop at least 7 days before procedure: Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide, Tirzepatide.
What to Expect on the Day of the Procedure
- Arrive 60 minutes before your appointment time.
- Expect to be at the endoscopy center for up to four (4) hours from check-in to discharge.
- Take any morning medications you need at least FOUR HOURS BEFORE your colonoscopy, with a few sips of water to swallow any pills, tablets or capsules.
- During the FOUR HOURS BEFORE your colonoscopy, for your own safety, there should be NOTHING IN YOUR MOUTH, not even chewing gum.
- Your stool should be clear and yellow, with no solid particles in it.
Lifestyle Changes Before an Endoscopy
Alongside dietary changes, certain lifestyle adjustments can enhance the preparation process.
Smoking and Alcohol
Refrain from smoking and consuming alcohol at least 24 hours before the endoscopy. Smoking can increase stomach acid production and irritate the digestive tract, while alcohol can interfere with sedation and the body’s ability to heal. Both smoking and alcohol consumption can also affect the accuracy of the results by causing inflammation in the digestive tract.
Hydration
Staying well-hydrated in the days leading up to the endoscopy is essential, but avoid drinking anything for several hours before the procedure as per your doctor’s instructions. Proper hydration helps maintain blood volume and makes it easier for the healthcare team to insert an intravenous (IV) line if needed.
Psychological Preparation
Preparing mentally for an endoscopy can help reduce anxiety and improve the overall experience.
Understanding the Procedure
Educate yourself about the endoscopy process to reduce anxiety and stress. Knowing what to expect can help you feel more relaxed and prepared. Your healthcare provider will explain the procedure, including the sedation used and any potential risks. Understanding that the procedure is typically quick and relatively painless can also ease apprehensions.
Relaxation Techniques
Practice relaxation techniques such as deep breathing, meditation, or visualization to calm your mind before the procedure. Stress and anxiety can increase discomfort, so it’s essential to approach the endoscopy with a relaxed mindset. Consider listening to calming music or engaging in light activities that help distract and relax you before the procedure.
Risks of Endoscopy
An endoscopy is generally a very safe procedure. However, like all medical procedures, there are some risks involved:
- Bleeding: Your risk of bleeding complications after an endoscopy is increased if the procedure involves removing a piece of tissue for testing (biopsy) or treating a digestive system problem.
- Infection: Most endoscopies consist of an examination and biopsy, and risk of infection is low. The risk of infection increases when additional procedures are performed as part of your endoscopy. Most infections are minor and can be treated with antibiotics.
- Tearing of the gastrointestinal tract: A tear in your esophagus or another part of your upper digestive tract may require hospitalization, and sometimes surgery to repair it. The risk of this complication is very low.
- A reaction to sedation or anesthesia: Upper endoscopy is usually performed with sedation or anesthesia. The type of anesthesia or sedation depends on the person and the reason for the procedure.
Post-Endoscopy Care
After the endoscopy, you will be monitored until the sedation wears off. It’s normal to feel groggy or have mild throat discomfort if you had an upper endoscopy. Follow your doctor’s instructions for post-procedure care, which may include:
- Avoiding solid foods for a few hours
- Drinking plenty of fluids to rehydrate
- Refraining from alcohol and driving for at least 24 hours