Gastroscopy prep instruct 121002

WHAT TO DO BEFORE YOUR GASTROSCOPY

CONFIRMATION: is a must. Please call to confirm your appointment with us at least 5
days in advance. There will be a fee of $200.00 for any cancellation made within 3
business days prior to the procedure.

HEALTH CARD: Patients must present a valid Health Card at the time of the appointment
as per the Ministry of Health.
REFERRAL LETTER: All new patients must be referred to the Holly Street Clinic by a
doctor.

INFORMED CONSENT: Prior to your procedure you will be asked to sign the enclosed
Consent Form. Please read carefully. Feel free to ask us any questions and for more
information on informed consent, preparation, your procedure, or risks, please see our
website www.hollyendoscopy.ca.
SEDATION: If you choose to have sedation, YOU CANNOT DRIVE FOR 24 HOURS.
You must bring a responsible adult with you who can escort you home from the
clinic. We recommend they stay with you for the next 3-4 hours.
PREPARING YOUR BODY IN GENERAL:
If you are taking prescribed medications, please continue on those after the procedure:

1) Aspirin & Plavix should be stopped in advance of your examination, otherwise,
removal of polyps or biopsies may cause bleeding. Aspirin should be discontinued 7 days prior, Plavix discontinued 10 days prior to your procedure (both medications can be continued 4 days after your examination). Ibuprofen, Advil, Aleve, Entrophen should be stopped as well. If you have taken Gravol, notify the doctor before the procedure.
2) Coumadin (Warfarin) if you are on Coumadin, talk to your cardiologist about stopping
4 days prior to the exam and get an INR test done the afternoon before your
examination. Ask your lab to fax us the results by 8:00 am the following day (416)
486-7888. Do not schedule a Monday appointment for the colonoscopy.
3) Electrocardiogram (ECG) patients over the age of 65 requesting sedation must
bring an ECG with them to the appointment. If not available, please use the
enclosed Requisition Form to arrange an ECG with your family doctor.

4) If you have an (a) artificial heart valve or (b) artificial joint or another device that has
been implanted within the last 6 months, you must be on antibiotics before the
examination. We recommend that you obtain a prescription from your family physician
for Amoxicillin 2gms, which is to be taken 1 hour before the procedure (for any
question about taking antibiotics, please consult your cardiologist). If you have a
pacemaker, please remind us at the beginning of your examination.
5) If you are a diabetic on oral medication, please continue to take your mediation.
Make an early morning appointment. If you are an insulin dependant diabetic, please consult with your family physician regarding your insulin requirement.
6) Oral iron tablets oral iron preparation & arthritic medication (Vioxx & Naprosen) must
be discontinued one week prior to your examination. 7) If you use an inhaler or use nitroglycerin in any form, please bring it with you to your

Your Appointment is at __________on ________________________________________

Please be sure to arrive 20 minutes prior to your appointment.
GASTROSCOPY INSTRUCTIONS

THE RISKS
Complications can occur but are rare. There is a small risk of aspiration which is significantly
reduced by making sure you do not eat or drink anything six hours prior to the procedure.
Perforation of the esophagus is rare, but may happen if there is narrowing or a tumor of the
esophagus. Bleeding may occur from the site of biopsy or polyp removal. It is usually minimal but
rarely may require transfusions or surgery. When you go home, should the bleeding increase and
cause you concern, please call the Clinic. If the Clinic is closed, please go to your local
Emergency Department immediately.
THE DAY BEFORE YOUR APPOINTMENT
No alcohol 24 hours before the procedure.
For a morning procedure, nothing by mouth after midnight. For an afternoon procedure, nothing
by mouth after 6:00 am the morning of the procedure.
Please wear loose, comfortable clothing (e.g., track suit) to your appointment. Kindly remove nail
polish (will allow our medical staff to properly monitor vital signs during your procedure).
WHAT TO DO AFTER YOUR GASTROSCOPY
You will be able to resume your normal diet one hour after the endoscopy unless you are
instructed otherwise.

Source: http://www.hollyendoscopy.ca/assets/2012_fall/Gastroscopy%20Prep%20Instruct%20121002.pdf