How to prepare to a colonoscopy (Fortrans)?

The condition for the examination is proper preparation (purification) of the intestine. The preparation recommendations should be followed very carefully, as any deviations may result in the test not being performed or its reliability being narrow. In a small percentage of people preparing for colonoscopy, despite all the recommendations, the intestine is not completely cleansed and the whole procedure has to be repeated. Vaccination against hepatitis B is advisable but not obligatory before the examination. All available medical records and current results of the following tests must be presented prior to the examination:

• blood group (oryginal result)
• morphology
• coagulogram (PT/INR, APTT)

In addition to the above tests, for general anaesthesia, please provide:

• ionogram (K, Na)
• EKG (EKG please perform the EKG at least one day before the examination)

Patients who take anticoagulants such as acenocumarol (e. g. Sintrom), clopidogrel (e. g. Plavix), warfarin (e. g. Warfin), rivaroxaban (Xarelto), etc. should replace the drug with low molecular weight heparin (e. g. Clexane) at an appropriate time determined by the doctor before the examination. At least 8 days before the examination, the type, dosage and the appropriate moment of treatment change should be agreed with the physician in charge of the examination.

Diabetic patients should inform the colonoscopy laboratory before the examination in order to set the date of the examination in the morning. Oral iron preparations should be discontinued at least 7 days before the examination. 5 days before the examination, you should limit yourself to a non-residuous diet.  

Permitted are:

• meat and fish
• pasta, rice and white bread
• pudding, kissel and jelly
• water, coffee, tea and clear juices

You should refrain from accepting meals that contain any food at all:  

• Fresh fruit and vegetables (especially those containing small seeds, e. g. kiwi, strawberries, raspberries, tomatoes, which clog the colonoscope’s working canals and may make it completely impossible to perform the test)
• Breads with added grains, poppy seeds and spices (except finely ground)

Regardless of the time the test is performed.

You should completely stop eating any food about 20 hours before the planned examination. Fortrans is sold in pharmacies on prescription – the preparation should be purchased a week before the test. The Fortrans package contains four sachets, each of which should be dissolved in 1 liter of still water. On the day before the examination at On the 22nd you should start taking Fortrans. Drink half of the solution (2 liters) between 24:00 and 1:00. Drink the rest of the Fortrans preparation (the remaining 2 liters) on the day of the examination within 2-3 hours in divided portions so that you finish taking the preparation with a maximum volume of 250 ml 2 hours before the examination. Due to the fact that Fortrans causes abundant and expected diarrhea, when planning to take the drug, you should include travel to the Medispace Medical Center, so as to finish taking the preparation about an hour before leaving home.

The finished Fortrans solution can be cooled and seasoned with clear (seedless) lemon juice or other non-coloring fruit juice to improve the taste. The consequence of taking the Fortrans solution is numerous bowel movements, in the final period of preparation, with a clear liquid. In people with constipation and difficulties with bowel movements or people with a BMI over 30 or a total weight over 100 kg, it is recommended to drink an additional liter of non-carbonated water after drinking Fortrans.

The basic condition for performing a planned colonoscopy is to follow the recommendations related to the preparation of the intestine for the procedure and to remain on an empty stomach, i.e. not to consume food, thick liquids, coffee or tea for at least 20 hours. Before a planned colonoscopy procedure, you are allowed to drink water to avoid feeling thirsty up to 2 hours before the procedure. The last liquid (still water) can be taken 2 hours before the procedure in an amount not exceeding a glass (250 ml). The last portion of Fortrans should also be included in this volume.

Medication taken chronically should be taken with a glass of water (250 ml) no later than 2 hours before the procedure. As previously agreed with your doctor, you should stop taking any medications affecting the clotting system (such as acetylsalicylic acid, clopidogrel, warfarin, acenocumarol, dabigatran, rivaroxaban, etc. ) beforehand.  Diabetic patients should stop taking oral hypoglycemic drugs or insulin while on fasting (during the period without food, dense liquids, coffee and tea). For patients taking insulin on an insulin pump or using continuous glucose monitoring systems, insulin should be discontinued if blood glucose drops below 100 mg/dL. Patients with kidney failure or heart failure should discuss their individual preparation with their doctor, as this may vary from case to case.

In addition, you should refrain from smoking and chewing gum for 6 hours before the examination. The patient doesn’t have to take a change of clothes.

If it’s decided for you to have anaesthesia for the procedure, you will be asked to come 30 minutes in advance to fill in an anaesthetic questionnaire about your health (available for download in the tab – downloadable materials). A correctly completed questionnaire will allow the anaesthesiologist to assess the risks associated with anaesthesia and to adjust anaesthesia to the current state of health. Anaesthesia is designed to provide comfort and will be adjusted to the type of procedure and individual needs of the patient and the doctor performing the procedure. If you experience symptoms of upper respiratory tract infection or an increased body temperature before the procedure, you should report this fact by phone to the clinic. This is a contraindication to anesthesia.

Please be advised that for safety reasons, after anaesthesia you must not drive a motor vehicle until 24 hours after the examination and you must leave the clinic with a companion.

AFTER PROCEDURE YOU ARE OBLIGATED TO COME BACK SAFETLY WITH AN ADULT, RESPONSIBLE PERSON

IMPORTANT: If the patient has been referred for the procedure and is 55+ years old, has a BMI above 35 (kg/m²) or suffers from a serious comorbidities, he or she should consult with one of our specialists about the the possibility of surgery and anesthesia.

For inpatient anesthesiology consultation, please prepare:

• medical records of the patient’s chronic diseases and medications taken,
• basic laboratory test results from the last 2 months (CBC, sodium, potassium, creatinine, APTT, PT, INR);
• blood group result;
• ECG result from the last 2 months;
• in case of concomitant thyroid diseases – TSH, FT3, FT4 results from the last 2 months;
• for cardiac conditions such as ischemic heart disease, heart defects, cardiac arrhythmias – the result of ECHO-heart from the last 6 months and a certificate from the attending physician stating that the disease is in a stable state and does not require modification of treatment;
• in the case of neurological diseases – a certificate from the attending physician with information that the disease is in a stable state and does not require modification of treatment;
• in the case of taking anticoagulants (so-called “blood thinners”)
• a certificate from the attending physician with recommendations for the patient regarding the possible discontinuation of these drugs or switching to low-molecular-weight heparins

For teleconsultation, please send scans of the documents according to the above guidelines before the date of the anesthesiology consultation and deliver the originals on the day of anesthesia!

Please be advised that even a positive qualification by the anesthesiologist during the anesthesiology consultation is not a 100% guarantee that anesthesia will be performed on the day of the examination/procedure. The final decision to perform anesthesia is made by the anesthesiologist present on the day of the examination/procedure based on the patient’s current condition and compliance with the recommendations indicated at the consultation and general recommendations, especially regarding food consumption and post-anesthesia care.

ATTENTION: We kindly inform you that the condition for reserving an appointment for endoscopic examination with or without general anesthesia is payment of the total prepayment within 24 hours of booking. In case of payment by bank transfer, please send confirmation to:

kontakt@medispace.pl

The fee is non-refundable unless the Patient cancels the examination no less than 48 hours before. The account number below to which payment should be made. Please include the Patient’s name in the title of the transfer.

mBank: 59 1140 2062 0000 5673 5500 1001