How to prepare for your combined upper gastro-intestinal (GI) endoscopy and colonoscopy – Picolax preparation

This leaflet tells you how to prepare for your combined upper gastro-intestinal (GI) endoscopy and colonoscopy examination (a camera which is passed into your stomach or bowels in a thin flexible tube) and how to use Picolax (a drink which helps to empty your bowels).

If you are taking Warfarin or any other blood thinning drugs, you must continue to take these. You should contact the Endoscopy Unit if you need any advice regarding your medication.

Do not stop taking any of the drugs listed below, if you have been told you have:

• A condition called Barrett’s Oesophagus and you are having an endoscopy as part of the relevant surveillance programme.
• A stomach ulcer and are having an endoscopy to check if your ulcer has healed.
• Oesophagitis and are having an endoscopy to check that it has healed.

The same applies if your Consultant has specifically asked you not to stop these medications before your procedure.

In any other case, you must stop taking the below medication 10 days before your upper GI endoscopy. If your appointment is within the next 10 days, stop taking them now.

Famotidine
Cimetidine (Tagamet)
Lansoprazole (Zoton)
Pantoprazole (Protium)
Nizatidine (Axid)
Famotidine (Pepcid)
Omeprazole (Losec)
Nexium (Esomeprazole)
Pariet (Rabeprazole)

You must follow the special low residue diet set out in this leaflet and take the Senokot laxatives and both sachets of Picolax.

Before taking Picolax

Please read the back of the Picolax packet and contact nursing staff in the Endoscopy Unit for further advice if you answer yes to any of the following questions:

• Are you allergic to any of the ingredients listed on the packet?
• Are you taking Clopidogrel?
• Are you taking Rivaroxaban?
• Are you taking Apixaban?
• Are you taking Dabigatran?
• Are you taking any other medication to thin your blood?
• Are you pregnant or breast feeding?
• Are you a diabetic on insulin or tablets?
• Do you suffer from any kidney disease?

If you are taking aspirin, you cancontinue to take this.

If you have diabetes, you must contact your GP or Diabetic liaison nurse for advice or the Endoscopy Unit where you have your appointment (see contact numbers).

7 days before your appointment

Stop taking any iron tablets. Iron makes everything inside your bowel black, making it difficult for your endoscopist (a doctor or nurse trained to do endoscopies) to see anything.

4 days before your appointment

Stop taking any drugs that may cause you to become constipated (unable to open your bowels), for example, Lomotil, Loperamide or codeine phosphate, but continue to take all other usual medications.

3 days before your appointment

You must drink between 250mls and 300mls (an average size mug full) of drink from the diet list every hour (while you are awake) over the 3 day preparation period. If you do this your bowel will be empty, clean and ready for your colonoscopy or flexible sigmoidoscopy examination.

2 days before your appointment

If you are taking Fybogel or any other fibre products stop taking them now. The fibre content of these products will work against the special diet you are about to take. Start your diet at breakfast.

Eat freely from the foods in the diet list below unless you are allergic to, or have been advised to avoid, certain foods.

Do not eat any foods or have any drinks that are not on the diet list.

Diet list

No milk in any form

Drinks: Water is preferred, however, you can also drink black tea or coffee, fizzy drinks, fruit squash not blackcurrant (not real fruit juice), Marmite, Oxo, Bovril, soda water.

Meat: Lean meat, for example, chicken, turkey, beef, and ham.

Fish: White fish only (do not fry).

Eggs: Boiled, poached or scrambled only, no milk to be used.

Potatoes: You must only have boiled or mashed, no milk to be used. You must not eat any other vegetables.

Pasta and rice: White, only boiled. No wholemeal varieties.

Bread: White bread and white bread rolls only.

Fats: A daily allowance of 25g (approx. 1oz) butter or margarine.

Other: Plain jelly, rich tea biscuits, honey, golden syrup, white sugar, artificial sweeteners, boiled sweets and salt.

1 day before your appointment

2.00pm: Take 4 Senokot tablets.

No more food to be taken after this time until after your examination.

Continue to follow the instructions given earlier and only eat and drink from this diet list.

Drink between 250mls and 300mls of drink from the diet list every hour (throughout the daytime).

5.00pm: Dissolve the first sachet of Picolax in 500mls (1 pint) of water. This can be prepared in advance, flavoured with fruit squash (not fruit juice) and stored in the fridge. Drink all of this mixture.

Make sure you are within easy reach of the toilet once you have taken the Picolax. Be prepared to have your bowels opened several times during the late afternoon and early evening. It will be like having diarrhoea (very loose watery bowel motions).

Common effects of Picolax are:

• nausea (feeling sick)
• vomiting (being sick)
• bloating
• abdominal pain
• anal irritation (itchy opening to your back passage)
• disturbed sleep.

It is normal to suffer from any of the symptoms above. However, if any of these symptoms become severe you should telephone the unit where you are to have your examination or you should contact the GP Out of Hours Service (see contact numbers).

You should have at least 250mls to 300mls of drink from the diet list every hour (throughout the day) to prevent yourself from becoming dehydrated.

Diarrhoea and severe vomiting may cause your body to become dehydrated.

Symptoms of dehydration are:

• dizziness
• headache
• confusion.

If you develop any of these symptoms you must contact your GP or the Accident and Emergency Department (see contact numbers).

If you develop a rash, your body becomes itchy or you have any redness or swelling in any part of your body you must attend the Accident and Emergency Department (see contact numbers) as you may be allergic to the Picolax.

On the day of your appointment

6.00am to 7.00am: Dissolve the 2nd sachet of Picolax in 500mls (1 pint) of water. Drink all of this mixture even if you have already had your bowels opened several times. If you have an early morning appointment you can drink the mixture between

5.00am to 6.00am.

You should continue to have at least 250mls to 300mls of drink from the above diet list every hour (throughout the day) to prevent yourself from becoming dehydrated.

You must not have anything to eat until after your colonoscopy or flexible sigmoidoscopy. Please continue to drink clear fluids up to your appointment time.

Before your examination you must:

• not smoke
• tie back long hair for comfort
• remove any nail varnish
• remove any make-up
• remove all jewellery except your wedding ring
• wear loose-fitting clothing.

Please do not bring any valuables with you.

If you are not sure about how to prepare for your colonoscopy or flexible sigmoidoscopy, please contact your Endoscopy Unit for advice.

Contact numbers

University Hospital of North Tees

Endoscopy Unit

Telephone: 01642 624387

Monday to Saturday 8am to 7pm

University Hospital of Hartlepool

Rutherford Morrison Unit

Telephone: 01429 522356

Monday to Friday 8am to 6.30pm

If you have any worries or concerns you should contact your GP during normal surgery hours. Outside surgery hours you should contact your GP’s surgery for the out of hours service number.

Further information is available from:

NHS Choices

Telephone: 111 (when it is less urgent than 999)

Calls to this number are free from a landline and mobile phones

via the website at www.nhs.uk

Comments, concerns, compliments or complaints

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We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

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Telephone: 01642 617617

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Telephone: 01642 383551

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Leaflet feedback

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