COLONOSCOPY

Dr. Mandelbaum is extraordinarily experienced in performing colonoscopy and he has endoscopic skills that allow him to easily complete the most difficult procedures smoothly, safely and without discomfort.  

Colonoscopy involves inserting a flexible tube (scope) into the rectum and examining the lining of the colon. On the end of the scope is a tiny camera which projects images on monitors, enabling physicians to see the inside of the colon. As physicians steer the flexible tube through the colon, they are able to spot polyps and remove them with devices passed through the scope. Sedation is given to keep you comfortable. 

Most regular medications should be taken at your usual time (if in the morning) with a sip of water before you have the procedure.  This is particularly the case for blood pressure medication, medication for epilepsy and heart medications.  

DIABETES medications are different.  If you take pills for diabetes they SHOULD NOT be taken before the procedure.  Examples of diabetes pills include metformin, gliclazide, invokana, janumet,  jardiance and ozempic.  If you take insulin in the morning, you should take one half your regular insulin dose before the procedure.  

Blood thinning medication such as, apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana), rivaroxaban (Xarelto), warfarin (Coumadin) or Plavix are usually stopped prior to a colonoscopy with Dr. Mandelbaum to allow him to remove any polyps that might be there without risk of bleeding.   If Dr. Mandelbaum has not given you clear instructions at the time you agreed to the procedure please contact the office.

These risks include: perforation, bleeding, missing something important.  Perforation (puncture of the bowel) risk is 1 in 5000 if no polyps are removed and up to 1 in 1000 if polyps are removed.  Bleeding can occur (1 in 5000) if polpys are removed or if biopsies are taken. If the bleeding cannot be controlled, a blood transfusion may be necessary, and very rarely, surgery may be needed. There is a 1 in 500 risk of missing an important finding.

BOWEL PREPARATION

A good bowel preparation can save your life.

The colon must be cleaned out completely to ensure the best result for you. It is ESSENTIALthat the instructions for cleaning out the bowels are followed carefully. If your colon is not properly cleaned out, the test may need to be rescheduled. A full description of the preparation will be given to you on a separate sheet. 

Remember that you should only be consuming fluids on the day of the preparation.  No solid food that day.

Click here for the COLONOSCOPY PREP and INSTRUCTIONS

When you arrive at Scarborough General Hospital you need to check in at registration on the main floor by the entrance and then go to the endoscopy unit on the 3rd floor. In the endoscopy unit an intravenous will be started and then you will be placed on a stretcher and wheeled to the hallway outside the procedure room.  The anesthetist will meet you and review your history.  To begin the procedure monitors for your vital signs will be placed and you will be asked to turn onto your left side.  Please curl your legs up into a fetal position.  

The anesthetist will then begin giving you the sedative.  This medication can burn in the arm for a short period as it goes in.  We will then perform the colonoscopy.  This portion takes about 20 minutes and most people do not remember having the tube inside at all.  Many wake up wondering if the procedure was actually done.

During the procedure small samples (biopsies) may be taken and polyps may be removed. These will be sent to the laboratory for examination by the pathologist over the next week. 

Dr. Mandelbaum will speak with you once you are awake in the recovery room to give you results.  

At this time, we will make a plan for follow up.

The nurses will then prepare you for discharge.  You will be in the recovery area for about 45 to 60 minutes while the sedation wears off.

If you have sedation, you must have a responsible adult to drive you home or accompany you in a taxi. We do not allow you to go home by public transport or to take a taxi on your own. You cannot drive or operate dangerous machinery or go back to work that day. You should avoid making important decisions during this period.  The following day you are fit to return to all usual activities.

All medications you regularly take can be resumed once you are discharged.

The effects of the sedation can last for the rest of the day leaving you feeling drowsy. During this time you should avoid alcohol. Some people feel a bit bloated from the introduced air.  

You should not have any pain after discharge from the endoscopy unit.  If you have abdominal pain, fever or nausea/vomiting you should go to the nearest emergency department.