Please present yourself at the Jewish General Hospital Endoscopy unit at Pavilion G, Room 304 (G-304) at 7:30 AM on _________________________
What is Video Capsule Endoscopy? This procedure involves ingesting a capsule (about the size of a large vitamin pill). The capsule will pass naturally through your digestive system while taking pictures of the intestine. The images are transmitted to the Sensor array, a series of wires and electrodes.. The Sensor Array is attached to a small data recorder which saves all the images. It is placed in a recorder belt which is worn around your waist. After 8 hours, you will return to the endoscopy unit to have the recorder belt removed. The capsule is disposable and will be excreted naturally in your bowel movement.
The day before the Capsule Endoscopy If you are diabetic and taking insulin, you must notify your endocrinologist or family doctor about modifying your diabetes medications before the procedure. If you are taking non-steroidal anti-inflammatory (e.g. Advil, Motrin, ibuprofen), iron or iron containing supplements, stop taking them 1 week prior to your scheduled capsule endoscopy.
1. The entire day before the procedure you will be on a clear liquid diet. This includes only: tea, coffee, clear broth soup, apple or white grape juice, soda, Jell-O (do not have red Jell-O), Gatorade or PowerAde 2. At 17:00, you will need to drink 2 liters of Golytely 3. Do not eat or drink anything after midnight.
The Day of the Capsule Endoscopy • Have nothing to eat or drink. • Do not take your regular medications the morning of the exam, but you may bring them with you. You will be able to take those 2 hours after you swallow the video capsule. • wear loose clothing
After ingesting the Capsule • Do not eat or drink anything for 2 hours after swallowing the capsule. After 2 hours, you will be able to drink clear liquids. After 4 hours, you may have a light lunch and continue drinking clear liquids throughout the procedure.
Capsule endoscopy lasts approximately 8 hours. You do not have to remain in the hospital during this time. Do not disconnect the equipment or remove the belt at any time during this period.
After ingesting the video capsule and until it is excreted, you should not be near any source of powerful electromagnetic fields such as one created near an MRI device or amateur (ham) radio. Occasionally, some images may be lost due to radio transmitter interference. On rare occasions this may result in the need to repeat the capsule endoscopy examination.
You will need to return to the Endoscopy Unit (G-304) 8 hours after ingestion of the capsule to have the equipment removed by the nurse. Removing the equipment should only take a few minutes.
After the examination is completed you may return to your normal diet. Contact your physician or the Endoscopy unit immediately if you suffer from any abdominal pain, nausea or vomiting during or after Capsule Endoscopy. Do not hesitate to call the Endoscopy unit with any questions you might have. The number is (514)-340-8222 ext. 5427 A full report will usually be available in 1 week. A copy will be forwarded to your physician. Please make a follow up appointment with your treating physician to discuss your results. Risks of Capsule Endoscopy Patients have not reported any pain or discomfort from the procedure. In rare cases, capsule retention can occur within the small bowel due to obstruction or narrowing. Patients with a history of prior gastrointestinal surgery or bowel obstruction are at an increased risk of capsule retention. In this case, surgery may be required for successful removal of the capsule. Patients with an implanted defibrillator or a pacemaker should not undergo capsule endoscopy.
Informed Consent I have read and understand the content of this form. I agree to undergo the video capsule endoscopy. ___________________________________ (Patient ____________________________________ (Witness ____________________________________ (Date)
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