How to Get Ready for Your Colonoscopy or Flexible Sigmoidoscopy for Ileostomy Patients

This resource will help you get ready for your colonoscopy or flexible sigmoidoscopy (sig-MOYDOS-koh-pee) if you have an ileostomy.

• A colonoscopy is an exam of your colon (large intestine).
• A flexible sigmoidoscopy is an exam of your rectum and lower colon.

A gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist) will do your procedure. A gastroenterologist is a doctor with special training in treating problems with digestion. They’re also called a GI specialist.

Your GI specialist will use a scope during your procedure. A scope is a flexible tube with a camera on the end. They will use either:

• A colonoscope to see inside and take photos of your colon during your colonoscopy.
• A sigmoidoscope to see inside and take photos of your rectum and lower colon during your flexible sigmoidoscopy.

The images will appear on a video screen during your procedure. During your procedure, your GI specialist can take a biopsy (small sample tissue) for testing. They can also remove a polyp (growth of tissue).

What to do 1 week before your procedure

Ask about your medicines

You may need to stop taking some of your usual medicines before your procedure. Or, you may need to take a different dose (amount) than usual. Talk with your healthcare provider about how to take your medicines before your procedure. Do not change how you take your medicines without talking with a healthcare provider.

This section lists some examples of medicines, but there are many others. Make sure your care team knows all the prescription medicines, over-the-counter medicines, and dietary supplements you take. A prescription medicine is one you can only get with a prescription from a healthcare provider. An over-the-counter medicine is one you can buy without a prescription.

‌It’s very important to take your medicines and supplements the right way in the days before your procedure. If you don’t, we may need to reschedule your procedure.

Anticoagulants (blood thinners)

Blood thinners are medicines that affect the way your blood clots. You may be taking a blood thinner to treat blood clots or to prevent a heart attack or stroke. If so, ask the doctor who prescribes it for you when to stop taking it.

Medicines for diabetes

If you take insulin or other medicines for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medicine what to do the day before and the morning of your procedure.

Do not take these medicines the day before or the day of your procedure:

• Metformin, such as Glucophage® or Glumetza®.
• Medicine that contains metformin, such as Janumet®.

It’s important to tell your healthcare provider if you take a GLP-1 medicine. You must follow special eating and drinking instructions before your surgery or procedure. It is very important to follow these instructions. If you do not follow them, your surgery or procedure may be delayed or canceled.

• Follow a clear liquid diet the day before your surgery or procedure. Do not eat any solid food. Read the “Follow a clear liquid diet” section of this resource to learn more.
• Stop drinking 8 hours before your arrival time. Do not eat or drink anything after this time, including clear liquids. You can have small sips of water with your medicines.

Here are some examples of GLP-1 medicines. There are others, so be sure your care team knows all the medicines you take. Sometimes, these are prescribed to help manage diabetes or other conditions. Other times, they are prescribed for weight loss.

Get a letter from your doctor, if needed

A clearance letter is a letter from your doctor that says it’s safe for you to have a procedure. You may need to get one or more clearance letters before your procedure. Your MSK healthcare provider will tell you if you do. They must have your clearance letter at least 1 day before your procedure.

Clearance letter for an automatic implantable cardioverter-defibrillator (AICD)

Tell your MSK healthcare provider if you have an automatic implantable cardioverter defibrillator (AICD). You’ll need a clearance letter from your cardiologist (heart doctor).

Clearance letter for other symptoms

You may need a clearance letter from a doctor if you’ve had any of these during the last 6 weeks:

• Chest pain.
• Trouble breathing that’s new or has gotten worse.
• Fainting.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

Buy supplies

• 1 saline enema (such as Fleet® enema). You can buy this without a prescription at your local pharmacy.
• Clear liquids.
• Petroleum jelly (Vaseline®) or A & D® ointment.

What to do 5 days before your procedure

Stop taking oral iron supplements

If you take an oral (by mouth) iron supplement or multivitamin with iron, stop taking it 5 days before your procedure. Iron supplements can cause color changes in your stool. This can make it harder for your doctor to see your colon clearly.

What to do 3 days before your procedure

Talk with an endoscopy nurse

A few days before your procedure, you’ll get a call from an endoscopy nurse between 8 a.m. and 6 p.m. They’ll review the instructions in this guide with you and ask you questions about your health history. The nurse will also review your medicines and tell you which ones to take the morning of your procedure.

What to do the day before your procedure

Starting the day before your procedure, do not eat anything. Follow a clear liquid diet.

Follow a clear liquid diet

Follow a clear liquid diet the day before your procedure. You can find examples in the “Clear liquid diet” table.

• Do not eat any solid foods.
• Try to drink at least 1 (8-ounce) cup of clear liquid every hour you’re awake.
• Drink different types of clear liquids. Do not just drink water, coffee, and tea.
• Do not drink any liquids you can’t see through, such as milk or smoothies.

How to follow a clear liquid diet if you have diabetes

Ask the healthcare provider who manages your diabetes:

• What to do while you’re following a clear liquid diet.
• If you need to change your dose of insulin or other diabetes medicine, if you take them.
• If you should drink sugar-free clear liquids.

Check your blood sugar level often while you’re following a clear liquid diet. If you have questions, talk with your healthcare provider.

Note the time of your procedure

A staff member will call you after noon (12 p.m.) the day before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to get to the hospital for your procedure. They’ll also remind you where to go.

If you need to cancel your procedure, call the GI scheduling office at 212-639-5020.

What to do the day of your procedure

Instructions for drinking

If you take a GLP-1 medicine, stop drinking all clear liquids 8 hours before your arrival time.

If you do not take a GLP-1 medicine, stop drinking all clear liquids 4 hours before your arrival time.

Do not eat or drink anything 8 hours before arrival

Start the enema at least 1 to 2 hours before your scheduled arrival time. This may be early in the morning. Follow the steps below.

• If you have chronic kidney disease, empty the fleets enema before using it. Fill it with room temperature tap water instead.
• Take only the medicines your healthcare provider told you to take the morning of your procedure. Take them with a few sips of water.
• Do not put on any lotion, cream, powder, makeup, perfume, or cologne.
• Remove any jewelry, including body piercings.
• Leave valuable objects (such as credit cards and jewelry) at home.
• If you wear contact lenses, wear your glasses instead.
• If you wear dentures, you’ll need to remove them before you go into the procedure room. You can put them in a denture cup and place them in a bag with your clothes.

What to bring

• A list of the medicine you take at home, including patches and creams.
• Your rescue inhaler (such as albuterol for asthma), if you have one.
• A case for your glasses.
• Your Health Care Proxy form, if you have completed one.
• A new ileostomy bag and wafer to replace after the procedure.

Your procedure will take place at one of these locations:

David H. Koch Center
530 East 74^th Street
New York, NY 10021

Take the elevator to the 8^th floor.

Surgery and Procedural Center at Memorial Hospital (MSK’s main hospital)
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065

Take the B elevator to the 2^nd floor. Turn right and enter the Surgery and Procedural Center (Endoscopy Suite) through the glass doors.

MSK Monmouth
480 Red Hill Road
Middletown, NJ 07748

Visit www.msk.org/parking for parking information and directions to all MSK locations.

What to expect when you arrive

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or similar names may be having a procedure on the same day.

When it’s time for your procedure, you will get a hospital gown to and non-skid socks to wear.

During your procedure

A staff member will bring you into the procedure room on a stretcher. Your healthcare provider will set up equipment to monitor your heart, breathing, and blood pressure. You’ll get oxygen through a thin tube that rests below your nose.

You’ll get anesthesia through your IV, which will make you fall asleep. Once you’re asleep, your doctor will examine your colon. They’ll use a scope to see the inside of your rectum and the end of your colon. Your doctor will take biopsies if needed.

After your procedure

In the Post-Anesthesia Care Unit (PACU)

You’ll be in the PACU when you wake up after your procedure. A nurse will be keeping track of your temperature, pulse, and blood pressure. Your nurse will explain your discharge instructions to you before you go home.

At home

• Don’t drink alcohol for 24 hours (1 day) after your procedure.
• You might have a little bleeding during your bowel movements. This may last for up to 24 hours after your procedure.

When to call your healthcare provider

Call you healthcare provider if you have any of the following:

• A fever of 101 °F (38.3 °C) or higher.
• Chest pain or shortness of breath (trouble breathing).
• Severe pain, hardness, or swelling in your abdomen (belly).
• Bleeding from your rectum that lasts more than 24 hours.
• Feeling weak, faint, or both.
• Any other questions or concerns.