Pouchoscopy Prep Question - Can do without laxative?

Yes. I do liquids the day before and tap water enemas until clear before leaving the house. 

Jan

I'm with Jan. I consider the laxatives to be abusive for a pouchoscopy. If the drive is really long, though, the procedure might go better if you add a tap water enema or two after arriving. I know this is difficult, unpleasant, and risky, but it will also clean out your pouch at the right time. 

Those laxative preps follow "one size fits all." Before and after my colectomy, I've vomited the preparatory laxative solution several times. The volume of liquid required is usually waaay too large for my stomach.

I understand now that I'm a tall guy with a small stomach. Hard lesson.

At a certain point in experience you inevitably make calls on your own.

Hello, Teddy92.

I am scheduled for endoscopy appointments every six months. My prep for pouch scopes and previously for colonoscopy procedures:  Soft foods three or four days in advance, such as fish, egg, tofu. Foods that are easily digested and pass through cleanly. No red meat, or seeds or grains, no corn or peas, no insoluable food.  Twenty four hours before the procedure I have only clear liquids and clear broth. No cranberry juice or anything with colour. I bring a thermos of warm broth so I can have something to drink right after the procedure when I am usually loopy and tired (I always ask to be sedated for endoscopy or any procedures happening back there!) I try to ease back into solid food afterward. Good luck. I hope your results are clear.

Wow.  If I recall, for pouchoscopy, Dr. Shen/Dr. Remzi at Cleveland Clinic basically said don't eat drink after midnight. (period)    My memory may be foggy though.  

Thank you all so much for the kindness and helpful info! I'll try and do just fluids 24 hours prior to the procedure and will bring an enema bottle to the hospital in case I think it'll help to clear things further before the procedure.

Winterberry, is there a reason you try to ease back into food? I was hoping to eat a normal full meal to help my empty stomach after the procedure!

Skipping the enema is best reserved for when your doctor is on-board with that approach. The procedure will take longer, and if he's impatient he won't get a look at everything. 

I never have sedation and always stop somewhere for lunch on the way home. I have no need to ease into food. 

Jan

I always have my pouchoscopy under sedation, no food from midnight the night before, with a fleet enema after check in for the procedure. Fleet enema works pretty quick and usually done within an hour of being wheeled in.

Hi, Teddy92,

i ease back into solid food after the endoscopy because I've spent a few days slowly emptying my stomach and pouch, and 24 hours pre-scope have only liquids, so I want to help my empty stomach and pouch accept the food without cramps or diarrhea. I start with sips of warm broth when I'm fully awake (I always ask for sedation) then I go home and have rice, pasta or chicken for lunch, although as soon as I'm awake the nurses offer juice and a cookie. Every patient is offered that whether they were sedated or not because of the recent fasting or enema to bring blood sugar back up. I've had three scopes since colon removal a year ago (including the pouchoscopy in preparation for takedown) and 25 years of sedated colonoscopies so I developed this routine that is easy on my stomach, and pouch. Once, I was hungry and we had a big lunch. I was sorry a few hours later with cramps and loose output that I could have avoided. Whatever you decide is best for you, remember to have fluids afterward to replace whatever you lost through enema or food slowdown. 

Winterberry (and all), thank you again! I'm a little nervous for this pouchoscopy; prep of any sort has never been easy for me, but I know it's an important test. I hope you all are doing well, and if anything interesting turns up from my test, I'm happy to share!

I haven't had a scope done since my post op scope in 2008. so I'm seeing a different doc. he has me on liquids for 2 days. laxatives the nite before. plus a fleet enema the morning of. and instead of air, uses water during the scope. Is this common?  I tend to have low blood pressure and dehydrate easily.  and my bowels are normally watery. I'm worried about all this. my score is in 2 days. please reply

Deb, this is more prep than most of us go through for pouchoscopy. Clear liquids the day before and a couple of tap water enemas (until clear) on the morning of the procedure is usually sufficient for most purposes. Did you get these instructions directly from the doctor or from some other staff member? They often don't have pouchoscopy-specific instructions prepared, so the staff will say all kinds of things. 

directly from the Dr

in gonna try the instructions as directed from Dr. but my blood pressure drops to about 90/63 while in sleeping.  I look to be in the ER by the morning of the prep tho

I'm sorry, Deb. I hope it goes okay, and I hope you find a better doctor. 

My Dr has me liquids the day before and half a small bottle of miralax with 32 oz g2. He uses water to clear his view if needed. 

I fast for two days prior to the pouchoscopy just having clear fluids, broths, jello, ect.  Apple juice acts on me like a like a Strong laxative.  The night before I drink some apple juice and after many trips to the bathroom I am then ready for the test.  I never drink apple juice unless I am prepping for a scope.....lol

I've never had to do any prep for a scope.

I never had anything before a pouchoscopy before. Always meet up and the doctor just goes through with it.

You two are lucky!!!! I always have to use some sort of laxatives. Magnesium Citrate- two bottles! YUCKKKKK!!!!

Wow!  If I did that I would end up in the hospital and not for the test!  I would need to have I.v. Fluids.  My pouch doesn’t know when to stop!

Be careful of "one size fits all" scope directions, as most GI offices draft  stock instructions for colonoscopies . 2 bottles of magnesium citrate is a colonoscopy prep. My doctor does like laxatives for a pouch prep- usually half a 10 ounce bottle of Mag Citrate is enough. But I also do a Fleet enema. You can probably get away with doing no laxatives if you drink clear liquids for a long enough time.

I am too scared to do enemas, I am afraid I might hit something, that is why I stick to Mag citrate bottles

I go to Cleveland Clinic and my surgeon has always told me no real prep.  I don't feel comfortable with that so I just don't eat in the morning.  She then has me do 2 fleet enemas and goes from there.  Super easy!  I'm not sure why all the prep.  Our pouches should be empty fairly quickly.

I am currently prepping as well 2 days prior. Pouchoscopy is on Tuesday and I started clear liquids today, Sunday (soup, powerade zero, Popsicles, apple juice and grape juice). I agree with what some are saying our pouches sometimes get left out in the prep work we are sent and i don't want to wreak havoc on my pouch so I think by doing the few days of liquid will help ensure I am cleared and cleaned by the time I go in without laxative.

I am prepping for my endoscopic balloon dilation tomorrow and just downed a 10 ounces bottle of Magnesium Citrate.  It always amazes me that I am able to get the entire bottle down without vomiting.  I always do it but I always have a sickening aftertaste in my mouth that doesn't go away for a long while.  But I never puked from it.  Any of you guys ever puke from Mag Citrate?

I will post in the EBD thread after the procedure and results are back.

Just had the procedure yesterday with . Dr Bo Shen's at Columbia.  

prep was clear liquids day prior and 1 bottle of Miralaxpowder (Polyethylene Glycol : 238 gmsor 8.5 oz.) mixed with 64 oz. bottle of Gatorade.  Drink 8 oz every 10-15 starting 6pm the night before, and plenty of clear liquids during prep. Then nothing by mouth 6 hrs before procedure.

This was also a component of the bowel prep prior to surgery with Dr. Kiran.

As someone who has suffered greatly with various prep methods in the past, I found it remarkably easy, especially for the pouchoscopy  

but as others have noted:  prep should be agreed upon by the endoscopist beforehand  

I just eat a low residue diet 2 days before and drink apple juice and clear fluids the day before and I’m good to go!

@AMB posted:

Just had the procedure yesterday with . Dr Bo Shen's at Columbia.  

prep was clear liquids day prior and 1 bottle of Miralaxpowder (Polyethylene Glycol : 238 gmsor 8.5 oz.) mixed with 64 oz. bottle of Gatorade.  Drink 8 oz every 10-15 starting 6pm the night before, and plenty of clear liquids during prep. Then nothing by mouth 6 hrs before procedure.

This was also a component of the bowel prep prior to surgery with Dr. Kiran.

As someone who has suffered greatly with various prep methods in the past, I found it remarkably easy, especially for the pouchoscopy  

but as others have noted:  prep should be agreed upon by the endoscopist beforehand  

Hey AMB,

How did it go with Shen? Did you have the banding?

Regarding the prep, I had the same with Shen which was way more than my local surgeon. I think it depends on what they plan to do during the scope. If they’re going to band and/or treat a sinus tract with needle knife than they probably want things a bit cleaner. Hence the laxative.

@Jan Dollar how do you get any type of scope done if you don't get sedated? I'm just curious because I need to be sedated for any procedure.

Sadie, I guess it is all quite individual. I don’t have anal strictures that would cause pain. My scopes are never long so the discomfort is tolerable for me.

Jan

@Jan Dollar thank you for sharing.  I guess that would make sense. 

@Pouch2021,

Procedure went well, Pouch in great shape except for a prolapse. The banding will happen after additional tests: barium defecogram and manometry.  Apparently this is to help evaluate the mechanics issue and identify where to band and also rule out significant functional problems for which they typically order biofeedback. I will skip any biofeedback because I think I have the straining under control and it is not practical for me because of distance.

In addition to the prep,  they put me out with propofol for the scope. He takes a biopsy during the procedure and tests for prolapse using air to emulate straining. Perhaps the prep and sedation are to allow for that evaluation. I'm curious about it, and will ask when I'm there next.

I think this review will help everyone

https://www.j-pouch.org/topic/...ntly-asked-questions

@AMB posted:

@Pouch2021,

Procedure went well, Pouch in great shape except for a prolapse. The banding will happen after additional tests: barium defecogram and manometry.  Apparently this is to help evaluate the mechanics issue and identify where to band and also rule out significant functional problems for which they typically order biofeedback. I will skip any biofeedback because I think I have the straining under control and it is not practical for me because of distance.

In addition to the prep,  they put me out with propofol for the scope. He takes a biopsy during the procedure and tests for prolapse using air to emulate straining. Perhaps the prep and sedation are to allow for that evaluation. I'm curious about it, and will ask when I'm there next.

https://www.j-pouch.org/topic/...ntly-asked-questions

This study might be the reason why the prep procedures are changing. I am given the option to fast from noon the day before, or have fleet enemas before the procedure. I pick fasting, because Fleet enemas burn my pouch really bad, so I believe they are irritating the pouch mucosa.

https://plu.mx/mtsinai/a/0q2N_...JZVekNIGhoDczMUvLAQ/

There is a third option which is emptying the Fleet bottle and substituting bottled water as mentioned above. I think Fleet enemas are harsh for most J Pouches, but enemas are important to flush out the pouch and should not be completely overlooked.

Tap water enemas before the procedure are quite helpful for rinsing off the pouch interior. I would never use the Fleet solution, but the bottles it comes in are very handy.