Dr Sunil P Kaushik MBBS (Hons, UNSW), FAMS, FRACP

Dr Sunil P Kaushik MBBS (Hons, UNSW), FAMS, FRACP Gastroenterologist West Coast Endoscopy Centre 1/32 Pimlico Place Tel: (08) 9301 4437 Joondalup WA 6027 Fax: (08) 9301 4438 CAPSULE ENDOSCOPY

Dear Patient

Following your recent Endoscopy and Colonoscopy procedures, it has been recommended that you have a Capsule Endoscopy.

We have enclosed information regarding the Capsule and the preparation required for you to read through.

Capsule Endoscopy is done by our Endoscopy Nurse at the following site:

West Coast Endoscopy Centre, Unit 1/32 Pimlico Place, JOONDALUP. WA 6027

You will need to attend an early morning appointment and then return to the rooms at 4.00 pm on the same day to have the belt and data recorder removed and downloaded onto the computer.

CAPSULE FEES –PAYMENT OPTIONS IF THE FULL AMOUNT IS PAID ON THE DAY Full Amount $2210.00 Medicare Rebate $1960.00 Out of pocket $250.00

IF GAP ONLY IS PAID ON THE DAY Full cost of Capsule Endoscopy $2235.00 Medicare Rebate $1960.00 Gap to be paid on the day $275.00

Please note that Capsule Endoscopy should be done within 12 months of your Endoscopy and Colonoscopy.

Please note that iron tablets/liquid need to be stopped 10 days before the procedure.

If you wish to go ahead with Capsule Endoscopy, please complete and return the Pre Admission Form to the West Coast Endoscopy Centre and we will then contact you to arrange an appointment.

If you do not wish to go ahead, please contact my rooms and let my staff know.

All enquiries should be made to 9301 4437

West Coast Endoscopy Centre Capsule Endoscopy Patient Instructions

ISO 9001:2008 certified core standards of safety & quality in healthcare. WA licensed class A Day Hospital - Location – M:\Med\gswcommon Dr Sunil P Kaushik MBBS (Hons, UNSW), FAMS, FRACP Gastroenterologist West Coast Endoscopy Centre 1/32 Pimlico Place Tel: (08) 9301 4437 Joondalup WA 6027 Fax: (08) 9301 4438 As part of your medical management it has been recommended that you have a Capsule Endoscopy. This is an outpatient procedure performed from my office. Capsule Endoscopy gives information that no other procedure can. It is designed to view the small intestine and is not reliable for viewing the oesophagus or stomach. You are required to go through a special diet, take a small amount of bowel cleansing liquid and then swallow a small pill- shaped video camera that passes through your digestive system taking pictures as it goes. Images are transmitted via a belt around your waist and images are saved in the Data recorder. You must return to the office 7-8 hours later to have the images transferred to a computer for analysis.

The capsule is excreted naturally in your bowel movements. In 0.75-5% of cases it may not be excreted and may require removal by an endoscope or operation. Most of the time failure to excrete the capsule is because of a disease process narrowing the intestine.

Please read these instructions very carefully. You will need to purchase 2 sachets of Picosalax (available from west coast endoscopy centre or any chemist).

Iron Tablets/Iron Injections Please note that iron tablets/liquids need to be stopped ten days before the procedure. You may continue with iron injections.

Diabetics (As a general guide, you may follow these instructions.) Tablets: Do not take your diabetic medication the night before and the day of your procedure. Take your tablets to the hospital with you. Insulin: Take half your normal dose the night before, check levels in the morning, if TOO LOW- Drink apple juice, if TOO HIGH – take half your insulin. Take your insulin to the hospital with you. If you have concerns, discuss this with your doctor.

The day before Capsule Endoscopy 1. After lunch the day before – start a clear liquid diet i.e. soup, jelly (not red, orange or purple), tea/coffee without milk and plenty of water. 2. At 5.00-6.00 pm take one sachet of Picosalax which you can buy over the counter. Drink 3 glasses of water. 3. At 8.00 p.m. take the second sachet of Picosalax and drink 3 glasses of water. Any medications can be taken up to 10.00 p.m. 4. Remain Nil by Mouth from 11.00 pm until the procedure. 5. No smoking for 24 hours before Capsule Endoscopy.

The day of Capsule Endoscopy 1. Arrive at West Coast Endoscopy Centre in loose fitting 2-piece clothing. 2. You will have a pre-procedure interview with the Practice Nurse and will be checked-in, asked for informed consent and be instructed on what to do during the study.

ISO 9001:2008 certified core standards of safety & quality in healthcare. WA licensed class A Day Hospital - Location – M:\Med\gswcommon Dr Sunil P Kaushik MBBS (Hons, UNSW), FAMS, FRACP Gastroenterologist West Coast Endoscopy Centre 1/32 Pimlico Place Tel: (08) 9301 4437 Joondalup WA 6027 Fax: (08) 9301 4438 3. The Sensor belt will be applied to your abdomen and will be connected to the data recorder, which is worn around your waist. 4. You will then be asked to swallow the capsule.

After swallowing the capsule

1. Do not drink for at least 2 hours. You may have a light snack after 4 hours and take normal medications at that time. You can return to your normal diet after the study is complete. 2. You cannot have an MRI scan until the capsule is excreted. 3. You should stay away from electromagnetic fields e.g. amateur radio or stand next to another patient having a Capsule study. Mobile phones are OK. 4. Do not disconnect the belt at any time but may loosen it to go to the toilet. 5. Do not get the Data Recorder or Sensor belt wet. Do not expose it to direct sunlight. Treat it carefully as it is a small computer, essential to your examination. 6. No strenuous physical activity during the study and do not bend over or stoop during the study. 7. Check that the blue light is still flashing.

After the Capsule Endoscopy Study

1. Return to the office at the set time for removal of the equipment. If we have asked you to remove the equipment, you will be given separate instructions. 2. Try to verify excretion of the capsule. If you cannot verify excretion of the capsule you may need to have an abdominal X-ray to verify excretion. If you develop abdominal pain, nausea or vomiting, contact my office or practice nurse as soon as possible. If unable to contact either of us, report to an Emergency Department for an abdominal X-ray and ask staff to contact me. 3. Do not undergo an MRI scan until excretion is completed and confirmed. 4. A report will be sent back to your referring doctor for further management. This will take between 6-8 weeks.

Please record your height in cm and weight in kg and record them below.

Height: ……………………………

Weight: ………………………….

CAPSULE ENDOSCOPY PRE ADMISSION FORM – Please complete and return to the above address. All enquiries should be made to 9301 4437.

Name: Address:

ISO 9001:2008 certified core standards of safety & quality in healthcare. WA licensed class A Day Hospital - Location – M:\Med\gswcommon Dr Sunil P Kaushik MBBS (Hons, UNSW), FAMS, FRACP Gastroenterologist West Coast Endoscopy Centre 1/32 Pimlico Place Tel: (08) 9301 4437 Joondalup WA 6027 Fax: (08) 9301 4438 Tel No: Date of Birth: Medicare No: Ref No: Expiry date: Please complete the following: (In Metric) Height: (m) Weight: (kg) Waist Size: (cm)

MEDICAL/SURGICAL HISTORY Do you have a bowel obstruction? Yes/No Have you had bowel or intestinal surgery? Yes/No If so, what type of surgery: Any complications? Have you had abdominal radiation therapy? Yes/No Have you previously had a Capsule Endoscopy or swallowed any other ingestible device? Yes/No Have you had any swallowing difficulty? Yes/No Do you take insulin? (dose: ) Yes/No Have you ever taken NSAIDS such as Voltaren, Indocid, Naprosyn, Feldene or Aspirin for more than 30 days? Yes/No Are you taking Vioxx or Celebrex? Yes/No Do you have a history of Crohn’s Disease? Yes/No Do you have a Pacemaker: Yes/No A YES answer to any of the above questions should be brought to Dr Kaushik’s attention. Have you seen Dr Kaushik before? When PLEASE READ THE FOLLOWING: Iron tablets should be stopped ten days before the Capsule Endoscopy. Capsule Endoscopy is contraindicated in patients with bowel obstruction, pregnancy, and in patients with a pacemaker or defibrillator. You should fast for 8 hours before the Capsule and for 2 hours after swallowing the Capsule. You may then eat a light meal 4 hours after swallowing the capsule. Please read through the preparation information sheet and follow the instructions carefully. You will have to wear a belt for 8 hours and return to the office later in the day to have the belt removed. Do not have an MRI during capsule procedure. Bring any abdominal X-rays taken within the last year with you.

ISO 9001:2008 certified core standards of safety & quality in healthcare. WA licensed class A Day Hospital - Location – M:\Med\gswcommon