(EGD) with Endoscopic Ultrasound (EUS) Prep Instructions

HEALTH ENGAGEMENT Upper Gastrointestinal Endoscopy (EGD) with Endoscopic Ultrasound (EUS) prep instructions

You have been scheduled to have an upper 3. If needed, small tools may be placed into the gastrointestinal endoscopy (EGD) with endoscope. This will be done to: endoscopic ultrasound (EUS). This procedure • take tissue samples for a biopsy helps detect and/or treat problems affecting • sample or drain a cyst or other abnormal your esophagus, stomach, liver, gallbladder, collection of fluid in the abdomen bile duct, lymph nodes, and pancreas. This procedure is performed using a long, flexible What to do before you have an EGD tube called an endoscope. This tube has a with EUS small light and camera on one end. There are three things you should do to What happens during the procedure? prepare for the procedure. 1. The doctor will give you a medicine to 1. Change your diet. sedate you. After the medicine is given, the 2. Follow the instructions in the table on the endoscope is placed into your mouth and next page. slowly moved through your esophagus and 3. Watch the EMMI video, Upper GI stomach until it reaches the first part of your Endoscopy, that has been ordered for you. small bowel (duodenum). If you have diabetes, please review the 2. The tip of the endoscope has a small Diabetes Medication Guide for Upper ultrasound probe that allows your doctor to Endoscopy (EDG) on the last page. examine the intestinal wall as well as some nearby organs and lymph nodes. The pictures from the camera can be seen on a monitor. THINGS TO DO KEEP IN MIND... At least 7 days before your procedure • You will receive a reminder about your upcoming • Since you will have sedation for the appointment. Please confirm the appointment. If you procedure, you will need an adult to are not able to keep your appointment, contact us take you home. right away. • You should not drive until the day after • Since you will have sedation, you will not be able to your procedure because you will have drive yourself home after the procedure. You will need sedation for the procedure. a responsible adult to drive you home. You may not use • Your driver or chaperon must be present public transportation, a taxi, or walk home without a when you check-in for your procedure. chaperon. If you do not have someone with you, • If you are taking Coumadin (warfarin), please talk the procedure will be rescheduled. Your directly with the Coumadin Clinic at least 7 days driver or chaperon must stay in the unit before your procedure. during the entire procedure so he/she can take you home as soon as you are ready to be discharged. • The Coumadin clinic will tell you how and when to stop your Coumadin. If another medicine is needed, the clinic will tell you what medicine to take. 5 Days before your procedure • Stop taking Plavix (clopidogrel) 5 days before your procedure, if advised by your doctor. • If you take aspirin or other NSAIDs like Advil, Motrin, Celebrex (ibuprofen), you can continue to take them as directed. You do not have to stop taking Tylenol (acetaminophen). 2 Days before your procedure Stop taking Pradaxa (dabigatran) 48 hours before your procedure, if advised by your doctor. 1 Day before your procedure You may eat a normal diet the day before your procedure. Day of your procedure • Take all prescription medicine, as directed, with a You will not be admitted if your driver or small sip of water. This includes ALL blood pressure chaperon is not present upon check-in. medicine. You can also continue to take aspirin. Most EGDs with EUS take about an hour • DO NOT take any blood thinners (Coumadin, Plavix, to perform. However, the two of you Pradaxa). should plan to be in the endoscopy suite for about 2 hours. • Do not apply any lotions or creams to your chest or abdomen. • Check in at your scheduled arrival time with your driver. You will not be admitted if your driver or chaperon is not present upon check-in. • You will be asked to review and sign a consent form the day of the procedure. This will give your doctor permission to perform your procedure. Please read this form carefully and ask questions if anything is not clear. Capitol Hill Medical If your procedure is scheduled in the After hours morning • Nurse’s Advice Line Center (703) 359-7878 700 2nd Street NE • Do not eat any solid food after midnight 6th Floor, Suite 605 • You can take your morning medicines with Procedure locations Washington DC 20002 a small sip of water, but you can not have (202) 346-3592 Falls Church Medical anything to drink within 2 hours of your Center arrival time. Largo Medical Center 201 North Washington 1221 Mercantile Lane Street 2nd Floor, Suite 202 If your procedure is scheduled in the Lower level afternoon (after 1pm) Upper Marlboro, MD Falls Church, VA 22046 20774 • Do not eat any solid food. You can have clear (703) 237-4084 (301) 618-5609 liquids early in the morning, but you can not have anything to drink within 2 hours of your Shady Grove Medical South Baltimore arrival time. Center Medical Center 1396 Piccard Drive 1701 Twin Springs Additional information 2nd Floor Road Rockville, MD 20850 2nd Floor Call the phone number listed under your (301) 548-5752 procedure location if you have questions, Halethorpe MD 21227 need more information, or need to cancel your (410) 737-5381 appointment. If calling after hours, call the Nurse Advice Line.

NOTE: If you must cancel your procedure, do so at least seven (7) days before your scheduled appointment date. Diabetes Medication Guide (insulin/tablets) Check your blood sugar often. When you are fasting, your blood sugar may drop faster than normal. If you have symptoms of low blood sugar, treat with sugar or glucose tablets and call the Advice Nurse at (703) 359-7878. Type 1 Diabetics and diabetics with insulin pumps STOP: Contact your Endocrinologist for further instructions Type 2 Diabetics – Follow the diabetes medication guide below as you prepare for your upper endoscopy.

IF YOU TAKE: MORNING LUNCH/DINNER TIME THE DAY BEFORE YOUR UPPER ENDOSCOPY Oral diabetes medicines • Take your usual dose • Metformin, Tradjenta: Take your usual dose • Glipizide, Prandin: Take ½ your usual dose Long acting insulin: Lantus, Levemir, • Take your usual dose • Take ½ your usual dose Toujeo, Tresiba Intermediate acting insulin: NPH, Humulin N, Novolin N Rapid/short acting insulin: Humalog, Novolog, Regular, Novolin R • Take your usual dose • Take your usual dose Premixed insulin: Humulin 70/30, Novolin 70/30, Novolog 70/30, Humulin 50/50, Humalog 75/25 THE DAY OF YOUR UPPER ENDOSCOPY If your upper endoscopy is in the morning

• Oral diabetes medicines • After the procedure: Eat and • DO NOT TAKE • Insulin take your usual dose. If your upper endoscopy is in the afternoon Oral diabetes medicines • DO NOT TAKE • Long acting insulin: Lantus, • If blood sugar is over 100: Levemir, Toujeo, Tresiba take ½ usual dose • Intermediate acting insulin: NPH, • If blood sugar is under 100: Humulin N, Novolin N DO NOT TAKE • After the procedure: Eat and Rapid/short acting insulin: Humalog, take your usual dose. Novolog, Regular, Novolin R • DO NOT TAKE Premixed insulin: Humulin 70/30, • If blood sugar is over 100: Novolin 70/30, Novolog 70/30, take ½ usual dose Humulin 50/50, Humalog 75/25 • If blood sugar is under 100: DO NOT TAKE