Getting Ready for Your Virtual Colonoscopy (VC) with the Routine Virtual Colonoscopy (MiraLAX) with Oral Contrast Prep Kit

Virtual Colonoscopy

Virtual colonoscopy (VC), also referred to as CT colonography, is a less-invasive, safe exam used for colon polyp screening. The entire colon lining can be seen with VC. A computed tomography (CT) scan creates a 3-D picture of the inside of your colon. This helps the doctor look inside the colon without having to insert a scope.

The main purpose of this exam is to screen for growths (polyps) in the lining of the large intestine (colon and rectum). This screening should start at age 45. If you have a first-degree relative (a parent, brother, sister, or child) with colorectal cancer, your doctor may decide to start screening before age 45.

If a large polyp or growth is found in your colon, you may need a standard colonoscopy to remove the polyp. “Large” polyps are those 1 cm (about ⅜ inch) or greater. They are removed because they have a higher chance of turning into cancer. A growth of this size is present in less than 5% of all patients. A nurse will set up the standard colonoscopy, if needed. If this occurs, someone needs to drive you home. If you have the standard colonoscopy on the same day or next day, you do not need a second bowel prep.

Doctors at UW Health can also watch a small colon polyp over time. Smaller polyps, 6 mm to 9 mm (about ⅓-¼ inch), can be safely watched by having a follow up VC exam in 3 years. Or, small polyps can be removed by standard colonoscopy, the same day or later, if you choose.

VC also allows the doctor to take a limited look outside the colon for problems in the abdomen and pelvis. This may help find problems such as abdominal aneurysms, other cancers, or conditions you may not be aware of. We may also be able to do a CT BMD (bone mineral density) exam to screen for osteoporosis. It is done at the same time as your VC exam with no extra scans or cost.

Getting Ready for Your VC Exam

If you want to be able to have a same-day standard colonoscopy if a polyp is found, stop taking iron tablets five days before the exam. If you cannot have a standard colonoscopy the same day because you do not have a driver, are on blood thinners or anti-platelet medicines, or have other plans, you may keep taking iron tablets. Iron tablets do not affect the VC exam. If you have any questions or concerns about stopping a medicine, call your doctor. You may take all other prescribed medicines before your VC.

Four days before the exam, avoid foods that are digested slowly (corn, popcorn, potato skins, nuts, fruits with skin or seeds, uncooked or raw vegetables, high fiber cereals) because they may interfere with your prep.

Stop taking any fiber supplements like:

• Metamucil®

• Citrucel®

• Benefiber®

Avoid anti-diarrhea medicines such as:

• Lomotil®

• Pepto-Bismol®

• Immodium®

• Loperamide
  

If You Have Diabetes

Call your doctor to discuss how your diabetes medicine should change before the VC. Test your blood sugar more often the day before this test. Also check your blood sugar the morning of your test. If your blood sugar level is low (less than 70 mg/dl) or if you have symptoms, take some glucose tablets or drink 4 ounces of a clear liquid that contains sugar. Always recheck your blood sugar level to make sure it stays above 70.

We can still do the VC unless you need to eat solid food to keep your blood sugar at a normal level. If the blood sugar ever gets too high or too low and you can’t bring it back to normal, call your primary care or diabetes doctor.

Diverticulitis

If you get diverticulitis before your VC, call your doctor first. Then contact the VC office to reschedule your exam for at least four weeks after your treatment.

Blood Thinners or Anti-Platelet Medicines

Do not stop taking them unless your doctor tells you to. Some examples include:

• Coumadin® (warfarin)

• Plavix® (clopidogrel)

• Effient® (Prasugrel)

• Pradaxa ® (Dabigatran)
  

VC is often advised for patients taking these types of medicines. There is a greater risk to stopping blood thinners for a standard colonoscopy. VC can safely look at your colon without stopping these medicines. If a polyp is found that should be removed, we will consult with your doctor who can set up the standard colonoscopy at a later date.

If your doctor tells you to stop these medicines so that you can have a same-day standard colonoscopy if a polyp is found, you must discuss how long to stop the medicine and any special instructions to do so safely with the doctor who prescribed the medicine for you.

Only stop iron tablets 5 days before your VC exam, if you have been told to stop the blood thinner or anti-platelet medicine.

Pregnancy

If you think you may be pregnant, do not start the prep kit; you cannot have a VC exam while pregnant. If you think you could be pregnant, call the VC office. A pregnancy test will be ordered before starting the prep.

Supplies To Buy Before Your Prep Day

You will need to buy two-32 oz bottles (or a total of 64 oz) of Gatorade or Powerade. No red, blue or purple.

The Day Before Your Exam (Prep Day)

Proper bowel cleaning is needed for the best exam. To get a clean and empty colon you will start to prepare the day before your exam. The laxative helps clean out the bowel for the exam. The contrast helps to highlight any stool or fluid left in your colon on the VC pictures.

Starting at midnight the entire day before your exam (prep day), you may drink as many clear liquids (see below) as you want unless you are on a fluid restriction by your doctor. If you are on a fluid restriction, please speak with your doctor to make sure this prep is right for you.

Drink only clear liquids for breakfast, lunch, dinner, and snacks. Do not eat any solid foods. Drink plenty of fluid to avoid dehydration and make the laxative work better. Avoid red or purple liquids (i.e., red Jell-O, cranberry juice, purple sports drinks). Clear liquids include:

• Gatorade, Powerade (sports drinks with electrolytes are recommended to help with hydration)

• Water, tea, or coffee (no cream or milk; sugar or honey is okay to add)

• Vitamin water, Crystal Light

• Bouillon or broth (chicken, beef, or vegetable)

• Jell-O, Popsicles (no fruit or cream added)

• Apple, white grape, or white cranberry juice (no orange, tomato, grapefruit, or prune juice)

• Soda such as Sprite, 7-Up, ginger ale, or any cola

• Clear hard candy, gum

• Lemonade (with no pulp), iced tea

• Clear liquid protein drinks such as Ensure Clear TM, or Resource Breeze
  

Follow the Bowel Prep medicine schedule. If you take other medicines, take them at least one hour before or at least one hour after taking the laxative Polyethylene Glycol. If you wish, you may put the Gatorade and barium sulfate in the refrigerator. Or you may drink them at room temperature. Do not put the Omnipaque (iohexol) in the refrigerator and do not store the bottle where it would be in direct sunlight.

You may have as many clear liquids as you like between each step and up until midnight.

Step 1 – Anytime before 9 AM: Take the four Bisacodyl tablets (5 mg each) with 1 glass (8 ounces) or more of clear liquids. Do not chew or crush them. Do not take them within 1 hour of taking an antacid. This will gently move your bowels (6-8 hours after you take this medicine) to help the laxative taken in Step 2 work better.

• Step 2 – At 1 PM: Mix Polyethylene Glycol prep and start drinking.

• Open the 8.3-ounce bottle of Polyethylene Glycol and mix half of the powder in one 32-ounce bottle of Gatorade or Powerade. Mix the other half of the 8.3-ounce bottle of Polyethylene Glycol powder into the second 32-ounce bottle of Gatorade® or Powerade. Mix or shake to dissolve. It is okay to keep the second bottle chilled while you are drinking the first bottle of prep.

• Start to drink 1 cup every 10 – 20 minutes. If you have nausea or stomach pains slow down or stop for 30 minutes. Expect liquid stools to begin in 1-2 hours. You will want to stay close to a bathroom. The time it takes for the laxative to start working varies for each person. You may have some cramping in your lower abdomen. This is normal. If you start to have severe, steady stomach pain, get lightheaded or dizzy, or you don’t expel any of the Polyethylene Glycol, call your primary care doctor.

• Once you have completed the first 32-ounce bottle of Gatorade® or Powerade containing Polyethylene Glycol, you can take a break and drink other clear liquids if you wish.
  

Helpful Hints:

• Wear more clothes if you feel chilled.

• Drink with a straw to lessen the taste.

• For a sore bottom after a bowel movement, cleanse with baby wipes and apply a protective ointment such as A+D®, or Vaseline®. TUCKS® medicated cooling pads may also provide relief.
  

Step 3 – At 4 PM: Drink the second 32-ounce bottle of Gatorade® or Powerade containing Polyethylene Glycol. Follow same drinking instructions above of 1 cup every 10 to 20 minutes.

When the laxative is done working, your bowel movements should be watery and free of solids (flecks are OK). The color may appear clear to yellow, green, or tan, but should be see-through.

You may continue to drink other clear liquids if you wish.

Step 4 – One hour after finishing the second bottle of Gatorade® or Powerade containing Polyethylene Glycol: Drink the entire 225 mL bottle of liquid barium sulfate suspension found in the prep kit. This is a contrast medicine used to highlight any leftover stool on the CT images. There is no lactose in the barium.

Step 5 – Two hours after drinking the barium: Omnipaque (iohexol) is another contrast medicine that helps highlight fluid in your colon. The bottle says it is for “injection,” but this medicine can also be taken orally, meaning you drink it. We want you to drink this medicine so that it will be in your colon by the next morning for your exam.

The plastic bottle has a pull-tab on the top, but you do not need to pull this. Instead, twist the entire top to remove it. Also remove the black rubber stopper before drinking the contrast.

Drink the entire 50 mL bottle of Omnipaque (iohexol) 350 mgI/mL. You may mix it in 8 ounces of clear juice, water, or soda and drink. Or drink the Omnipaque and then follow it with 8 ounces of clear juice, water, or soda. You do not need to drink it quickly unless you want to.

Your bowel prep is done!

You may keep drinking clear liquids until midnight.

The Day of Your Exam

Do not eat or drink anything after midnight the day of your exam until you are told to do so after your exam. You may take your daily medicines as prescribed with small sips of water. If you haven’t been able to have a bowel movement or to finish the prep kit, please call the VC office to ask if the exam can still be performed or if we need to reschedule the exam for a later date.

If you have diabetes, test your blood glucose level more often when you can’t eat as well as before your exam. You should adjust your insulin or oral diabetes pills as discussed with your doctor. Go back to your normal schedule after you get the exam result phone call and are able to eat again. If your blood glucose level is low (less than 70 mg/dl) or you have symptoms, please drink a clear liquid that has sugar in it or take glucose tablets. Always recheck your blood sugar level to make sure it stays above 70. We can still do the exam unless you need to eat solid food to maintain your blood glucose. It is better to maintain your blood glucose than to have the exam. We can always schedule your VC in the future.

Driving Home

You do not need to have a family member or friend drive you to and from the VC exam, as you are not given any medicine that will make you sleepy. If you need a standard colonoscopy the same day, then you will need to arrange for someone to drive you for that test.

During the Exam

The VC exam most often takes 30 minutes or less to do. Allow up to 50 minutes to change your clothes and talk with the CT technologist (tech). You do not need pain or sedation medicine or an IV for this exam. You are asked to change into a hospital gown and then taken to a CT exam room where you lie on the CT exam table.

A small tube is gently placed a very short distance into your rectum (this feels like having a digital rectal exam). Carbon dioxide will be placed slowly into your colon. The exam should not be painful, though you may have some abdominal fullness, discomfort, or cramping during the exam. You may feel the urge to have a bowel movement. These feelings should go away as soon as the exam is over.

Pictures are taken of your abdomen and pelvis while you are lying on your back and then on your stomach. You are asked to hold your breath for about 10 seconds while the CT scanner takes pictures.

After the Exam

The CT tech will ask you for your phone number so the team can call you with your colon results in about 2 hours. Many people go back to work or other activities after the exam.

• If you wish to have a polyp removed the same day as your VC, do not eat or drink until you hear from us. If you need to have a standard colonoscopy, the VC team can set up this second exam for the same day if you have not eaten or had liquids to drink.

• If you take prescription blood thinners, anti-platelet medicines, or do not wish to have a same-day standard colonoscopy, you may go back to your normal diet right after the exam. If a polyp is found that should be removed, a standard colonoscopy is set up at a later date by your doctor’s office.

• If you do not have colon polyps, you can go back to your normal diet and any medicines you may have stopped when we call with the results. If you have colon polyps, we will review options with you and help set up further care as needed.

• If any other problems are seen outside your colon, the results are sent to your doctor in the full VC report. If you have not heard from your doctor about other results within 2 weeks, we suggest you call your doctor’s office to follow up.
  

Who to Call

To find out more about the virtual colonoscopy exam and prep, please see our video at https://uwhealth.org/vcprep

VC Program Office to speak to a nurse or team member: 608-263-9630

If you have an urgent concern after normal business hours, contact your primary care doctors on call service. If your referring doctor is from outside the UW Health system, you may call the paging operator for urgent VC concerns at 608-263-6400 and ask for the radiology resident on-call.

If you need urgent medical help, call 911 or go to the nearest emergency room.

If you need to reschedule for any reason, call 608-263-9729.