Samuel N. Marcus M.D., Ph.D.




How do I prepare for a gastroscopy exam (stomach scope test)?

To prepare for a gastroscopy examination, you need:

  • An appointment for the examination
  • An empty stomach. You must fast (no food or drink) for 6 hours prior to the exam
  • A driver to take you home since you will not be able to drive until the following morning.

We ask that your driver drop you off and when you are ready to be picked up, on average 1 ½ hours later, we then will contact him/her. Do not plan to use a cab. You need to have a driver who can stay with you while the sedative wears off.

How do I prepare for an upper endoscopy exam?

Although most patients will be given our standard upper endoscopy preparation instructions, your specific requirements may warrant a modification to our standard procedures. The doctor will discuss your preparation with you during your initial visit.

How do I prepare for a colonoscopy exam (colon scope test)?

To prepare for a colonoscopy examination, you need:

  • An appointment for the examination.
  • A driver to take you home since you will not be able to drive until the following morning. We ask that your driver drop you off and when you are ready to be picked up, we then will contact him/her.Do not plan to use a cab. Your driver must take you home and watch over you while the sedative wears off. Complications are rare, but you should have someone available who can assist you if necessary.
  • A full day before the exam to empty your colon.

The standard preparation for a colonoscopy begins the morning of the day before your appointment. After having a light breakfast, you should have only a clear liquid diet the rest of the day. This means no solid food or dairy products. Only tea, Jell-O (flavors without red dye), clear broth, non-cola soft drinks and water are allowed. Patients are asked to use a bowel preparation the day before your procedure. Don’t make any plans for that evening. You will be at home in your bathroom most of the time.

What happens if I start vomiting while taking the laxative preparation solution?

If you are taking your laxative solution and develop symptoms of nausea or vomiting, stop the preparation process for an hour or so. Then, if you feel better, try to pick up where you left off.

If you cannot complete the preparation, let our staff know. Your test may need to be rescheduled or an alternative preparation tried. During the day, call our office nurses’ station at 650-988-7488. After office hours, one of our doctors is always on call to help you. Call our office and the answering service will contact the doctor who is on call.

If you develop severe abdominal pain during your preparation, stop and call our office right away at 650-988-7488.

What should I do if I am drinking the laxative preparation solution and my bowels have not moved?

Be patient. This laxative solution rarely fails. Most patients have a bowel movement within two to four hours of starting the solution. Sometimes, there may be a delay. If you have drunk at least half of the solution (8 glasses) and your bowels have not moved, stop for a while. If nothing happens in an hour, try taking a small disposable 4-oz Fleet s enema. They are available at your drugstore.

A tip: Don’t drive to the store; send someone else. Your bowels may “wake up” enroute.

Another tip: Avoid being constipated the day you take your laxative prep. This laxative solution works best if your “pipes are open” before you start the flushing process. Otherwise, you may have a delayed response. If you feel that you are constipated the day before the prep day, take whatever laxative works for you to remedy the situation. A good choice would be a dose or two of Milk of Magnesia and several glasses of water.

Do you use the pill for colonoscopy preparation?

There is a pill called Visicol. We do use it, but the pills are large and you have to take a total of twenty pills over a period of 4 hours. We have not found this method preferable to Suprep.

What do I do if I lose my instructions on how to prepare for my exam?

We provide most patients with printed instructions for their preparation. If you lost your instructions, call our office or, if after hours, the physician on call.

Should I take my normal medications before a scope test?

Yes. Generally it is best for you to take all of your normal medications before and after your test. However, tell your doctor if you:

  • Currently are taking blood thinning medications (such as aspirin, Coumadin (warfarin), Plavix, Ticlid), non-steroidal anti-inflammatories (Advil, Aleve, Celebrex, Ibuprofen, Motrin, Naprosyn), vitamin supplements containing vitamin E, or homeopathic medications, such as ginko or fish oil. Your doctor may want you to stop taking them before your procedure.
  • Have a heart murmur or artificial heart valve. Your doctor may want you to take antibiotics before your procedure.
  • Take medications for diabetes. Your doctor may want to adjust your dosage(s) or have you stop taking them before your procedure.

What if the instructions on the bottle of laxative solution are different from what you gave me?

Please follow the instructions that our office provided to you. If you have misplaced those instructions, please call our office and we will provide them to you again.

Can I put flavoring into the laxative preparation solution?

Yes, if you were given the unflavored solution and wish to add some flavoring, it is okay. Add one packet of Crystal Light Lemonade or Iced Tea Mix. These two flavors do not interfere with the preparation or testing. Do not add any brightly colored flavoring, such as cherry.

Won't my rectum be sore after having so many bowel movements prior to my test?

It might be. The very nature of the cleanout process means that you will have many liquid bowel movements over several hours. This might cause some soreness around the anal area.

You can minimize discomfort by using extra soft toilet paper, followed by a baby wipe (Huggies, etc.) after each bowel movement. Some patients report fewer problems if they apply Dessitin cream to the anal area after each bowel movement. You might consider purchasing these items when you go to the store for your laxative solution.

Should I stop taking aspirin prior to a colonoscopy?

Theoretically, aspirin and drugs like ibuprofen can inhibit blood clotting and make the risk of bleeding higher. You would think this would be important if you are going to have a biopsy taken or polyp removed. But in practice, this does not seem to be a too much of a problem. Your doctor will help you make that decision.

Most doctors no longer routinely ask their patients to stop aspirin products before a scope test. But, if you& are on a daily aspirin or ibuprofen regimen and wish to stop it before your exam, you must stop at least a week before your test to get the medication out of your system.

Caution: If you are taking a daily aspirin to prevent a stroke or heart attack, don’t stop it without your doctor’s approval. Of course, if you have any bleeding tendencies, let your doctor know.

Why do I need a driver for my appointment and does he/she have to stay while I am there?

Scope examinations, such as gastroscopy and colonoscopy, require sedation to prevent pain and discomfort. These medications make the test comfortable for the patient, but do not wear off immediately. Because of this, you cannot drive your car until the following morning.

Therefore, it is necessary for you to come with a friend or family member who can safely drive you home after your test is over. We ask that your driver comes with you, leaves until your procedure is completed (we will call to notify your driver when it is over) and returns prior to your discharge so the doctor can meet with him/her to explain the test results. Because of the effect of the sedation, you may forget the details of the results of your test. Your driver can help you remember them. Do not plan to use a cab. The driver cannot listen to the physician’s instructions and you need someone who can take you home and watch over you while the sedative wears off.

How long will my examination take?

If you are scheduled for a scope test, plan to be in our center for about an hour and a half.

Procedures such as gastroscopy or colonoscopy require sedation to make them safe and painless. Even though the test itself takes about 15 to 45 minutes, you will need extra time for registration, pre-operative check-in, the test itself, and post-operative recovery.

Currently, our patients’ average stay is about one and a half hours.

Will my examination be painful?

In most instances, no. That is the nice part. With the modern anesthetic sedatives, your examination should be painless and comfortable. In fact, after their exams some patients ask, “When is the test going to start?” Of course, the price you pay for a painless test is the fact that you will not be able to work or drive the rest of the day. That is why you need a driver to take you home.

If you do experience discomfortduring the test, you will be given higher doses of sedation, provided it is safe to do so.

Does a colonoscopy show if I have colon cancer?

Yes. In fact, a colonoscopy is considered to be the most accurate way to determine the health of your colon. This includes checking for cancer, polyps, colitis, diverticulosis, and other less common lower digestive problems.

What should I expect during my scope test?

After your pre-operative assessment, you will be taken to the Endoscopy Room. Don’t be surprised if it looks like an operating room. They look similar.

The GI Technician will place you on equipment that monitors your heartbeat and blood pressure and provides you with nasal oxygen. Don’t be alarmed. This is routine for everyone.

You will then be asked to roll onto your left side on the padded stretcher. Under your doctor’s instructions, the nurse will then administer the sedative into your intravenous line, and that’s about all you can expect. The rest of the test is done while you are in a state called “conscious sedation.” This is not like general anesthesia such as heart surgery, but a pleasant semiconscious state in which you should feel no pain and be unaware of the actual test itself.

Will I say things that I shouldn't while sedated?

This is a normal and common fear. Most individuals are afraid of losing control, giving away their secrets, or saying something embarrassing while they are asleep. Don’t worry. This is not truth serum. The medicine does not work that way. While in a state of conscious sedation, patients don’t say much of anything.

If the doctor finds a polyp during my test, will he remove it?

In most cases, yes. Our doctors are trained in the latest endoscopic techniques. Most polyps can be removed at the time of colonoscopy. Rarely, a polyp is too big or too flat to remove and surgery is necessary. Best of all, each polyp removed is a potential colon cancer prevented.

How soon will I be able to eat after my test?

Immediately. As soon as you awaken in our recovery room, our nurse will offer you some juice to treat your dry mouth and hunger pain. Once you go home, you can have a normal breakfast or lunch. Eat whatever you feel like. Just go slow at first. Don’t try to make up for three missed meals at one time!

How soon can I drink alcohol after my test?

The medicines used for sedation should not be mixed with alcohol. We suggest you do not drink any alcoholic beverages (e.g., beer, wine, whiskey) until the day after your examination.

How soon can I return to work after my test?

Patients are usually able to return to work the following morning.

I am drug tested at work. Is this a problem?

The sedatives used for sedation will show up in blood tests for several days. If your job requires random drug testing and you need a written excuse for work, let the doctor know.

How long do I have to wait before I fly or travel after my test?

The risk of complications is very low for these procedures. In general, if you feel well, you may fly or travel the day after your scope test.

However, if the doctor removes a large polyp or if your procedure was unusual in any way, he may request that you stay in the area for at least a week after the exam. This rarely occurs.

Certainly, you should not travel to any part of the world where medical attention is not readily available right after any medical procedure. Should a complication occur, you may require prompt medical attention.

How long do I have to wait for the results of my test?

Unlike an x-ray, the results of a scope test are immediate. After you awaken from your sedation, the doctor will discuss the results of the test with you and your driver. We also give you a written explanation of what was found and what treatment, if any, is anticipated. You also will have an opportunity to ask questions.

Of course, any biopsies or samples taken for lab analysis will not be available that day. In that case, we will contact you as soon as we obtain the results, usually within two to three working days.

What are the symptoms of complications from a procedure?

Complications from a colonoscopy, sigmoidoscopy, or upper intestinal endoscopy (gastroscopy/upper endoscopy) are rare, especially when specially trained physicians are administering them.

However, should you experience any of the following symptoms after a test, contact the doctor immediately.
Following a colonoscopy or sigmoidoscopy

  • Severe abdominal pain
  • Fever and chills
  • Rectal bleeding (bleeding from biopsies and polyp removals can occur several days after the procedure)

Following an upper intestinal endoscopy

  • Fever
  • Difficulty swallowing
  • Increasing throat, chest, or abdominal pain