Endoscopy Services

Typically, a colonoscopy procedure takes as little as 20 minutes but can take longer because of a patient’s unique anatomy or the presence of conditions that require interventions. It is also helpful to note that the process from admission to discharge usually takes about 3 hours. We will do everything possible to avoid delays, but emergencies and complex cases may interrupt our schedule.

You will be receiving sedation for your procedure, so you will need to avoid driving, operating heavy machinery, making major decisions, etc. for 24 hours to allow your body to fully clear the anesthesia.

Our anesthesia providers use a type of sedation called monitored anesthesia care, which allows our Endoscopy procedures to be performed using enough sedation to ensure that patients are comfortable throughout the procedure. When patients are comfortable, they don’t move around, which permits the doctor performing the procedure to move the camera through the patient’s esophagus and/or colon with minimal interruption and to view the lining of the patient’s esophagus and/or colon clearly, allowing for the most thorough exam.

• If you are anxious about sedation, please reach out to your primary care provider about options to minimize your anxiety before the procedure.
• If you do not want sedation because you do not have a ride home from the procedure, please contact the Endoscopy Services department at 207-755-3601.

Your financial responsibility will vary depending on the reason for your procedure (screening vs. diagnostic) and your specific insurance plan. Patients are encouraged to contact their insurance company and/or Ensemble (1-866-620-4781) for an estimate of financial responsibility.

There are some medications that require dosage adjustments or will need to be stopped temporarily for safety reasons. These are typically medications for diabetes, weight loss, and to thin your blood/prevent blood clots. Prior to your procedure, we will coordinate with your prescribing providers and then review the necessary adjustments with you if you are taking these specific medications. If you take medication for diabetes, weight loss, or to thin your blood and you have not heard from our office 8 days before your procedure, please call us at 207-755-3601 M-F, 7am – 4pm so that we can review your medication list with you.

We encourage patients to minimize the number of medications that they take the morning of their procedure, but include directions in our prep instructions regarding medications for blood pressure, heart rate, thyroid function, and seizures, as these medications should be taken to ensure that you are best situated to receive sedation.

Other medications, like those that treat anxiety and pain, can be helpful to take the morning of your procedure to help maintain an ideal blood pressure and heart rate.

• The general rule for these medications is to take them in the morning of your procedure, with a sip of water, up to 2 hrs before your scheduled arrival time.

If you have any questions regarding your medications, we encourage you to call your prescribing provider or the Endoscopy Services department.

Our bowel prep instructions include directions for patients with blood sugar disorders, and we encourage all patients with questions and concerns to contact their PCP, endocrinologist, or the Endoscopy Services department for recommendations regarding how to complete the prep successfully, safely, and as comfortably as possible.

In addition, as part of our pre-procedure phone calls, an Endoscopy Nurse will attempt to call patients with diabetes to review recommended adjustments to insulin, oral, and injectable medications in the week leading up to your procedure.

The following weekly injectable medications require special adjusted dosing and possibly a bridge therapy, which will be coordinated by your primary care provider or endocrinologist:

• Ozempic/Wegovy (semaglutide)
• Mounjaro (tirzepatide)
• Trulicity  (dulaglutide)
• Victoza/Saxenda (liraglutide)
• Byduron/Byetta (exenatide)

Many of our patients take medications that work to prevent blood clots, often by “thinning the blood.” These medications make it harder for your body to stop bleeding. Because Endoscopy procedures can involve interventions such as stretching the esophagus or removing polyps, patients who are on medications to prevent blood clots are at higher risk of bleeding after an endoscopic procedure. When we schedule a patient, we review the patient’s medication list to identify any medications that will need to be paused for a period of time prior to the procedure. We contact the ordering provider to request a recommendation for holding/pausing the medication, and then will contact the patient to review instructions for pausing the medication for the recommended number of days before the procedure, and also advise the patient when it is safe to resume taking them.

Some patients cannot hold these medications. In these cases, the patient and the ordering provider should discuss whether there is benefit to having the Endoscopy procedure to identify potential problems that will require intervention and/or treatment in the future. Typically, patients with an above average risk for colon cancer or who are experiencing concerning bowel habit changes are patients who would benefit from a colonoscopy to identify the presence of polyps or other potentially treatable conditions.

Please call the Endoscopy Services unit at 207-755-3601 if you take any of the following medications:

• Xarelto (rivaroxaban)
• Eliquis (apixaban)
• Coumadin (warfarin)
• Plavix (clopidogrel)

Our prep instructions include an adjusted schedule for those patients who find drinking 8 oz of fluid every 10 minutes to be problematic, but it is important to note that virtually all successful prep routines require drinking a larger amount of fluids in a shorter amount of time than the average person drinks in a typical day. While there are some commercially available colon prep kits that utilize pills, they do also require that patients drink larger than normal amounts of liquid in a short period of time in order to be effective. We want your preparation and your procedure to be as successful as possible; our colon prep regimens have been carefully designed to account for the variety of patients with unique needs that we see in our daily practice.

If you still have concerns after reading through the colon prep instructions you received, please call the Endoscopy Services department.

You will likely receive a call from Ensemble, pre-registering you for your procedure. While pre-registration can streamline your check-in on the day of your appointment, it does not replace checking in at the hospital’s lab registration before coming to the Endoscopy unit, which is around the corner from the hospital’s outpatient lab. Once you are checked in by the lab registration staff, you’ll be given your ID bracelet and directed to the Endoscopy Services unit for your procedure.

The bowel cleanse process is the least pleasant part of the colonoscopy for many patients. There are some ways to make it less uncomfortable and more successful:

• Follow the instructions faithfully. They are designed to make the colon cleanse medications more effective and to make the cleanse easier to complete.
• Drink lots of clear fluids. Think of your colon like a pipe that has a partial blockage. Flushing the pipes with fluid will push that blocking material through the pipes more effectively than a trickle of water would.
• Drinking often, or eating clear liquids like Jell-O or popcicles/Italian ices (any color but red) can help you feel full throughout the day prior to your procedure. This is especially true if you are participating in an extended, 2 day bowel cleanse schedule.
• Use baby wipes. They now even make wipes with lotion for sensitive skin. This will lessen the discomfort from multiple bowel movements in a short time as well as cleanse the area with fewer wipes, which further reduces irritation to the area.
• Dab the area after each bowel movement instead of wiping, to reduce the friction which inflames the sensitive skin of your perineal area.
• Time your prep to account for work and family routines. Be sure you can be close to a bathroom so you are not waiting on others or do not have any privacy. Also consider your sleep routine when making your appointment. Early morning appointments require an early waking time to complete the morning portion of your bowel cleanse. If you are not a morning person, making an appointment time for later in the day may make your sleep and prep schedule less challenging for you.