Capsule
Endoscopy

Capsule Endoscopy Miralax Preparation Instructions

Check in:

• 7:45-8:00AM with our front office staff
• If you arrive later than 8:00 am, we will be unable to proceed with the Capsule Endoscopy.

About Capsule Endoscopy:

A Capsule Endoscopy is a procedure in which a small wireless camera inside a vitamin-sized capsule is swallowed and takes thousands of pictures of your gastrointestinal tract. The pictures are then transmitted and saved to a recorder on a belt that is around your waist.

Key Information:

• DO NOT EAT any solid food the ENTIRE DAY before your test. Drink only clear fluids.
• Bring your photo ID, insurance card, co-pay/co-insurance/deductible with you to your test.

What to bring and do prior to your test:

• You should plan on being at our facility for at least 10 minutes.
• Read prep instructions THOROUGHLY.

Weight Loss/Diabetes Medications:

• GLP-1 Agonists: including Mounjaro (tirzepatide), Trulicity (dulaglutide), Victoza, Saxenda (liraglutide), Adlyxin (lixisenatide), Ozempic, Wegovy (semaglutide subcutaneous), Bydureon BCise (exenatide extended-release), Byetta (exenatide), Rybelsus (semaglutide tablet), Stop the oral or injectable medication one week prior to your test.

If you have diabetes, follow these instructions:

• Long-Acting Insulins (ex. Lantus, Basaglar, Semglee, Toujeo, Insulin Glargine): Decrease basal rate by ½ the day before and the day of your procedure.
• Rapid-Acting and Regular Short-Acting Insulin (ex. Lispro, Humalog, Admelog, Regular Insulin): If your blood sugar is high and you need to take a correction, take ½ or 50% of your usual correction. This applies to the day before and the day of your procedure.
• Insulin Pump: Decrease basal rate by ½ the day before and the day of your procedure. Do not administer bolus doses.
• Other Diabetic Oral & Injectable Medications (ex. Metformin, Glipizide, Sulfonylureas, Tradjenta, Dipeptidyl Peptidase IV (DPP IV) Inhibitors, Januvia, Janumet, Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors): Do not take the day before or the day of your procedure.
• Check your blood sugar at same intervals as usual, and additionally, if needed: If your blood sugar is less than 60, please take glucose tablets at any time before your procedure with a sip of water.

Procedure Cancellation Notice Requirements:

• Procedure cancellations must be made three (3) business days prior to your appointment.
• Failure to provide the required advance notice will result in a $50 Total Cancellation Fee.

Checklist to Ensure Proper Preparation

To ensure the proper completion of your procedure, we strongly suggest that you PRINT OUT this document and check off each of the instructions as you complete them.

GROCERY STORE LIST: Purchase the items below at least five days before your test:

☐ 1 – 8.3 oz bottle of MiraLAX (119 grams) or generic equivalent. (You will only use half of bottle)

☐ 1 – 28 oz or 32 oz bottles of Gatorade (NOT Red or Purple). Patients with diabetes should use Gatorade G2 (low sugar version-not red or purple). See clear liquid list on page 3.

☐ 4 – Gas-X tablets (simethicone) containing 125 mg of simethicone each.

☐ 1 – Easily measurable 8-ounce glass/cup: You will be drinking multiple quantities of 8 oz liquids.

5 days before your test:

☐ Make sure you have purchased your bowel preparation items! (listed above!)

☐ DO NOT take medications that stop diarrhea such as Imodium (loperamide), Pepto-Bismol (bismuth subsalicylate) or Lomotil (diphenoxylate/atropine).

☐ DO NOT take fiber supplements such as Metamucil, Citrucel, Psyllium or Benefiber.

☐ DO NOT take products that contain iron such as multi-vitamins or iron supplements.

3 day before your exam:

☐ Discontinue high-fiber foods – Please see Low Fiber Diet tips attached.

Checklist: One Day Before Your Test

☐ If you have diabetes, please see Diabetes instructions on page 1.

☐ Only drink clear liquids the ENTIRE DAY before your procedure. NO solid foods.

☐ Drink at least 8-ounces of clear liquids EVERY HOUR after waking up.
The charts below will show you examples of what you can and cannot drink:

3:00 pm – the afternoon before your procedure, prepare the MiraLAX bowel preparation solution:

☐  Mix ½ of MiraLAX bottle (4.2 oz) into the 28 oz or 32 oz Gatorade bottle, until dissolved. You may have to drink a little or pour some of the Gatorade out, to make room for the MiraLAX. Keep Gatorade bottle cool in the refrigerator. DO NOT add ice.

☐  Take two tablets of simethicone/Gas X.

4:00 pm – the afternoon before your procedure:

☐ 4:00 pm: Drink 8-ounces of the MiraLAX Gatorade bottle.
☐ 4:15 pm: Drink 8-ounces of the MiraLAX Gatorade bottle.
☐ 4:30 pm: Drink 8-ounces of the MiraLAX Gatorade bottle.
☐ 4:45 pm: Drink the rest of the MiraLAX Gatorade bottle.
☐ 5:00 pm: Drink an 8-ounce glass of clear liquid (see chart above).
☐ 5:15 pm: Drink an 8-ounce glass of clear liquid.
☐ 5:30 pm: Drink an 8-ounce glass of clear liquid.
☐ 9:00 pm: Take two additional simethicone tablets.
☐ Set your alarm!

10:00 pm – the night before your procedure check-in time

☐ Discontinue mints, gum, hard candy, and chewing tobacco.
☐ STOP DRINKING ALL LIQUIDS!

The day of your exam:

☐ No medication should be taken before 10 am the day of your exam. You CAN resume medications 2 hours after ingesting the capsule.
☐ Please wear comfortable, loose, two-piece clothing.
☐ Do NOT arrive to your exam later than 8:00 am. We will not be able to proceed if you do.
☐ At the office, you will ingest the capsule, and have the equipment attached to you.
☐ You may have clear liquids 2 hours after swallowing the capsule.
☐ You may have a light meal 6 hours after swallowing the capsule.
☐ PLEASE RETURN TO THE OFFICE BETWEEN 4:00-4:15 PM TO HAVE THE EQUIPMENT REMOVED.
This should only take a few minutes.

Instructions/expectations following the exam:

☐ After ingesting the capsule and until it is excreted, you should not be near any electromagnetic fields,
such as an MRI device or amateur (ham) radio.
☐ We will not need the pill after it is excreted.
☐ It will be approximately 2 weeks before the report is available. Your provider’s nurse or medical assistant will contact you with the results. If you have any questions, please contact our office.

Download Prep Instructions