Before your procedure: paperwork and eligibility
Procedures at The Tweed Day Surgery run on Queensland time, regardless of which state you're travelling from, so double-check your appointment time against QLD time when planning your day.
- Preadmission forms must be completed and submitted at least one week before your procedure, via the Tweed Day Surgery preadmission portal.
- Medical certificates for time off work can be arranged in advance; ask reception when your procedure is booked.
What to expect: gastroscopy
A gastroscopy examines the oesophagus, stomach, and the first part of the small bowel (duodenum) using a thin, flexible camera passed through the mouth. It's typically used to investigate symptoms such as reflux, swallowing difficulty, abdominal pain, or anaemia, and may involve taking small tissue samples (biopsies) from the lining of the upper gut.
- Performed under sedation from a specialist anaesthetist, so you won't be awake for the procedure itself.
- No food for 6 hours before your procedure. Clear fluids and water are permitted until 2 hours before your scheduled arrival time. Required medications may be taken with a sip of water on the morning of the procedure, and diabetic patients are given separate instructions.
- Complications are uncommon, occurring in roughly 1 in 2,000 examinations. The main risks are anaesthetic-related reactions and minor trauma to the mouth or throat from the scope; perforation is extremely rare.
- Radiological alternatives (barium studies, CT, or ultrasound) exist but are generally less sensitive and don't allow biopsies to be taken.
What to expect: colonoscopy
A colonoscopy examines the large bowel (colon) using a flexible colonoscope, about the thickness of an index finger, passed through the rectum. It's used for bowel cancer screening, investigating symptoms like rectal bleeding, iron deficiency, or a change in bowel habit, and monitoring conditions such as polyps or inflammatory bowel disease. A working channel in the scope also allows polyp removal, biopsies, or treatment of bleeding during the same procedure.
- Also performed under sedation. A typical procedure takes 20 to 45 minutes, depending on findings.
- Requires full bowel preparation beforehand; see the bowel prep section below.
- Colonoscopy is more accurate than CT (virtual) colonoscopy, which can miss 10 to 30% of clinically significant polyps and doesn't allow tissue sampling or treatment.
- Significant complications are rare, occurring in fewer than 1 in 1,000 procedures. These include missed lesions (particularly with sub-optimal bowel prep), intolerance to the bowel prep itself, anaesthetic reactions, and, less commonly, bleeding or perforation, with rates rising somewhat if a polyp is removed during the procedure.
Bowel preparation (PLENVU)
Bowel prep clears the large bowel so it can be examined properly. Poor bowel preparation may mean the procedure has to be stopped and repeated on another day, so it's worth following the schedule closely even though it's the least pleasant part of the process. The aim is a clear to yellow fluid bowel output by the time you arrive.
PLENVU is available over the counter at any pharmacy, no prescription required. Ask the pharmacist for it by name. Note: the instructions inside the PLENVU pack are generic, always follow the specific schedule given to you by the facility for your appointment time, not the leaflet in the box.
| Timing | Morning appointment (from 7:30am) |
|---|---|
| 3 days before | Start low-fibre diet, avoiding all seeds, vegetable skins, and nuts. |
| Day before, 7am–1pm | Low-fibre breakfast and lunch. Lunch is your last meal before the procedure. |
| Day before, 6pm | Dose 1: dissolve the sachet in 500mL warm water, drink slowly over 30 minutes, then a further 500mL clear fluids over the next 30 minutes. Continue roughly a glass per waking hour after that. |
| 4am on the day | Dose 2 (Sachets A and B together): dissolve in 500mL warm water, drink slowly over 30 minutes, then a further 500mL clear fluids. Continue clear fluids until 5:30am. |
| 5:30am onward | Clear fluids may continue until 2 hours before your hospital presentation time. From that point, nil by mouth. |
| Timing | Afternoon appointment (from 12pm) |
|---|---|
| 3 days before | Start low-fibre diet, avoiding all seeds, vegetable skins, and nuts. |
| Day before, 7am–1pm | Low-fibre breakfast and lunch. Lunch is your last meal before the procedure. |
| Day before, 8pm | Dose 1: dissolve the sachet in 500mL warm water, drink slowly over 30 minutes, then a further 500mL clear fluids over the next 30 minutes. Continue roughly a glass per waking hour after that. |
| 8am on the day | Dose 2 (Sachets A and B together): dissolve in 500mL warm water, drink slowly over 30 minutes, then a further 500mL clear fluids. Continue clear fluids until 11am. |
| 11am onward | Clear fluids may continue until 2 hours before your hospital presentation time. From that point, nil by mouth. |
Expect frequent, loose bowel motions from one to two hours after the first dose. Plan to be near a toilet, and stay well hydrated with clear fluids throughout.
Medications: continue your regular medications, including aspirin and blood pressure or heart medications. Exceptions:
- Iron tablets and fish oil supplements: stop 7 days before the procedure.
- Blood-thinning medications (warfarin, rivaroxaban, dabigatran, apixaban, ticagrelor, clopidogrel, prasugrel, heparin/clexane): tell reception or your doctor if you're on any of these, since these need individual planning.
- Diabetes medications: also individualised. Discuss any concerns with reception or your referring doctor before the day.
- If you find yourself constipated during the low-fibre phase, a daily dose of Movicol, Agarol or Coloxyl can help. Avoid fibre supplements such as Metamucil, Benefiber, or Psyllium in the lead-up.
Diet in the days before your procedure
What you eat in the lead-up matters, particularly for colonoscopy, because it affects how completely the bowel clears.
| Meat & eggs | Lean beef, veal, pork, grilled fish, eggs. Avoid fatty, fried, seasoned meats and stews. |
|---|---|
| Dairy | Milk, low-fat ice cream, plain yoghurt, butter, margarine. |
| Fruit & veg | Boiled or mashed potato, pumpkin, carrot or squash, stewed apples or pears (no skins or seeds). Avoid all other fruit and vegetables. |
| Bread & cereal | White bread, plain rolls, plain bagels, pancakes, cornflakes, rice bubbles, white rice, white pasta. Avoid wholemeal, rye, seeded breads, and wholegrain cereals. |
| Drinks | Tea, coffee, water, plain milk drinks, soft drinks, soy drinks, clear apple juice, clear soup. Avoid unstrained juice and flavoured milk. |
| Sweets | Honey, custard, yoghurt. Avoid pies, pastries, jam, dried fruit and nuts. |
Anything not listed above isn't permitted on the low-fibre diet.
The day before your procedure: your last low-fibre meal is lunch at 12pm. After that, clear fluids only, no milk and no solid food, and no dinner the evening before.
Clear fluids include: water, apple juice, clear soup (Bonox, consommé), jelly (avoid red colours), light-coloured sports drinks (Powerade, Gatorade), light-coloured soft drinks with no sediment (lemonade, ginger beer), and black tea or coffee with no milk. As a rule of thumb, if it stays see-through in a glass, it's fine.
If you have diabetes, are pregnant, or have another condition that affects fasting safety, flag this when your procedure is booked so your prep and fasting plan can be adjusted appropriately.
Costs and the Medicare gap
When you're admitted to a private hospital or procedure centre as a private patient, you may need to contribute toward the cost of your treatment. This out-of-pocket amount, sometimes called the medical gap, is the difference between the doctor's fee and the combined Medicare rebate and private health insurer benefit for the service.
Dr Fagan is registered with the Medical Gap Scheme of all Australian health funds. Many health funds now offer lower-premium contracts that pay doctors at a reduced rate (the MBS schedule fee). If your fund's contract doesn't pay the accepted Access Gap rates, there may be an out-of-pocket cost for you.
Self-funded (uninsured) patients are welcome. Contact reception for current procedure pricing. Note that the Medicare Gap Scheme applies only to policies and procedures within Australia, it doesn't apply to overseas health insurance, regardless of Medicare card status.