Capsule Endoscopy Instructions

Day Before the Procedure:

On the day before your procedure, you can enjoy breakfast followed by a light lunch. Please document what you had for lunch. After lunch, you will begin a clear liquid diet for the remainder of the day/night before the procedure (nothing red to drink).

• Mix seven (7) capfuls (119 grams) of Polyethylene glycol (MiraLAX®, ClearLax, PureLax, GaviLax, LavaClear brands) with 32 oz. of water or non-red electrolyte replacement drink and drink all contents.

• At 9:30 pm, take .6mL of Mylicon (simethicone) drops mixed well with 8 oz. water. • Nothing to drink after 10pm (small sips of water with medications allowed).

Day of the Procedure:

Hold medications until 2 hours after swallowing the capsule unless your doctor deems it necessary, then take small sips of water with medications.

• Two (2) hours prior to the time scheduled to swallow the capsule, mix 1 capful (17 grams) of Polyethylene glycol (MiraLax, ClearLax etc.) with full glass of water or non red electrolyte replacement drink. The Polyethylene glycol bottle top is a measuring cap marked to contain 17 grams of powder when filled to the indicated line.

• Arrive at our office at your scheduled appointment time.

• Swallow CapsoCam Plus capsule with 0.6 ml of Mylicon drops in 8 oz of water. • Resume clear liquids two (2) hours after swallowing the capsule.

• Four (4) hours after swallowing capsule, mix 17-grams of Polyethylene glycol (MiraLax, ClearLax etc.) with full glass of water or non-red electrolyte replacement drink, drink all of the contents.

• Enjoy a light lunch any time after drinking the last dose of Polyethylene glycol (MiraLax, ClearLax, etc.). Please document what you have for lunch.

• Eat normally for dinner. No further diet restrictions are necessary.

Please note:

• Strictly following the aforementioned instructions, the capsule will typically take 3- 30 hours to pass. If you haven’t passed the capsule at 72 hrs. after swallowing the capsule, contact your physician.

• Please adhere to the instructions for capsule and return capsule back to the office when convenient or if instructed, please drop off at local FedEx location.

• To avoid a repeat of this study, please adhere to instructions and use the retrieval pan provided until the capsule is collected.

• If provided a pre-labeled padded envelope in your take-home kit, place the capsule inside the capsule container. Ensure the lid of the capsule container is closed, put the capsule container into the zip bag and seal it. Place the zip bag with the capsule container inside in the envelope, seal and drop the envelope off at any FedEx drop box or physical FedEx location.

• Place the capsule inside the capsule container. Ensure the lid of the capsule container is closed. Return the capsule to the physician’s office during normal working hours.

Visit capsovision.com/patient-resources/what-to-expect-with-capsocam to watch the retrieval video instructions if desired.