Carson Endoscopy Center

Reno Endoscopy Center South Meadows Endoscopy Center Carson Endoscopy
Center
880 Ryland Street 10619 Professional Circle 1385 Vista Lane
Reno, Nevada 89502 Reno, Nevada 89512 Carson City, Nevada
89703
(775) 329-1009 (775) 852-1886 (775) 884-8818
For Scheduling Changes, please call:
Reno (775) 329-4600 South Meadows (775) 852-4848 Carson (775) 884-4567
Patient Name: ________________________________
_____________
________________
Carson Endoscopy Center
Appointment Date:
Check-in Time:
FECAL TRANSPLANT AND GASTROSCOPY PREPARATION
Your physician has determined that you are a candidate for fecal transplant via gastroscopy
(EGD). It is very important that you follow the instructions below as carefully as possible. If you
have any questions, please call our procedure facility prior to your examination so we may take
care of any concerns well ahead of time.
Special Considerations
If any of the following apply to you, please let us know well in advance of the examination so that
we can provide special instructions:
• You take ANY medication that prevents your blood from clotting, ie. Coumadin
(warfarin, Jantoven), Plavix, Pradaxa, and Effient
• You have ANY condition requiring antibiotics
• You have diabetes
Special Instructions: (see individual sections below for detailed instructions)
1. Select Stool Donor in conjunction with your MD
2. The week before your procedure Obtain:
a. Stool donor lab tests
b. Prescriptions as ordered
c. Blender
d. New container with lid that can be securely sealed; plastic or glass is acceptable.
Selecting a Stool Donor: Your physician will help you determine a suitable stool donor. Your
physician will give lab testing orders to your stool donor.
Preferred stool donors (in order of preference) are:
1. Someone you are in intimate physical contact with; your spouse or significant partner
2. Another household member
3. Any other healthy donors.
Screening and preparation of stool donors:
1. Donor should not have received antibiotic therapy in the past six (6) months. If the
donor has
received antibiotic treatment within the last six (6) months, notify your MD
immediately.
2. Donor blood and stool test: seven (7) days prior to donation, the donor blood and
stool is to be tested for evidence of previous exposure to contagious infectious agents. These
tests are to be done at a laboratory of the donor’s choice. Please take the physician
order for blood and stool
tests to the lab.

a. Note: Contact the lab the week prior to the test to obtain stool sample
collection kit and
any special instruction for collection.
b. Note: Lab test results will be filed into the fecal transplant recipient’s medical
record.
Medication Preparation for stool transplant recipient
• 2 weeks prior to the procedure fill prescriptions and take as directed:
• Take the Xifaxin 550mg as directed: take ½ of the 550mg tablet three times by mouth daily
starting 10 days before the procedure. Discontinue the Xifaxin 24 hours before the procedure
date.
Start Date for Xifaxin: ______/_______/_______
Stop Date for Xifaxin: ______/________/_______
Take One Nexium 40mg , Prevacid 30mg or Omeprazole 20mg by mouth the evening before the
procedure and One Nexium 40mg, Prevacid 30mg, or Omeprazole 20mg by mouth the morning of
the procedure. Take the Nexium 40mg, Prevacid 30mg or Omeprazole 20mg with a small sip of
water.
EGD Prep Instructions:
The Day before the Procedure: ____/____/____
• You may have your usual diet during the day but only clear liquids after 8 p.m.
Foods allowed: water, clear fruit juices (pulp-free, no red or purple), soft drinks (no red or purple),
strained soups and bouillon, Jell-O (no red or purple), Popsicles (no red or purple), black coffee or
tea, and Lifesavers (no red or purple).
NO SOLID FOODS, COFFEE, OR MILK PRODUCTS ARE ALLOWED
• Your stomach must be empty when we perform the procedure
• Follow your normal medication schedule with sips of water or other clear liquids.
The Day of the Procedure: ____/____/____
• Do not eat anything before the procedure except for small amounts of clear liquids
such as water, clear sodas, clear fruit juices (pulp-free, no red or purple), and bullion
(absolutely nothing by mouth four (4) hours before the procedure).
• Take your usual a.m. medications (high blood pressure medication, etc.) up to four (4) hours
before the procedure with small sips of water. If you have an early procedure (before 10 a.m.)
you should take you’re a.m. medications right after the procedure.
Stool Specimen Preparation:
The Day of the Procedure, within six (6) hours of the procedure time:
• Obtain stool sample within six (6) hours of the transplantation procedure. Stool should not
come into contact with toilet water or bowl, sample can be collected in a container or by
placing clear plastic wrap over bowl water. Transfer approximately one (1) to two (2) inches
of stool sample into a secured container.
• Place container with sample into paper bag and bring to the Center by 8 am (regardless of
procedure time, sample required to be at Center by 8 am for processing).
GENERAL INFORMATION
• Leave all jewelry and valuables at home.Bring your inhalers if you use them
• If applicable, please bring your glasses and/or hearing aids.
• Your dentures will be removed during the exam for safety reasons.

• Do not forget to arrange for transportation home after the procedure. Since you have
been sedated you will be unable to drive for the remainder of the day. You will not be
able to operate any machinery or go to work until the following day.
• If leaving by taxi, you will not be allowed to leave by yourself. You must be
accompanied by a friend or relative.
• Co-Pay, Co-Insurance and Deductible amounts are due at the time of service. Please
be prepared to pay for these fees on the day of your procedure.
• If you are coming from out of town or staying at a place other than your main residence,
please call our office and leave a number where you can be reached.
Reno Endoscopy Center (775) 329-1009
South Meadows Endoscopy Center (775) 852-1886
Carson Endoscopy Center (775) 884-8818
All Out of Town Patients (800) 442-0041