Excellent healthcare and an excellent healthcare experience.

The Elliot Endoscopy Center at River’s Edge, New Hampshire’s only ASGE recognized Center of Excellence

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Endo Group

About the Center

In April of 2011, Elliot Hospital opened the Endoscopy Center at River’s Edge.  The Center is conveniently located near the Queen City Bridge, in Manchester, with easy access to major highways.  River’s Edge Endoscopy is an outpatient, State licensed, Medicare Certified, JCAHO accredited Endoscopy Center. 

In 2012 the Endoscopy Center at River’s Edge became the only American Society for Gastrointestinal Endoscopy recognized Center of Excellence in the state of New Hampshire.  What is a Center of Excellence?  As stated by the ASGE:
The rationale for the Endoscopy Unit Recognition program was two-fold. First, ASGE recognized the need to standardize and promulgate best practices, particularly with regard to infection control, to help its members ensure that the endoscopic services they deliver are the highest in quality and safety. Second, the society also sought to provide a means for gastroenterologists, endoscopists, and the units in which they work to distinguish themselves from lesser-quality services offered in varied environments by many types of practitioners.

We are quite proud of our ASGE recognition as we are dedicated to providing a positive experience for all that enter our facility.  We recognize that each person has specialized needs and concerns, and our full attention is given to your care.  The River’s Edge team is comprised of a highly trained staff of registered nurses and technicians who are cross-trained to all areas of the Center.  Our nurses are certified in Advanced Cardiac Life Support and the Center maintains a policy of “readiness” for all medical emergencies.

If you have an upper endoscopy or colonoscopy appointment scheduled you can expect a nurse to call 1-2 weeks in advance to review your health history and answer any questions you may have. 

The Endoscopy Center at River’s Edge is open Monday through Friday 7:00am to 3:30pm. If you have concerns after hours and need to reach your Elliot GI physician please call 314-6900.

We are very pleased that you and your physician have chosen the Elliot at River’s Edge Endoscopy Center for your gastroenterology procedure.  Our website has been designed to provide you with an overview of our center and to inform you of what to expect before and after your procedure.  Please do not hesitate to call us if you have any concerns regarding your procedure at 603-663-4601.

Please Read:
General Information for Those Undergoing a Colonoscopy or Upper Endoscopy

Please know your insurance guidelines! If your insurance requires a PCP authorization (insurance referral), please be sure Elliot GI Associates has received this prior to your procedure. Please confirm that your primary physician has taken care of the referral.

Do verify your insurance benefits. Not all insurance policies cover screening colonoscopies. If you are under 50 years of age and/or have PPO insurance, this procedure may not be covered. Everyone’s insurance coverage is different; please contact your insurance plan’s customer service department to ascertain your benefit coverage.

You will receive intravenous sedation during this procedure, which requires monitoring of your blood pressure, heart rate and oxygen levels in your blood. The medications used during the procedure although relatively short acting, may have subtle prolonged effects on your reaction time, thought processes, and wakefulness. It is necessary that the following guidelines are followed:

You must arrange to have someone drive you home after the procedure. You may not drive yourself home as you are legally under the influence. Discharge in a cab is not acceptable unless you have a person to accompany you. You may not drive for the remainder of the procedure day.
No exceptions. 
If you have small children, arrangements should be made for their care for the entire day.
You may not return to work or sign legal documents.
Alcohol should not be consumed for the remainder of the day.
We fully expect you to return to normal activities the following day.

We will provide a light snack and beverage for you after your procedure.  If you have special dietary considerations and would like to bring your own snack please feel free. 

 Our department offers free WiFi access

 

What To Expect:

ColonoscopyColonoscopy

Overview: The Basics
A colonoscopy is a visual examination of the entire large intestine (colon) using a lighted, flexible colonoscope. To be certain you are comfortable and relaxed, you will be sedated through an I.V. Most people are asleep during the entire procedure and remember little to nothing about it. Your heart rate, breathing and blood pressure are monitored throughout the procedure. 

What to Expect: During the Screening
When it's time to start the screening, you will be asked to lie on your left side. Once sedation takes effect, the colonoscope is inserted through the rectum and navigated gently around the bends of the colon. As the colonoscope makes its way through the colon, the physician evaluates the lining of the colon for any abnormalities. Typically, the physician looks all the way to the end of the large intestine, and back, for anything unusual. The entire procedure generally takes between 15 and 30 minutes. When complete, your nurse will take you into a recovery area, where the sedation quickly wears off. Before you leave you will be made aware of your exam results and any pending pathology. The findings along with written discharge instructions will be sent home with you.

What can be found?
If polyps (abnormal growths of tissue) are found, your doctor can perform a biopsy immediately. Since most colon cancer starts as a benign polyp, when a polyp is removed the possibility of it turning into cancer is removed as well. The biopsy involves passing an instrument through the scope to remove the polyp, which is then sent to a laboratory to be analyzed. 

You will feel nothing when a biopsy or polyp is taken, and there will be no residual pain afterwards. While the overwhelming majority of polyps are harmless, polyps are always sent to the lab afterwards for analysis. After the procedure is complete you may experience some flatus, or gas that we will encourage you to expel.  The gas or air in your intestine is air we used to gently inflate the colon to ensure thorough viewing and has no odor.

 What happens afterwards?
The sedation wears off quickly, once you are awake and alert you will be offered a snack and your discharge instructions will be reviewed.  Even though you will feel fine, the lingering, subtle effects of the sedation will make it dangerous for you to drive, so a responsible adult must accompany you home. You should be able to resume normal activity the next day.

How to Prepare

Thorough cleansing of the entire bowel is essential for a thorough evaluation. Instructions for doing this will be given by your physician (see the tab for Bowel Preps on the home page).
  • If you take Coumadin (Warfarin), Plavix, Aggrenox, Ticlid, Lovenox or any other prescription blood thinner you MUST contact your primary care physician or the physician that prescribed the medication to you for instructions on IF and WHEN to stop the medication.
  • If you take insulin or oral diabetes medication, you must contact your prescribing physician for advice on adjusting your medication dosing.
  • You may continue your routine medication before the procedure unless listed above.
  • You may resume your diet as usual after the procedure.

 

To avoid dehydration, patients should drink clear, fat-free bouillon or broth, gelatin, strained fruit juice (no grape juice or any liquid with red color), water, plain and unsweetened coffee or tea, or soda. Unless otherwise instructed, continue taking any regularly-prescribed medication. Your physician may also ask you to stop taking iron preparations a few weeks before the test if you are on them. Finally, you need to arrange for someone to drive you home afterward because lingering, subtle effects of the sedation will make it unsafe for you to drive until the next day.
Your doctor will also want to know if you have heart disease, lung disease, or any medical condition that may need special attention.

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Bowel Prep


Bowel Prep using Nulytely

Split Dose Preparation Instructions using NuLytely

3 Days Before 2 Days Before Day Before Procedure Procedure Day

 

Review all prep instructions.

Fill NuLytely prescription at pharmacy.  You may use provided flavor packets or crystal light powder. Purchase 4 Dulcolax tablets.

Arrange and confirm your transportation. Day of procedure no driving all day
-If using public transportation you MUST have a responsible adult to accompany you.  No walking home.

Stop all Herbals and Supplements.

Call your prescribing provider for management of diabetic medications: pill controlled and/or insulin controlled.

 

Avoid nuts, popcorn, fruit and vegetable seeds and skin. 

Ensure that you have purchased your Prep solution.

Purchase approved clear liquids
- water, including vitamin waters
- chicken broth or bouillon
- clear fruit juices without pulp (apple, white grape)
- soft drinks; regular or diet
- Gatorade/powerade
- black coffee and black tea
- jell-o
- popsicles

No RED, BLUE, or PURPLE!

No Alcohol.

 

**Eat ONLY what is listed

Breakfast before  9am
2 eggs; 2 pieces white toast
         OR
1 cup plain/vanilla yogurt (no seeds, berries/fruit, nuts) & 1 banana

Refrigerate Nulytely.

After 9am drink only clear liquids throughout the day, NO FOOD. No Red, Blue, or Purple colored liquids are allowed. No milk or dairy products

Try to drink 8 glasses of water or approved clear liquid throughout the day to help prevent dehydration.

Start between 3-5pm take 4 Dulcolax tablets.  Drink only 32oz (1/2 of bottle) of Nulytely solution.  Drink 1 glass every 15-20minutes.  Refrigerate the remaining 1/2 of solution.
Take regular evening medications.

 

8 hours before arrival

  • No broth

5 hours before arrival

  • Start drinking remaining 32oz of Nulytle solution.  You MUST finish drinking the rest of the solution 4 hours before to your check in time.

4 hours before arrival 
NOTHING by mouth, or your procedure may be cancelled.

  • No gum
  • No hard candy
  • No smoking
  • No water

Leave all jewelry at home.  Please wear glasses, no contacts.  Please allow for 2 hours at the facility.

 

Purchasing Nulytely bowel preparation

  • Fill prescription for Nulytely, purchase 4 Dulcolax tablets.  The tablets can be purchased over the counter at any pharmacy.  If you have any questions please ask the pharmacist.  May use either liquid or powdered flavorings that are not red, blue, or purple. (crystal light is popular)

2 days before the procedures:

  • DO NOT eat seeds, nuts, popcorn, fruit and vegetable skins.  If you want apples, pears, or peaches you must peel them first.

Day before procedure:

  • Eat ONLY what is listed.
  • Breakfast to be eaten before 9am – you may have up to 2 eggs any style and 2 pieces of white toast (butter okay)  OR  1 cup plain or vanilla yogurt (no seeds, berries/fruit, nuts) and 1 banana.
  • Starting at 9am drink only clear liquids throughout the entire day.  Drink at least 8 glasses of water or clear liquids.  It is important to drink a lot of fluids the day before the procedure, as the preparation is very dehydrating. 
  • Approved clear liquids: water, clear broth or bouillon, black coffee, black tea, Gatorade, carbonated soft drinks, apple juice, white grape juice, jell-o, popsicles.  NO alcohol.
    • RED, BLUE, and PURPLE colored items are NOT allowed.
    • Milk and dairy products are NOT allowed. 
  • Mix and refrigerate Nulytely with flavoring if desired.
  • Between 3-5pm take the 4 Dulcolax tablets and begin drinking Nulytely solution.  Drink only 32oz (1/2 bottle) of Nulytely solution.  Drink 1 glass every 15-20 minutes.
  • Individual response to laxatives vary.  You may feel bloated, nauseated or have abdominal cramping while drinking the solution; this is temporary and will begin to disappear once you start having bowel movements.  Move around and drink slowly through a straw.  The prep often works within 2 hours of ingestion, but may take longer.

Day of Procedure:

  • No Broth 8 hours before your arrival time or your procedure may be cancelled.
  • 5 hours before your arrival time start drinking remaining 32oz (rest of bottle) of Nulytely solution.  Finish 32oz within 1 hour.
  • Nothing by mouth 4 hours before arrival time or your procedure may be cancelled
    • No gum, hard candies, or water!
  • 2 hours before to your arrival you may take only these medications with a small sip of water.
    • Daily narcotic
    • Anti-anxiety
    • Blood pressure medication
    • Seizure medication
    • Asthma inhalers
    • Acid reflux medication

 

  • Please contact the office with any medication questions. (603) 314- 6900

Stop Iron supplements and or multivitamins that contain Iron 10 days before to procedure.
If you take Coumadin or other anti –coagulant (blood thinning) medications, please advise our office and call your prescribing provider for instructions regarding these medications.
Please wear glasses, do not wear contacts.  Leave all jewelry at home, including body piercings.  It is okay to brush your teeth and wear dentures.  If menstruating, you may wear a tampon.  Please bring a complete list of medications you are currently taking to the facility with you.
We fully expect you will be able to return to your normal activities the day after your procedure, ie: return to work and drive.
You will receive a call from one of our nurses a few days before your procedure to review your health history and answer any questions you may have.  This will also help stream line the admission process the day of your procedure.

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Bowel Preparation For Your Procedure Using Miralax

Split Dose Preparation Instructions using Miralax

3 Days Before 2 Days Before Day Before Procedure Procedure Day

 

Review all prep instructions.

Purchase Prep solution, 1- 238 gram bottle of Miralax and 4 Dulcolax tablets. 1- 64oz bottle of approved clear liquid to mix with prep. (water, crystal light, clear juices watered down)

Arrange and confirm your transportation. Day of procedure no driving all day
-If using public transportation you MUST have a responsible adult to accompany you.  No walking home.

Stop all Herbals and Supplements.

Call your prescribing provider for management of diabetic medications: pill controlled and/or insulin controlled.

 

 

 

 

Avoid nuts, popcorn, fruit and vegetable seeds and skin. 

Ensure that you have purchased your Prep solution.

Purchase approved clear liquids
- water, including vitamin waters
- chicken broth or bouillon
- clear fruit juices without pulp (apple, white grape)
- soft drinks; regular or diet
- Gatorade/powerade
- black coffee and black tea
- jell-o
- popsicles

No RED, BLUE, or PURPLE!

No Alcohol.

 

 

 

**Eat ONLY what is listed

Breakfast before to 9am
2 eggs; 2 pieces white toast
         OR
1 cup plain/vanilla yogurt (no seeds, berries/fruit, nuts) & 1 banana

Mix and refrigerate Miralax.

After 9am drink only clear liquids throughout the day, NO FOOD. No Red, Blue, or Purple colored liquids are allowed. No milk or dairy products

Try to drink 8 glasses of water or approved clear liquid throughout the day to help prevent dehydration.

Start between 3-5pm take 4 Dulcolax tablets.  Drink only 32oz (1/2 of bottle) of Miralax solution.  Drink 1 glass every 15-20minutes.  Refrigerate the remaining 1/2 of solution.

Take regular evening medications.

 

 

 

8 hours before arrival

  • No broth

5 hours before to arrival

  • start drinking remaining 32oz of Miralax solution.  You MUST finish drinking the rest of the solution 4 hours before to your check in time.

4 hours before arrival 
NOTHING by mouth, or your procedure may be cancelled.

  • No gum
  • No hard candy
  • No smoking
  • No water

Leave all jewelry at home.  Please wear glasses, no contacts.  Please allow for 2 hours at the facility.

Purchasing Miralax bowel preparation

  • 238 gram bottle of Miralax.  4 Dulcolax tablets.  These can be purchased over the counter at any pharmacy.  If you have any questions please ask the pharmacist.

2 days before the procedures:

  • DO NOT eat seeds, nuts, popcorn, fruit and vegetable skins.  If you want apples, pears, or peaches you must peel them first.

Day before procedure:

  • Eat ONLY what is listed.
  • Breakfast to be eaten before 9am – you may have up to 2 eggs any style and 2 pieces of white toast (butter okay)  OR  1 cup plain or vanilla yogurt (no seeds, berries/fruit, nuts) and 1 banana.
  • Starting at 9am drink only clear liquids throughout the entire day.  Drink at least 8 glasses of water or clear liquids.  It is important to drink a lot of fluids the day before the procedure, as the preparation is very dehydrating. 
  • Approved clear liquids: water, clear broth or bouillon, black coffee, black tea, Gatorade, carbonated soft drinks, apple juice, white grape juice, jell-o, popsicles. NO alcohol.
    • RED, BLUE, and PURPLE colored items are NOT allowed.
    • Milk and dairy products are NOT allowed.
  • Mix and refrigerate Miralax with one of the above approved liquids.
  • Between 3-5pm take the 4 Dulcolax tablets and begin drinking Miralax solution.  Drink only 32oz (1/2 bottle) of Miralax solution.  Drink 1 glass every 15-20 minutes.
  • Individual response to laxatives vary.  You may feel bloated, nauseated or have abdominal cramping while drinking the solution; this is temporary and will begin to disappear once you start having bowel movements.  Move around and drink slowly through a straw.  The prep often works within 2 hours of ingestion, but may take longer.

Day of Procedure:

  • No Broth 8 hours before your arrival time or your procedure may be cancelled.
  • 5 hours before your arrival time start drinking remaining 32oz (rest of bottle) of Miralax solution.  Finish 32oz within 1 hour.
  • Nothing by mouth 4 hours before arrival time or your procedure may be cancelled
    • No gum, hard candies, or water!
  • 2 hours before your arrival you may take only these medications with a small sip of water:
    • Daily narcotic
    • Anti-anxiety
    • Blood pressure medication
    • Seizure medication
    • Asthma inhalers
    • Acid reflux medication
  • Please contact the office with any medication questions. (603) 314- 6900

Stop Iron supplements and or multivitamins that contain Iron 10 days before to procedure.
If you take Coumadin or other anti –coagulant (blood thinning) medications, please advise our office and call your prescribing provider for instructions regarding these medications.
Please wear glasses, do not wear contacts.  Leave all jewelry at home, including body piercings.  It is okay to brush your teeth and wear dentures.  If menstruating, you may wear a tampon.  Please bring a complete list of medications you are currently taking to the facility with you.
We fully expect you will be able to return to your normal activities the day after your procedure, ie: return to work and drive.
You will receive a call from one of our nurses a few days before your procedure to review your health history and answer any questions you may have.  This will also help stream line the admission process the day of your procedure.
Please call Elliot Gastroenterology at (603) 314-6900 with any questions.

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Two Day Bowel Prep: For Those With Chronic Constipation Or A History Of Poor Prep Results

  • You will need to purchase a small bottle of Miralax powder (this is an over the counter product) at the pharmacy as well as a 1 Liter beverage of your choice.
Also it is important to drink lots of water in the days preceding the procedure as this will help your body to more easily clean out for the procedure.
This is only an addition to the regular preparation instructions, please follow the rest of the packet as directed.

2 Days before your procedure please mix whole bottle of Miralax powder in 1 Liter of fluid and drink at 6PM. This is to help ensure that your preparations will be as effective as possible for your upcoming procedure. You will begin the clear liquid diet the following day as stated in the included instructions.

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Gastric Bypass Addendum

The day before your procedure you will need to follow the clear liquid diet as explained on the preparation instructions, additionally you will need to follow the instructions below:

1  Begin your preparation liquid at 2pm.
2  Drink a 4 oz glass followed by a second 4 oz glass approximately 20 minutes later. You should be drinking 2 glasses per hour
3 Repeat the same steps every hour until the prep is gone OR you are passing a clear to yellow liquid when having a bowel movement.

You will be able to maintain your clear liquid diet throughout the night but you will need to stop all beverage intake 4 hours prior to your procedure.

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Upper EndoUpper Endoscopy

Overview: The Basics
Also called an esophagogastroduodenoscopy, EGD or gastroscopy, an upper endoscopy uses a thin scope with a light and camera at its tip, called an endoscope, to look inside the upper digestive system of the esophagus, stomach and begining of the small intestine. The endoscope is passed through the mouth and down the throat to the esophagus. The duration of the procedure is about 5 -10 minutes.  Biopsies may also be taken and sent for analysis to rule out any tissue abnormality.

What to Expect: During the Screening
A bite block will be inserted to protect your teeth as well as the endoscope. You will lie on your left side, and, after the sedative has taken effect, the endoscope will be gently guided through the esophagus to the stomach and finally to the beginning of the small intestine. Air will be introduced through the endoscope to enhance viewing. The lining of the esophagus, stomach and upper small intestine is examined, and biopsies can be performed at the same time.

What can be found?
During this visual exam the physician is looking for ulcers, irritation, polyps, tumors and any general abnormality of these areas, a hiatal hernia or narrowing of the esophagus can also be seen.   If abnormality of any kind is noted, biopsies are often taken and sent to pathology for analysis.  You will be notified of all biopsy results within two weeks of your procedure by mail or phone.  If biopsies were taken and you have not been notified after two weeks please call the gastroenterologists office for the results.

How to Prepare
The stomach must be empty for the procedure to be thorough and safe. You should not eat any solid foods after midnight the night prior.  Clear liquids may be continued up to 4 hours prior to procedure time.  If you are on Plavix or any blood thinning agents you should speak with your primary physician regarding if/when these medications need to be held.


After the Procedure
On occasion there is some residual air left in the abdomen after the procedure, this is not painful and is similar to having a carbonated beverage.  Typically people state they feel as if they haven’t had anything done as there is no lingering soreness or pain.  Even though you will feel fine, the lingering, subtle effects of the sedation will make it dangerous for you to drive, so a responsible adult must accompany you home