A H y d r o P r e p C a s e Study: S o u t h L a k e T a h o e
A HydroPrep Case Study: South Lake Tahoe
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By Susan Frailey, RN, BSN
At Barton Memorial Hospital (BMH), in South Lake Tahoe, Calif., patients undergoing colonoscopy now
have a new prep option. The HydroPrep is a combination of low-volume oral prep, clear liquids the day
before colonoscopy, plus colon hydrotherapy the morning of the procedure.
This combination w a s used by the ACG Scientific Study preformed at Danbury Hospital In Connecticut In
2006. Go-Lytely, Phospho Soda, and the HydroPrep were compared regarding visual clarity in all
quadrants of the colon, along with patient satisfaction.
Dotolo Research Toxygen BSC-UV colon hydrotherapy device w a s used, and electrolyte studies were
performed.
So how does the HydroPrep work? Patients are Instructed to have a light, low-fat breakfast followed by
clear liquids the day before colonoscopy. The oral prep consists of four Dulcolax at 10 a.m., followed by
three packets of Miralax in 12 ounces of water at noon. One gallon of water throughout the day is also
advised. Patients are typically finished eliminating by 5 p.m. and are ready for a good night's sleep.
Patients can delay the oral prep until 3 p.m. If they are working during the day before their colonoscopy.
The patient Is NPO after midnight.
The morning of the colonoscopy, patients come in for colon hydrotherapy. Colon hydrotherapy is a safe,
gentle, and effective method of removing w a s t e from the large intestine using purified w a t e r via FDAapproved colon hydrotherapy equipment. The system is closed and uses a pre-packaged, single-use,
disposable speculum, water, and w a s t e lines,
The patient lies supine on a comfortable table while purified w a t e r flows slowly into the colon with the
assistance of an endoscopy nurse certified in colon hydrotherapy. Flow, temperature and pressure are
monitored while the nurse practices specialized technique and patient care. Water and w a s t e are
released when the large intestine is full or pressure Indicates, This process is repeated four to five times
during the approximate 45-minute treatment.6 Cleaning the equipment is straightforward, and done
according to manufacturer Instructions.
The HydroPrep evolved at Barton Memorial from the need to offer patients a new option of bowel prep for
colonoscopy due to intolerance of the high-volume preps. BMH w a s witnessing a cancellation rate of five
percent due to this situation. Patients experienced excessive vomiting, dehydration, or inability to
consume all the volume required to continue and keep their colonoscopy appointment, setting up the
potential for a missed cancer.
Barton Memorial Hospital's gastroenterology department coincidentally had a nurse experienced in colon
hydrotherapy. She w a s certified through the Shea International School of Colon Hydrotherapy, and
subsequently owned and operated a colon hydrotherapy business for four years. With data from the
Danbury study, assistance from Dotolo Research, Inc., and a nurse certified In colon hydrotherapy, a plan
for the new service w a s implemented in February 2011.
The HydroPrep became an instant success and patient cancellations dropped dramatically. Through wordof-mouth and local advertisement, colonoscopy with the HydroPrep booked six w e e k s in advance, six
months after Its inception. Three additional endoscopy nurses were certified in colon hydrotherapy during
this time through a program offered by More Alive Now, LLC, an approved provider by the California Board
of Nursing and Dotolo Research, Inc.
The demand for a new prep option arose from patients who could not tolerate the high-volume preps, but
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A HydroPrep C a s e S t u d y South Lake T a h o e
BMH's Statistical survey has shown that 65 percent of HydroPrep patients are experiencing a colonoscopy
for the first time. Sixty-six percent of survey respondents said they chose BMH for colonoscopy because
the HydroPrep w a s offered. The gender ratio is 57 percent female, and 43 percent male.
Barton has also s e e n an increase in patients scheduling from out of the a r e a .
Many of the remaining patients presenting for the HydroPrep came from the classic group of people
dreading and putting off their follow-up colonoscopies, even if they had positive history. Several of these
patients did, in fact, have pre-cancerous polyps at the time of their follow-up colonoscopy with the
HydroPrep.
There has been one failed HydroPrep since program initiation on a patient who presented with liver
d i s e a s e , on a liver transplant list, and taking Lactulose daily. Lactulose w a s withheld, along with other
medications, and the patient had no response to the oral preps probably due to dependency. Colon
hydrotherapy w a s performed and w a s tolerated very well, but bowel prep remained inadequate in the
right, and portions of the transverse colon. Patient continued a clear liquid diet, repeated oral preps, and
colonoscopy w a s successfully completed the next day.
All colonoscopy preps have the potential to achieve adequate visualization of the colon. Much depends on
patient health history and compliance. The Danbury results show advantages with the HydroPrep as far
as visual clarity, patient hydration, and comfort, but the bottom line is that patients want it. Barton
Memorial Hospital's patient satisfaction surveys have been overwhelmingly positive.
After the HydroPrep w a s established, patients who chose Go-Lytely and experienced intolerance halfway
through were able to come in for colon hydrotherapy to keep their scheduled colonoscopy appointment.
At Barton Memorial Hospital the charge for colon hydrotherapy for colonoscopy Is $100 dollars. This
amount w a s chosen to cover the cost of the packaging, machine, nurse and use of the room. BMH does
not make money on the colon hydrotherapy, but this service does allow patients to be s e e n for
colonoscopy. All patients pre-pay and are more than willing to comply.
The HydroPrep is a simple and cost-effective solution to the gastroenterology department and meets
demand for a new prep option. This new service now has an established direction, and nurse certification
can be accomplished in a three-day program, after facility s e t up.
The HydroPrep, which includes colon hydrotherapy, is an evidence-based practice. With certified
endoscopy nurses, a professional setting, and standardized prep, patients now have another choice. The
HydroPrep for colonoscopy has been proven safe and effective, and has Increased patient satisfaction.
What Patients are Saying
"The hydrotherapy nurses are a w e s o m e ! As is the rest of the crew. First-time colonoscopy... I w a s
hesitant because of the prep. I will recommend hydro to all!"
" I know a couple of other people that will probably schedule this procedure. They have been putting off
their colonoscopy due to that AWFUL prep. This is definitely the way to go! Thanks to all!"
"All went well. I will return for the same prep."
"For an experience I w a s dreading, the hydrotherapy helped a lot to take the discomfort out of the
equation."
"Much better than oral preps!"
"The hydro nurse w a s great! She made the procedure about as good as it could be!"
"It w a s a great option versus my previous Go-Lytely and Phospha experiences. I have told all of my
friends and they are asking their GI doctors why it isn't offered at their facility!"
Lastly, one patient offered the following testimonial:
"Dear Barton Hospital,
"I wanted to personally thank the Barton Hospital executive t e a m . Dr. Norman, and S u s a n Frailey, RN, for
their willingness to offer this alternative colonoscopy prep.
"Four years ago I had a colonoscopy and used the Golytely prep. Unfortunately that prep made me quite
sick and therefore the results were clouded and potential polyps couldn't be s e e n . I had to follow that
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A HydroPrep C a s e S t u d y South Lake T a h o e
colonoscopy with a same-day barium enema which gave the s a m e inconclusive results. Not a fun day to
say the least!
"With a new family history of colon polyps, I knew I had to repeat the colonoscopy! I really didn't want to
go through the whole ordeal again, but thankfully Dr. Makris and Dr. S h a n a h a n urged me to.
"Donna from Dr. Norman's office s e n t me a letter telling me about the option of colon hydrotherapy. I
jumped at the chance and I w a s so thankful I did. The "day before" prep w a s so much easier and didn't
make me sick. The colon hydrotherapy w a s a comfortable, private experience and not embarrassing.
S u s a n Frailey made me feel relaxed and confident in her expertise. I felt like it w a s a very effective prep
and that good visualization of the colon would be possible.
"Dr. Norman did find a precancerous polyp and it w a s removed. Knowing that I will need a repeat
colonoscopy in three years makes the colon hydrotherapy prep a desirable option for me, which is one of
the reasons I'm writing and urging you to keep this prep a s an option.
"Thank you again for being open minded to alternatives for your patients.
"Sincerely,
(Anonymous)"
Evidence
ACG 2006: The American College of Gastroenterology Annual Scientific Meeting
This study compares the three preps for colonoscopy: Phospho Soda, Go-Lytely, and HydroPrep.
Patients were randomly assigned to receive 4 L PEG-ES, two d o s e s of aqueous sodium phosphate, or
same-day hydrotherapy, as bowel preparation. The endoscopists were blinded to the method of
preparation. The overall quality of the colon cleansing w a s evaluated with respect to the adequacy of
visualization of the right, t r a n s v e r s e , and left colon. Patients were asked to rate the preparation with
respect to e a s e , convenience, and comfort using structured, validated questionnaire. Results were
analyzed using the chi square test.
Conclusion: The quality of colon cleansing, overall tolerance, comfort, and convenience were significantly
better for colon hydrotherapy. In this study ASP w a s better than PEG-ES for the same parameters.
To download the full study, visit
www.MoreAliveNow.com.
Susan
Frailey, RN, BSN, is a gastroenterology
nurse at Barton Memorial
Hospital,
founder
of
MoreAliveNow.com
and author of "More Alive Now: Simple Nutrition to Change Your Life." Susan is a certified
colon
hydrotherapy
instructor
and offers an RN training program
exclusively
for hospitals
CEP approved
by the CA Board of
Nursing.
References
1. ACG 2006: The American College of Gastroenterology, Annual Scientific Meeting, Abstract Number:
751814, Joseph Fiorito MD, Department/Institute: Gastroenterology, Danbury Hospital
2. Effects of Colon Irrigation on Serum Electrolytes.J G Collins, ND, P Mittman ND, Journal of Naturopathic
Medicine, Vol. 1, 1990
3. Value of Colon Hydrotherapy, Medical Journalist Report, M Walker, DPM, 2000
4. Bartonhealth.org
5. DotoloResearch.com
6. MoreAliveNow.com
r.endonurse.com/articles/2012/08/a-hydroprep-case-5tudy-south-lake-tahoe.aspx