SUPREP-Ensure Split Preparation

SUPREP-Ensure Split Preparation for Colonoscopy

In order to achieve an accurate evaluation of your lower gastrointestinal (GI) tract, it is important that you properly prepare for the procedure. Doctors are able to obtain the clearest view of the bowel when it is flushed completely free of waste material. The thoroughness of this intestinal cleaning depends on you. Without your cooperation, the examination cannot accomplish its purpose and may have to be repeated.

If you are taking anticoagulants or blood thinners such as (but not limited to) those listed below, please discuss this with your Health Care Provider. In most circumstances, these medications are temporarily discontinued prior to your procedure.

• Coumadin (warfarin)
• Plavix (clopidogrel)
• Persantine (dipyridamole)
• Aggrenox (aspirin-dipyridamole)
• Effient (prasugrel)
• Pradaxa (dabigatran etexilate)
• Xarelto (rivaroxaban)
• Eliquis (apixaban)

This bowel preparation should not be used if you have a history of congestive heart failure, renal failure or renal impairment.

Certain weight reduction and diabetic medications can slow the emptying of the stomach and increase the risk of aspiration when sedated for the procedure. Some of these are commonly called GLP-1 medications. Examples include semaglutide (Wegovy, Oxempic, Rybelsus), terzepatide (Mounjaro), dulaglutide (Trulicity) and exenatide (Byetta) in addition to others. Some of these medications need held up to a week before the procedure. If you have not reviewed your medications with us, please contact the office to review. Using your patient portal is the best and most efficient way to communicate with us.

Note; Our instructions for the SUPREP may differ slightly from the package inset. Please follow our instructions. This prep is split into two parts. The second part is taken about 6 hours after the first.

If you have questions or you need to reschedule or cancel your procedure, please call (717) 761-0930.

Supplies

1. SUPREP Bowel Prep Kit – Prescription sent to your local pharmacy.
2. Three bottles of Ensure Plus® or Boost Plus®.  Any flavor you would like.  If you are a diabetic, you should choose Ensure Max Protein or Boost Max which have less sugar.

5 Days Before Procedure

1. Confirm you have a friend or family member to take you home.  You cannot drive for 12 hours after the procedure.  Unfortunately, at this point in time, state regulations do not permit patients who have been sedated to be taken home through a driving service such as Uber or Lyft.
2. Do not take any ibuprofen or similar products (nonsteroidal anti-inflammatories – NSAIDS). Tylenol (acetaminophen) is allowed. If you are on aspirin, you may continue the aspirin.
3. Do not take oral iron tablets.
4. Avoid foods that contain seeds or nuts. These foods take longer to pass through the bowel and should be avoided.
5. It is best to lighten your diet a few days before the procedure.  It will make the prep go more easily.
6. If you feel constipated, it is advised to take a stimulant laxative such as Dulcolax of Senna.

The Day Before Procedure

1. Morning: Drink one, 8-ounce bottle of Ensure or Boost. You may also have a light breakfast such as scrambled eggs, dry cereal, no-grain toast, coffee or tea (no milk or cream).  Drink 2 to 3 glasses of water.  You can continue a clear liquid diet.
2. Noon: Drink another 8-ounce bottle of Ensure or Boost.  Follow with another 2 to 3 glasses of water. You can also continue a clear liquid diet.
3. Afternoon: Drink the third 8-ounce bottle of Ensure or Boost.  We suggest drinking the third bottle of Ensure or Boost around 4 pm the day before your procedure.  You can also continue a clear liquid diet.

First Dose of the Preparation

1. At 5:00 p.m., pour one (1) 6-ounce bottle of SUPREP into the mixing container provided.  Add COLD water to the 16-ounce line on the container, and mix. Drink all the liquid in the container within 20 minutes. You must drink two (2) more 16-ounce containers of water over the next hour.  You may drink more fluid if you’d like.

Second Dose of Preparation

1. Seven (7) hours before your scheduled procedure, pour one 6-ounce bottle of SUPREP liquid into the mixing container. Add cool drinking water to the 16-ounce line on the container and mix. Drink ALL the liquid in the container. You must drink two (2) more 16-ounce containers of water over the next 1 hour. You can continue a clear liquid diet up until four (4) hours of the procedure.  You must have completed the prep 4 hours prior to your procedure time.

NOTES:

1. If you are scheduled for an early morning procedure, you will need to set your alarm to assure the preparation is taken at the correct time. We are aware of the inconvenience and your disrupted sleep, but the two-stage prep provides a superior cleansing of the colon.  Many studies have confirmed that the two-stage prep with the second stage completed as close to 4 hours as possible before the procedure provides a superior prep, increases identification of pre-malignant polyps, and reduces the likelihood of developing colon cancer.
2. It is normal to feel very “full” or “bloated” during your prep. Some people may also experience nausea and vomiting. If this occurs, simply wait about 30 minutes before resuming drinking.  Sipping some ginger ale can help.  Walking around can also help move the fluid downstream and relieve the nausea. The nausea will likely disappear once bowel movements begin. If the vomiting becomes persistent, please call our office at (717) 761-0930.
3. If your bowel movements are not clear or pale yellow an hour after completing the prep, please call our office at (717) 761-0930.

On the Day of the Procedure

1. Do not have anything to eat.
2. At 6:00 a.m., take any currently prescribed thyroid, heart and blood pressure medications (except for blood thinners, as detailed above) with a sip of water.
3. If you are diabetic: Do not take your diabetic medications (pills or insulin) the morning of your procedure. If you normally monitor your blood sugars at home, please check your blood sugar the morning of your procedure. If your blood sugar is over 150 or below 90, please contact the West Shore Endoscopy Center at (717) 975-2430. An anesthesia specialist will provide you with further instructions.
4. If you have asthma, COPD or another lung condition for which you regularly take an inhaler, please bring the inhaler with you.
5. You may drink clear liquids until 4 hours before your procedure.   No chewing gum, hard candy or chewing tobacco should be consumed no less than 4 hours before your appointment.
6. Please report to your appointment at the scheduled time. NOTE: Plan to be at the procedure center for about two to two and one-half hours.
7. A driver must come with you in order to drive you home after the procedure. You will be sedated for your colonoscopy. You may not drive for 12 hours after the procedure. For later afternoon procedures, drivers must be present no later than 4:00 p.m. The West Shore Endoscopy Center closes at 4:00 p.m.