How Long Does It Take For System To Clear Suprep

This information will help you get ready for your colonoscopy while you're under care at Memorial Sloan Kettering (MSK) using a SUPREP^® Bowel Prep Kit. Your doctor will give you a prescription for the kit.

A colonoscopy is an exam of your colon (large intestine). Your doctor will use a colonoscope (flexible tube with a camera on the end) to see the inside of your colon on a video monitor. During your procedure, your doctor can:

Remove a small sample of tissue (biopsy) for testing
Remove a polyp (growth of tissue)
Take photos of the inside of your colon

Follow these instructions carefully. It's very important that your colon is empty for your colonoscopy. If there's stool inside your colon, your doctor may not be able to see polyps or other problems inside your colon and you may have to repeat the procedure. If you have any questions, contact your doctor's office.

1 Week Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Examples are listed in the "Common anticoagulants (blood thinners)" table. There are others, so check with your doctor if you're not sure.

Common anticoagulants (blood thinners)
apixaban (Eliquis^®) cilostazol (Pletal^®) clopidogrel (Plavix^®) dalteparin (Fragmin^®)	enoxaparin (Lovenox^®) fondaparinux (Arixtra^®) heparin	rivaroxaban (Xarelto^®) tinzaparin (Innohep^®) warfarin (Coumadin^®)

Medications for diabetes

If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure. Tell your doctor you will be drinking a sugar-free clear liquid diet the day before your procedure.

If you take metformin (such as Glucophage^®or Glumetza^®) or a medication that contains metformin (such as Janumet^®), don't take it the day before or the day of your procedure.

Tell your doctor if you have an AICD

Tell your MSK doctor if you have an automatic implantable cardioverter-defibrillator (AICD). If you have this device, you will need to have your procedure done at Memorial Hospital (MSK's main hospital).

Get a letter from your doctor, if needed

If you have an automatic implantable cardioverter-defibrillator (AICD), you need to get a clearance letter from your cardiologist (heart doctor) before your procedure.
If you've had chest pain, dizziness, trouble breathing that's new or worse, or have fainted in the last 6 weeks, you need to get a clearance letter from your doctor before your procedure.

Your MSK doctor's office must receive your clearance letter at least 1 day before your procedure.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely and report concerns to your healthcare providers, if needed. Make sure to plan this before the day of your procedure.

If you don't have a responsible care partner to take you home, call one of the agencies below. They'll send someone to go home with you. There's usually a charge for this service, and you'll need to provide transportation. It's OK to use a taxi or car service, but you must still have a responsible care partner with you.

3 Days Before Your Procedure

Avoid certain foods

You should follow a low-fiber diet starting 3 days before your colonoscopy. During this time, do not eat:

Raw (fresh) fruits and vegetables.
Whole kernel corn, including canned corn
Whole grains (such as oatmeal, brown rice, quinoa, or wheat bread)
Seeds (such as poppy or sesame)
Nuts

Talk with your endoscopy nurse

An endoscopy nurse will call you between 8:00 am and 6:00 pm 3 days before your procedure. They will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which medications to take the morning of your procedure. Use the space below to write them down.

1 Day Before Your Procedure

Starting the day before your procedure, do not eat anything. Follow a clear liquid diet.

Follow a clear liquid diet

A clear liquid diet includes only liquids you can see through. Examples are listed in the "Clear Liquid Diet" table. While you're following this diet:

Don't eat any solid foods.
Try to drink at least 1 (8-ounce) glass of clear liquid every hour you're awake.
Drink plenty of liquids other than water, coffee, and tea.
Don't drink anything red, purple, or orange.
If you have diabetes, only drink sugar-free clear liquids and check your blood sugar level often. If you have any questions, talk with your healthcare provider.

Clear Liquid Diet
	Drink	Do Not Drink
Soups	Clear broth, bouillon, or consommé	Any products with particles of dried food or seasoning
Sweets	Gelatin, such as Jell-O^® Flavored ices Hard candies, such as Life Savers^®	Anything red, purple, or orange
Drinks	Clear fruit juices, such as apple, white cranberry, or white grape Soda, such as 7-Up^®, Sprite^®, ginger ale, or seltzer Gatorade^® Black coffee Tea Water	Juices with pulp Nectars Milk or cream Alcoholic beverages Anything red, purple, or orange

Note the time of your procedure

A staff member will call you after 11:00 am the day before your procedure. The staff member will tell you what time to arrive for your procedure. If you're scheduled for your procedure on a Monday, you will be called on the Friday before. If you don't receive a call, call your doctor's office.

If you need to cancel your procedure, call the doctor who scheduled it for you.

‌ Write your appointment information below.

Scheduled arrival time: ____________________
Date: ____________________

SUPREP bowel preparation

You will drink a large amount of cool liquid for your SUPREP bowel preparation. This may cause bloating or discomfort in your abdomen (belly), nausea, or a headache. These things aren't cause for alarm. If you have pain in your abdomen or vomit, call your doctor.

Do your SUPREP bowel preparation in 2 parts.

At 5:00 pm the evening before your procedure, start drinking the first part of your SUPREP bowel preparation. Start at 5:00 pm no matter what time you're scheduled to arrive for your procedure.

Empty 1 (6-ounce) bottle of SUPREP liquid into the mixing container.
Add cool drinking water up to the 16 ounce line on the container. Mix.
Drink all of the liquid in the container.
Drink 2 more 16-ounce containers of water (32 ounces total) over the next hour. You don't need to drink the water all at once, but it's important to finish all 32 ounces over the next hour.
After you finish all 32 ounces of water, you can keep drinking other clear liquids until 4 hours before your scheduled arrival time.

You will repeat steps 1 to 5 for the second part of your SUPREP bowel preparation. The time you start drinking the second part of your SUPREP bowel preparation depends on your scheduled arrival time.

If your scheduled arrival time is before 11:00 am, start at 8:00 pm the night before your procedure.
If your scheduled arrival time is 11:00 am or later, start at _____________ (5 hours before your scheduled arrival time) the day of your procedure.

The Day of Your Procedure

If your scheduled arrival time is 11:00 am or later, remember to start drinking the second part of your SUPREP bowel preparation 5 hours before your scheduled arrival time.

Starting 4 hours before your scheduled arrival time, do not eat or drink anything. This includes water, hard candy, and gum.

Things to remember

Take only the medications you were instructed to take the morning of your procedure. Take them with a few sips of water.
Don't put on any lotion, cream, powder, makeup, perfume, or cologne.
Remove any jewelry, including body piercings.
Leave valuable items (such as credit cards and jewelry) at home.
If you wear contacts, wear your glasses instead.

What to bring

A list of the medications you take at home, including patches and creams.
If you have an implanted pacemaker or cardioverter-defibrillator (AICD), bring your wallet card with you if it isn't already on file with the hospital.
Your rescue inhaler (such as albuterol for asthma), if you have one
A case for your glasses
Your Health Care Proxy form, if you have completed one

Where to go

Your procedure will take place at one of these locations:

Endoscopy Suite at Memorial Hospital (MSK's main hospital)
1275 York Avenue (between East 67^th and East 68^th Streets)
New York, NY 10065
Take the M elevator to the 2^nd Floor. Enter the Endoscopy Suite through the glass doors.
MSK Monmouth
480 Red Hill Road
Middletown, NJ 07748

What to expect

Once you arrive, you will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar names may be having procedures on the same day.

After changing into a hospital gown, you will meet your nurse. They will place an intravenous (IV) catheter into one of your veins, usually in your hand or arm. The IV will be used to give you anesthesia (medication to make you sleep) during your procedure. You may also get fluids through the IV before your procedure.

You will talk with your doctor before your procedure. They will explain the procedure and answer your questions.

You will also meet with your anesthesiologist. They will review your medical history with you and talk with you about the kind of anesthesia (medication to make you sleep) you will receive.

When it's time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through a thin tube that rests below your nose. You will lay on your left side with your knees bent. You will get anesthesia through your IV, which will make you fall asleep.

Once you're asleep, your doctor will examine your rectum. Next, they will place a colonoscope into your rectum. Your doctor will use air and fluid to move the colonoscope along the length of your colon while looking for anything unusual on the video monitor.

After Your Procedure

In the Post Anesthesia Recovery Unit (PACU)

You will wake up in the PACU. Your nurse will continue to monitor your heart, breathing, and blood pressure. You may feel bloated and have stomach cramps. This is normal and goes away by passing gas.

Once you're fully awake, your nurse will remove your IV. If you have someone waiting with you, your nurse will explain your discharge instructions to both of you before you go home.

At home

You can eat all of your usual foods after your procedure, unless your doctor gives you other instructions.
Don't drink alcoholic beverages for 24 hours after your procedure.
You can go back to doing your usual activities 24 hours after your procedure.

If you had a biopsy, it's normal to have a small amount of bleeding from your rectum. There should be no more than a few drops of blood, and the bleeding should stop within 24 hours after your procedure.

After a colonoscopy, it's normal for your bowel movements to be irregular or different from your usual habits. This may last for up to a week after your procedure.

When to Call Your Healthcare Provider

Call your healthcare provider if you have any of the following:

A fever of 101° F (38.3° C) or higher
Severe stomach pain or hardness
Bleeding from your rectum that lasts more than 24 hours
Bleeding between bowel movements
Weakness, faintness, or nausea
Heavy bleeding from your rectum

Contact Information

If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at 212-639-2210. After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000.

Low-Fiber Diet

See the next page for examples of foods to eat and foods to avoid while you're following a low-fiber diet.

	Low-fiber foods to eat	High-fiber foods to avoid
Grains	White bread Plain crackers, such as saltines Cooked cereals, such as cream of wheat or grits Cold cereals, such as corn flakes or puffed rice White rice, noodles, and pasta	Seeds, nuts, and coconut Popcorn Whole-grain products, such as pasta, cereals, crackers, and breads
Fruits and Vegetables	Well-cooked canned vegetables without seeds, such as asparagus tips, beets, green beans, carrots, mushrooms, spinach, seedless squash, and pumpkin Cooked potatoes without skin Ripe bananas Melon, such as cantaloupe and honeydew Canned or cooked fruits without seeds or skin, such as applesauce or pears Avocado	Most raw vegetables Most raw or dried fruits, such as pineapple, raisins, and figs Certain cooked vegetables, such as peas, broccoli, winter squash, Brussels sprouts, cabbage, corn (and corn bread), onions, cauliflower, and potatoes with skin
Meats and Proteins	Lean and tender meats, such as beef, lamb, chicken, fish, and pork Eggs	Beans Lentils Tofu
Snacks	Plain cakes and cookies Gelatin, puddings, custard, and sherbet Ice cream and popsicles Pretzels Vanilla wafers	Peanut butter Jam, marmalade, and preserves Popcorn
Drinks	Coffee and tea Carbonated drinks Milk Apple juice, no-pulp orange juice, and cranberry juice Strained vegetable juices	Fruit juices with pulp or seeds Prune juice Nectars