Dotolo Research
Corporation970 Harbor Lake DriveSuite ASafety Harbor, Florida 34695727-723-7777www.dotoloresearch.comColon Hydrotherapy for Pre-endoscopy preparation
Hebei Medical
Journal, Dec 2004, Vol 25, No. 12
Nurse Hua JH, Surgeon
Zhao Fa, Guo LinLi
ABSTRACT:
Objective:
To evaluate the effectiveness of colon hydrotherapy in preparing the
large bowel for colonoscopy, as a new approach to pre-colonoscopy preparation.
Method:
Colon hydrotherapy was carried out in 690 patients who were scheduled
for colon-oscopy. The degree of
cleansing achieved was determined and documented after colonoscopy. Results: Colon hydrotherapy procedure carried out to
prepare the large bowel for colonoscopy was successful in 98% of cases.
Summary:
Colon hydrotherapy is an effective means of cleansing the large bowel in
cases undergoing colonoscopy. It
is more effective than the use of either oral mannitol or magnesium sulfate as
a means of cleansing the large intestines prior to colonoscopy.
Colonoscopy is an important diagnostic procedure undertaken
to evaluate colon disorder.
Preparing the bowel is necessary prior to colonoscopy, to allow clear
visualization of the bowel wall and any pathology within. There are presently a number of
recommended measures to prepare the large bowel. These include the use of enema, oral mannitol and oral
magnesium sulfate. At the
hospital, we have been carrying out colon hydrotherapy using the Toxygen Model
BSC UV colon hydrotherapy instrument manufactured by Dotolo Research USA prior
to colonoscopy with the Olympus CF-230 colonoscopy since August 2000. Results have proved to be very
satisfactory.
1. METHODOLOGY 1.1 Materials
Details of patients undergoing colonoscopy after colon
hydrotherapy sessions were documented between Aug 2000 and April 2003. There was a total of 690 patients, 378
males and 312 females; age ranged from 26 to 76 years – average of 49
years. Among them were 144 cases
requiring polypectomy, 74 cases with chronic constipation and 116 cases with
history of diarrhea. Cases with
constipation were prescribed 50 mls of 33% Magnesium sulfate at 8:00 p.m. of
the night before colonoscopy to facilitate the softening of stool in the bowel.
1.2 Colon
hydrotherapy procedure
Colon hydrotherapy sessions are carried out using an
instrument to introduce water into the large bowel. Water is filtered to remove solid sediments and particles as
well as passed through an ultra-violet unit to kill bacteria and viruses prior
to infusion. Water pressure and
temperature is carefully monitored throughout the procedure. Abdominal massage carried out by the
therapists during the procedure facilitates the elimination of waste matter
from the entire length of the colon.
This ensures that the colon is adequately cleansed.
Preparing for the procedure is simple. The patient maintains normal meals
without the need for fasting.
Prior the procedure, the bladder is emptied. After lying down, he assumes the Sim’s position, (lying of
left side, left leg straightened and right leg bent towards chest to allow
examination of anus and insertion of speculum). A digital rectal examination is carried out to ascertain
there is no anal or rectal pathology, anal tone and direction of rectal
passage.
After the speculum is connected to the colon hydrotherapy
instrument with disposable tubing, the tip of the speculum is lubricated with
Vaseline cream or surgical lubricant and inserted through the anus into the
rectum. Care is taken to ensure
insertion follows the anatomy of the rectal passage. After insertion, patients assume a supine position.
The patient is ready to proceed with the cleansing
procedure. Purified and
ultra-violet light irradiated water which is pre-heated to between 36 t0 39
degree C by the colon hydrotherapy instrument is then infused into the patient
under low pressure. When the
patient experiences a strong urgency to evacuate, the flow is terminated and
outflow valve is opened to allow the colon to spontaneously empty itself
(emptying phase) of waste which is carried out by the outflow of water. During this emptying phase, abdominal
massage is carried out along the length of the colon to push the water deeper
until it reaches the cecum. Massage
also help to loosen the waste from the colon wall and to encourage peristaltic
action of the colon. A series of
fill and emptying phase is carried out until the discharging effluent is clear
of fecal matter. The speculum is
then withdrawn. Time taken to
complete the colon hydrotherapy sessions varies between 30 to 60 minutes with
an average of 46 minutes.
1.3 Results
Findings on colonoscopy after colon hydrotherapy were
categorized as:
RESULTS
VIEW OF COLON
LOOSE DEBRIS/WASTE
REMARKS
Excellent
Clear
Negligible
Good
Clear
Small amount, not affecting results
Satisfactory
Adequate
Moderate amount
Require adjustment eg. Flushing, position change for
proper viewing
Poor
Inadequate
Significant amount
Colonoscopy unsuccessful
1.
Excellent: clear view of
colon lumen with negligible amount of retained debris.
2. Good: clear view of colon lumen with small
amount of retained debris, not affecting vision.
3.
Satisfactory: clear view of lumen only with positional adjustment and
some flushing during
procedure, waste moderate amount.
4. Poor: view of lumen and introduction of scope
affected by significant amount of retained waste.
Colonoscopy unsuccessful.
Results of findings were blinded to individual
colonoscopist.
Criteria 1,2,3 indicated successful procedure. Criteria 4 indicate unsuccessful
procedure.
For ascending colon: result was as follows
Excellent:
total 630 = 91.30%
Good: 45
Poor: 15 = 8.70%
For transverse colon: result was as follows
Excellent:
total 675 = 97.82%
Good: 9
Poor: 6 = 2.17%
For descending colon: result was as follows
Excellent:
total 684 = %
Good: 3
Poor: 3 = %
Patients with poor results generally had swelling within
lumen interfering with entry of scope.
Patients response from questionnaire survey indicated 651
(94.30%) were receptive of colon hydrotherapy as a pre-colonoscopy preparatory
measure. A small number indicated
there were slight abdominal discomfort and abdominal distension during
procedure.
DISCUSSION
Preparing the colon is a necessary step for
colonoscopy. Standard
pre-colonoscopy preparation procedure varies with different hospitals and even
with different practitioners performing colonoscopy. Each approach has its pros and cons. The degree of effectiveness wee usually
similar – to provide a clear view during colonoscopy.
Prior to the introduction of colon hydrotherapy, our
department was using the following colon prep method.
- Oral
Mannitol
- Oral
Magnesium sulfate
The action of oral Mannitol on the colon is due to its lack
of absorption by colon resulting in an increase of osmotic pressure within the
colon lumen. Thus water is
retained resulting in distension of colon lumen and reflex peristalsis which
helps to expel colon contents and empty the colon. However, oral Mannitol can be acted upon by the intestinal
flora and can lead to gaseous build up and over distension. If Mannitol prep is used prior to
certain surgical procedures with high frequency electronic equipment, it is
potentially hazardous with possibility of being explosive in nature.
Use of Magnesium sulfate requires 100 to 150 mls of 33%
MgSO4 to be given orally 5 hours prior to colonoscopy. This is followed 30 minutes later with
drinking of 1.0 to 1.5 liters of water.
Patient should be fasting prior to colonoscopy. This method offers a 95% success rate.
Patients using this approach need to undergo a fasting
period and thus may not be suitable in diabetic patients and those who are
unable to tolerate a fast. For the
elderly and frail individual who may have mobility problems and difficulty
getting to the toilet quickly due to the induced diarrhea, it is also not
recommended. In addition MgS04 may
be nauseating to some and prevent large volume of fluids being consumed, thus
making this approach unsuitable for clearing the bowels.
Other methods such as the used of enema agent is possible
but results are different from colon hydrotherapy. Enema products tend to only clear waste from the rectum and
distal part of the colon. Colon
hydrotherapy can effectively remove waste from the entire length of the colon
without the discomfort and distress associated with an enema.
Colon hydrotherapy is not only useful in cleansing the
colon; it avoids the discomfort of diarrhea episode, the need to drink a large
volume of water with its potential upset of electrolyte balance or to undergo a
period of fasting. Normal intake
of food and drinks is allowed although reduce amount is recommended. Chronically constipated patients do not
have to undergo fasting; however it is recommended that they are prescribed a
dose of 50 mls 33% MgS04 on the night before the procedure. This assists in softening fecal matter
up to the cecum. Colon
hydrotherapy is carried out 2 hours prior to colonoscopy.
Since we started using colon hydrotherapy in preparation of
patients undergoing colonoscopy in our hospital, we achieved excellent results in
630 patients and good results in 45 patients giving a 98% success in our study
population of 690 patients.
In the early days of our study, a small portion of our
patients had minor abrasion and small bleed on the surface of the rectum
wall. This commonly occurs as a
result of forceful insertion of the speculum without realizing the anatomy of
the ano-rectal passage. A rectal
examination with the forefinger will help to determine the anal tone, the
direction of passage, any mass within lumen and surrounding structure. Such precautions are necessary to avoid
injury to rectal wall. This rectal
examination together with a brief clinical history and examination is necessary
as a pre-screening procedure for all patients undergoing colon hydrotherapy.
Colon hydrotherapy is a simple and effective way to prepare
the colon for colonoscopy as well as other colon procedures, especially in the
elderly, frail and constipated. It
is also useful in diabetics and patients unable to undergo fasting as well as
those who are unable to tolerate an episode of diarrhea.
Colon hydrotherapy actively promotes peristalsis, enhancing
the tone of the colon musculature and supports the elimination of physical as
well as toxic waste from the colon.
This is of advantage to patients suffering from constipation and those
with poor bowel habits.
We have been using the colon hydrotherapy instrument which
is FDA registered and manufactured by Dotolo Research of USA. The instrument incorporates
temperature, pressure and flow control to ensure safety of the procedure. Pressure of water rarely exceeds 2 psi
(pound per sq. inch) to achieve the necessary results in elimination of
waste. In the USA, the use of the
instrument for over 30 or more years has not resulted in any adverse incident. The use of disposable speculum and
tubing recommended maintains hygiene and avoids contamination. Patients undergoing the procedure have
expressed a high level of satisfaction.
With the increasing level of effluence, it is expected colon hydrotherapy
will become a recommended preparatory approach for individuals who require
colonoscopy.
Reference:
*Several references from other Chinese publications quoted.
