The management of 'hard-to-prepare' colonoscopy patients

Expert Rev Gastroenterol Hepatol. 2017 Aug;11(8):731-740. doi: 10.1080/17474124.2017.1338947. Epub 2017 Jun 14.


Effective bowel cleansing is crucial for high quality colonoscopy. A notable portion of patients still present with low quality bowel preparation prior to their colonoscopy, compromising the overall quality of their colonoscopy. Areas covered: This review focuses on the main strategies that can improve the cleansing quality with a special interest on those clinical conditions that have been associated with a poor bowel preparation quality, such as patients with chronic constipation, history of bowel resection, liver cirrhosis, diabetes mellitus and chronic kidney disease. The review provides a practical and evidence-based approach to help clinicians in the management of 'hard-to-prepare' patients. Expert commentary: In the past few years, the quality of colonoscopy has become a hot topic and bowel cleansing is a crucial part of it; however, the approach to patients with an increased risk of poor bowel preparation quality is still not always supported by high-quality evidence, since most of these patients are routinely excluded from the clinical studies. Trials focused on this subgroup of patients are recommended to provide tailored bowel preparation regimens and guarantee high-quality procedures.

Keywords: Bowel preparation; bowel resection; chronic constipation; chronic kidney disease; colorectal resection; diabetes mellitus; liver cirrhosis; low-fiber diet; quality of colonoscopy; split-dose.

Publication types

  • Review

MeSH terms

  • Adenoma / epidemiology
  • Adenoma / pathology*
  • Adenoma / physiopathology
  • Cathartics / administration & dosage*
  • Colon / drug effects*
  • Colon / pathology*
  • Colon / physiopathology
  • Colonic Neoplasms / epidemiology
  • Colonic Neoplasms / pathology*
  • Colonic Neoplasms / physiopathology
  • Colonoscopy*
  • Comorbidity
  • Constipation / epidemiology
  • Constipation / physiopathology
  • Defecation / drug effects*
  • Drug Administration Schedule
  • Humans
  • Pamphlets
  • Patient Education as Topic / methods
  • Predictive Value of Tests
  • Therapeutic Irrigation / methods*


  • Cathartics