Purpose of review: Colonoscopy is the gold standard for visualization and diagnosis of conditions involving the colon and terminal ileum. It also facilitates screening and prevention of colorectal cancer, which is the second leading cause of cancer death in the USA. Adequate cleansing is essential for thorough visualization of the colon with successful detection of colon polyps.
Recent findings: While the original large-volume polyethylene glycol preparations are still commonly used, several lower volume regimens are widely available and selected based on provider and patient preferences. There remains a strong urge from patients for an even lower volume and more palatable regimen. Split-dose preparation is strongly recommended and additional data has come to support same-day preparation regimens as well. Despite extensive research and comparison of various preparation regimens, between 10 and 25% of patients continue to have inadequate colon cleansing on the day of colonoscopy. Several patient factors have been associated with poor preparation and this chapter will touch on scoring systems, which may be used to predict colon cleansing. Documentation of preparation quality is essential to guide the practitioner in timing of follow-up examination. We recommend the use of the Boston Bowel Preparation Scale (BBPS) which is a validated and reliable scale for evaluation of cleansing. In patients with an inadequate preparation, we emphasize the importance of repeat examinations with consideration of a more aggressive preparation regimen. We predict that dietary liberalization prior to colonoscopy will be more commonly practiced in the future as it improves both patient satisfaction and adherence. Thorough bowel cleansing is essential for visualization of the colon with successful detection of colon polyps. While polyethylene glycol regimens are still the most commonly used for preparation, recommendations regarding dose timing and volume continue to evolve to optimize patient satisfaction and success of bowel cleanse. As the patients presenting for colonoscopy are evermore complex with medical comorbidities and extensive medication lists, a patient-centered approach to colonoscopy preparation will likely yield the highest rates of success.
Keywords: Bowel preparation; Colonoscopy; Polyethylene glycol; Quality.
Usefulness of an Intensive Bowel Cleansing Strategy for Repeat Colonoscopy After Preparation FailureM Ibáñez et al. Dis Colon Rectum 54 (12), 1578-84. PMID 22067188. - Clinical TrialAn intensive regimen consisting of a low-fiber diet, bisacodyl, and a split dose of polyethylene glycol can achieve good colon preparation with an improved detection rate …
Randomized Controlled Trial Comparing Efficacy and Acceptability of Split- And Standard-Dose Sodium Picosulfate Plus Magnesium Citrate for Bowel Cleansing Prior to ColonoscopyG Manes et al. Endoscopy 46 (8), 662-9. PMID 25019969. - Randomized Controlled TrialThe split-dose regimen of PMC was superior to the standard regimen in terms of effective colon cleansing and compliance.ClinicalTrial.gov (NCT01909219).
Administration of Olive Oil Followed by a Low Volume of Polyethylene Glycol-Electrolyte Lavage Solution Improves Patient Satisfaction With Right-Side Colonic Cleansing Over Administration of the Conventional Volume of Polyethylene Glycol-Electrolyte Lavage Solution for Colonoscopy PreparationE Abut et al. Gastrointest Endosc 70 (3), 515-21. PMID 19555936. - Randomized Controlled TrialPretreatment with olive oil before administration of a low volume of PEG-ELS enhances both patient satisfaction and the quality of right-side colonic cleansing over the a …
Bowel Cleansing Before Colonoscopy: Balancing Efficacy, Safety, Cost and Patient ToleranceNM Harrison et al. World J Gastrointest Endosc 8 (1), 4-12. PMID 26788258. - ReviewEffective colorectal cancer screening relies on reliable colonoscopy findings which are themselves dependent on adequate bowel cleansing. Research has consistently demons …
Achieving the Best Bowel Preparation for ColonoscopyA Parra-Blanco et al. World J Gastroenterol 20 (47), 17709-26. PMID 25548470. - ReviewBowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleas …
Cited by 1 PubMed Central articles
Bowel Preparation: The Elderly, the Hospitalized, and the ColonoscopeT AlAmeel. Saudi J Gastroenterol 24 (2), 73-74. PMID 29637912.