Bowel Cleansing
Key Points
Key Points
- Colonoscopy is used widely for colorectal cancer (CRC) screening and surveillance and the diagnostic evaluation of symptoms and other positive CRC screening tests.
- The success of colonoscopy is linked closely to the adequacy of preprocedure bowel cleansing.
- Up to 20%–25% of all colonoscopies are reported to have an inadequate bowel preparation. The Multi-Society Task Force sets a new benchmark that at least 85% of all colonoscopies are rated as adequate on a per-physician basis.
- Adverse consequences of ineffective bowel preparation include lower adenoma detection rates, longer procedural time, lower cecal intubation rates, increased electrocautery risk, and shorter intervals between examinations.
- Consequently, the choice of a bowel cleansing regimen should be based on cleansing efficacy first and patient tolerability second.
Recommendations
...ommendatio...
Preliminary assessment of preparation qual...
...py is complete to cecum, and the pre...
...reparation is deemed adequate and the colono...
...Timing of Colon Cleansing Regimen...
...f a split-dose bowel cleansing reg...
...same-day regimen is an acceptable alternative...
...se of split preparation ideally should begin 4–6...
...t During Bowel Clean...
...g a split-dose bowel cleansing regimen, diet recom...
Usefulness of Patient Education and N...
...essionals should provide both oral...
...performing the colonoscopy should ensure tha...
...the Quality of Bowel Preparation During Colonoscop...
...equacy of bowel preparation should...
...the rate of adequate colon cleansing...
...uate preparation, defined as cleansing that allo...
...DA-Approved Preparatio...
...n of a bowel-cleansing regimen should take into co...
...split-dose regimen of 4-L PEG-ELS provides high...
...n healthy nonconstipated individuals,...
...C Non-FDA-Approved Pre...
...C bowel cleansing agents have variable e...
Although the OTC purgatives generall...
Adjuncts to Colon Cleansing Before Colonoscopy
The routine use of adjunctive agent...
...Patient Preference/Willingness to Repeat...
...-dose bowel cleansing is associated with greater w...
...he use of low-volume bowel cleansing age...
...of Bowel Preparation in Specific Pop...
...sufficient evidence to recommend specific bowel p...
...sufficient evidence to recommend s...
...uld be avoided in patients with known or suspec...
...onal bowel purgatives should be consid...
...ow-volume preparations or extended ti...
...ter enemas should be used to prepar...
...cient evidence to recommend specific regimens...
...e Options for Inadequate Preparation...
...emas can be attempted for patients who, pres...
...gh-the-scope enema with completion colonoscopy...
...the patient entirely from sedation...
Evaluation
...luation...
...ble 1. Aronchick Bowel Preparation Sc...
Table 2. Boston Bowel Preparation Scale...
...tawa ScaleThe Ottawa bowel preparation...