GuidelineBowel preparation before colonoscopy
Section snippets
General considerations
It is important that patients are educated and engaged in the colonoscopy preparartion process,13 and it has been shown that effective education significantly improves the quality of bowel preparation.14 Patient counseling along with written instructions that are simple and easy to follow and in their native language should be provided to patients,15 and patient education may improve with the use of visual aids.16 Recently, educational booklets were shown to improve bowel preparation and
Timing of preparation
Giving part (usually half) of the bowel preparation dose on the same day as the colonoscopy (termed split-dose) results in a higher-quality colonoscopy examination compared with ingestion of the entire preparation on the day or evening before colonoscopy.31, 32, 33, 34, 35, 36, 37, 38, 39 A higher-quality bowel preparation due to this split-dose has been demonstrated to increase the adenoma detection rate.40 In addition to a higher-quality bowel preparation, split-dosing also improves patient
Regimens for colonic cleansing before colonoscopy
The currently available preparations commonly used for colonoscopy preparation are summarized in Table 2. For the purposes of this document, the classification of preparations as high-volume denotes that the preparation requires at least 4 L of cathartic consumption. Preparations described as low-volume preparations require smaller volumes of cathartic consumption, but the reader should understand that the recommended additional fluid intake with so-called low-volume preparations may approach 4
Laxatives
Laxatives such as bisacodyl and/or magnesium citrate are administered in some regimens to reduce the volume of lavage solution required and hence volume-related symptoms, such as abdominal bloating and cramping. Bisacodyl is a diphenylmethane derivative that is poorly absorbed in the small intestine and is hydrolyzed by endogenous esterases. Its active metabolites stimulate colonic peristalsis.107 One study of bisacodyl as a preparation adjunct found that the laxative shortened the duration of
Documentation of preparation quality
It is important for preparation quality to be properly documented in colonoscopy reports. The U.S. Multi-Society Task Force on Colorectal Cancer defines an adequate examination as one that allows confidence that lesions other than small (≤5 mm) polyps were generally not obscured by residual colonic contents.123 In clinical practice, preparation quality should be graded after efforts to remove residual effluent and fecal debris have been completed. Validated scoring systems that have been
Inadequate bowel preparation
Inadequate bowel preparation for colonoscopy can result in missed lesions, canceled procedures, increased procedural time, increased costs, and a potential increase in adverse event rates.127, 128 In patients with fair bowel preparations, 28% to 42% had adenomas found when the examination was repeated within 3 years, including up to 27% with advanced adenomas.128, 129, 130 It has been estimated that intraprocedural cleansing accounts for 17% of total colonoscopy procedural time.131 One study
Recommendations
- 1.
We recommend that bowel preparations be individualized by the prescribing provider for each patient based on efficacy, cost, safety, and tolerability considerations balanced with the patient’s overall health, comorbid conditions, and preferences. ⊕⊕⊕⊕
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We recommend that verbal counseling regarding preparation administration be provided to patients along with written instructions that are simple and easy to follow and in their native language. ⊕⊕⊕○
- 3.
We suggest intensive education and more aggressive
Disclosure
The following authors disclosed financial relationships relevant to this article: Dr Khashab is a consultant for and on the Advisory Board of Boston Scientific, is a consultant for Olympus America, and has received research support from Cook Medical. Dr Chathadi is a consultant for Boston Scientific. Dr Fisher is a consultant for Epigenomics. Dr Cash is on the Speakers’ Bureau of Salix. Dr Hwang is on the Speakers’ Bureau of Novartis, has received a grant from Olympus, and is a consultant for
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2023, Journal of Perianesthesia NursingCitation Excerpt :A written colonoscopy application protocol, including the pre-colonoscopy nutrition protocol and a routine hospital application, was given to all three groups as they made an appointment. The educational booklet and video, prepared by the researcher in line with the previous studies contained information about the colonoscopy procedure itself, why it was necessary to carry it out, intestinal preparation before the colonoscopy, physical characteristics of the colonoscopy room, position required and the special pants worn during colonoscopy, people present in the colonoscopy room, problems that might occur during the colonoscopy, the fact that colonoscopy is no test to be embarrassed about, and what happens after the colonoscopy.37-41 During the preparation of the video, the A Dance with Cancer Association was contacted and permission was obtained for the use of the video that they had prepared about colonoscopy.
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This document was developed by the ASGE Standards of Practice Committee. This document was reviewed and approved by the Governing Board of the ASGE.
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Drs Saltzman and Cash contributed equally to this article.