Enhancing bowel preparation for colonoscopy: an integrative review

Colorectal cancer is the third most common cancer and second leading cause of cancer-related deaths in the United States. Currently, colonoscopy is considered the gold standard to detect colorectal cancer. Poor bowel preparation in patients undergoing colonoscopy compromises the quality and efficacy of this procedure, affecting patient outcomes and increasing overall costs. With up to 25% of patients undergoing colonoscopy having poor bowel preparation, interventions to enhance the quality of bowel preparations are vital to improving clinical practice. Through an extensive review of the current literature, split-dose bowel preparation regimens appear to be the most well-supported and plausible intervention for meaningful change in efforts to enhance bowel preparation. Several studies of high quality and strength have drawn consistent conclusions that split-dose bowel preparations result in significantly better bowel cleansing than traditional day-prior bowel preparation regimens. Strengths, limitations, gaps in the current literature, and areas for future research are identified, which can help to direct future studies needed to strengthen the evidence and determine further practice initiatives to address the problem of poor bowel preparation for colonoscopy.