Update on Bowel Preparation for Colonoscopy

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.

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.