Updated bowel preparation regimens for colonoscopy: benefits and drawbacks

Optimal bowel preparation is critical for high-quality colonoscopy and the effective prevention of colorectal cancer. Although traditional high-volume polyethylene glycol (PEG) electrolyte lavage solutions are effective and safe, they are frequently limited by poor patient tolerability. To improve adherence, several low- and ultralow-volume PEG-based regimens, particularly 2 L and 1 L PEG plus ascorbate, have demonstrated noninferior efficacy and better patient compliance. Hyperosmotic alternatives, including oral sulfate solution and sodium picosulfate with magnesium citrate, provide comparable bowel-cleansing efficacy and are often favored for their improved palatability and tolerability. The recent introduction of oral sulfate tablets offers the convenience of a tablet form while maintaining efficacy similar to that of PEG-based regimens and significantly enhancing tolerability. However, a few cases of gastric mucosal irritation have been reported. Adjunctive simethicone also improves mucosal visibility by reducing intraluminal bubbles. With the growing diversity of bowel preparation options, regimen selection should be tailored to individual patient characteristics, including age, comorbidities, prior experiences, and personal preferences. A personalized evidence-based approach, guided by patient-specific factors and supported by emerging clinical data, can improve adherence, ensure adequate bowel cleansing, and enhance the diagnostic yield and procedural efficiency of colonoscopy.