Key Points
GRADE Strength of Recommendations and Implications
Grade
Implications of strong and conditional (weak)
guideline recommendations
Strong • Patients: Most individuals in this situation would want the
recommended course of action and only a small proportion would not.
• Clinicians: Most individuals should receive the recommended course
of action. Formal decision aids are not likely to be needed to help
individuals make decisions consistent with their values and preferences.
Conditional
(weak)
• Patients: The majority of individuals in this situation would want the
suggested course of action, but many would not.
• Clinicians: Different choices will be appropriate for different patients.
Decision aids may well be useful in helping individuals making decisions
consistent with their values and preferences.
Clinicians should expect to spend more time with patients when
working toward a decision.
Reprinted with permission from Sultan et al. Clin Gastroenterol Hepatol. 2013;11:329–332.
➤ 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.
Key Points
