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Bowel Cleansing

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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

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