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Bowel Cleansing

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➤ Preliminary assessment of preparation quality should be made in the rectosigmoid colon, and if the indication is screening or surveillance and the preparation clearly is inadequate to allow polyp detection >5 mm, the procedure should be either terminated and rescheduled or an attempt should be made at additional bowel cleansing strategies that can be delivered without cancelling the procedure that day. (Strong; Low Quality of Evidence) ➤ If the colonoscopy is complete to cecum, and the preparation ultimately is deemed inadequate, then the examination should be repeated, generally with a more aggressive preparation regimen, within 1 year. Intervals <1 year are indicated when advanced neoplasia is detected and there is inadequate preparation. (Strong; Low Quality of Evidence) ➤ If the preparation is deemed adequate and the colonoscopy is completed then the guideline recommendations for screening or surveillance should be followed. (Strong; High Quality of Evidence) Dosing and Timing of Colon Cleansing Regimens ➤ Use of a split-dose bowel cleansing regimen is strongly recommended for elective colonoscopy. (Strong; High Quality of Evidence) ➤ A same-day regimen is an acceptable alternative to split dosing, especially for patients undergoing an afternoon examination. (Strong; High Quality of Evidence) ➤ The second dose of split preparation ideally should begin 4–6 hours before the time of colonoscopy with completion of the last dose at least 2 hours before the procedure time. (Strong; Moderate Quality of Evidence) Diet During Bowel Cleansing ➤ By using a split-dose bowel cleansing regimen, diet recommendations can include either low-residue or full liquids until the evening on the day before colonoscopy. (Weak; Moderate Quality of Evidence) Usefulness of Patient Education and Navigators for Optimizing Preparation Results ➤ Health care professionals should provide both oral and written patient education instructions for all components of the colonoscopy preparation and emphasize the importance of compliance. (Strong; Moderate Quality of Evidence) ➤ The physician performing the colonoscopy should ensure that appropriate support and process measures are in place for patients to achieve adequate colonoscopy preparation quality. (Strong; Low Quality of Evidence) Recommendations

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