➤ 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
