Rating the Quality of Bowel Preparation During Colonoscopy
➤ Adequacy of bowel preparation should be assessed after all appropriate
efforts to clear residual debris have been completed. (Strong; Low Quality
of Evidence)
➤ Measurement of the rate of adequate colon cleansing should be conducted
routinely. (Strong; Moderate Quality of Evidence)
➤ Adequate preparation, defined as cleansing that allows a recommendation
of a screening or surveillance interval appropriate to the findings of the
examination, should be achieved in 85% or more of all examinations on a
per-physician basis. (Strong; Low Quality of Evidence)
FDA-Approved Preparations
➤ Selection of a bowel-cleansing regimen should take into consideration the
patient's medical history, medications, and, when available, the adequacy
of bowel preparation reported from prior colonoscopies. (Strong;
Moderate Quality of Evidence)
➤ A split-dose regimen of 4 L PEG-ELS provides high-quality bowel
cleansing. (Strong; High Quality of Evidence)
➤ In healthy nonconstipated individuals, a 4-L PEG-ELS formulation
produces a bowel-cleansing quality that is not superior to a lower-volume
PEG formulation. (Strong; High Quality of Evidence)
OTC Non–FDA-Approved Preparations
➤ The OTC bowel cleansing agents have variable efficacy that ranges
from adequate to superior, depending on the agent, dose, timing
of administration, and whether it is used alone or in combination.
Regardless of the agent, the efficacy and tolerability are enhanced
with a split-dose regimen. (Strong; Moderate Quality of Evidence)
➤ Although the OTC purgatives generally are safe, caution is required when
using these agents in certain populations — for example, magnesium-
based preparations (both OTC and FDA-approved formulations) should be
avoided in patients with chronic kidney disease. (Weak; Very Low Quality
of Evidence)
Adjuncts to Colon Cleansing Before Colonoscopy
➤ The routine use of adjunctive agents for bowel cleansing before
colonoscopy is NOT recommended. (Weak; Moderate Quality of Evidence)
Recommendations
