Optimal bowel prep for quality colonoscopy outcomes

The U.S. Multi-Society Task Force on Colorectal Cancer (MSTFCRC) developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the colonoscopy findings. MSTFCRC recommends using a split-dose bowel preparation regimen and suggests that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy. Still, MSTFCRC suggests a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. MSTFCRC recommends limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. MSTFCRC suggests the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.