Colonoscopy Bowel Prep Guidelines Updated by US Multi-Society Task Force on Colorectal Cancer
New evidence-based guidance for bowel prep considers patient preference and history and updates timing of prep regimen, dietary restrictions, and follow-up recommendations.
On March 4, the US Multi-Society Task Force on Colorectal Cancer (MSTFCRC) released updated consensus recommendations for optimizing the quality of bowel preparation before colonoscopy. The guidelines, which emphasize clinical strategies before, during, and after the procedure, update practice guidance last published in 2014.
©Issara/stock.adobe.com
The revised evidence-based recommendations focus on a patient-centered approach to the prep process and procedure. MSTFCRC authors emphasize patient education, patient history and choice of preparation, prep timing, and volume of preparation doses, as well as salvage maneuvers to account for inadequate prep.
“Colorectal cancer remains the second most common cause of cancer death in the United States, and colonoscopy is considered the gold standard for evaluating the colon, including assessing causes of colon-related signs or symptoms and the detection of precancerous lesions,” the MSTFCRC authors wrote. “It is well recognized that the adequacy of bowel preparation is essential for optimal colonoscopy performance.”
Recognizing that adequacy as a quality benchmark, the task force recommends a target of at least 90% both at the level of individual endoscopists and endoscopy units. "Our guidance, which is an update of the 2014 recommendations, aims to help all gastroenterologists achieve a benchmark of 90% of exams with adequate bowel preparation," Joseph C. Anderson, MD, a co-lead author of the MSTFCRC recommendations, said in a news release.
Without adequate advance cleaning of the colon, important findings, such as small polyps, may be missed. “Many cases end up cancelled when the bowel preparation is inadequate, and that creates tremendous frustration for patients and inefficient use of resources,” Brian C. Jacobson, MD, MPH, also a co-lead author, said.
The guidance, published in the journals of the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, aims to ensure high-quality bowel preparation, a critical factor in detecting precancerous lesions and preventing colorectal cancer.
Select Recommendations and Key Concepts
- Choice of bowel pre regimen: Selection should consider patient preference, comorbidities, safety, cost, and ease of administration. Individual medical history and previous prep adequacy should guide regimen choice.
- Dosing and timing: Splitting doses between the night before and 4 to 6 hours before the start of the colonoscopy is effective for morning procedures. A same-day regimen is suitable for afternoon colonoscopies but is considered less effective for morning procedures.
- Dietary restrictions: For individuals at low risk for inadequate prep, dietary limitations should be confined to the day before colonoscopy, with clear liquids or low-fiber, low-residue diets for earlier meals.
- Assessing bowel prep: Endoscopists should evaluate preparation quality only after thorough washing and suctioning, using standardized descriptors. "Adequate bowel preparation" should indicate that standard screening or surveillance intervals can be followed based on findings of the procedure.
- Quality monitoring: Institutions should track bowel preparation adequacy at both individual and unit levels, targeting a rate of 90% or higher.
According to the authors, the majority of the MSTFCRC recommendations focus on outpatients at low risk for inadequate bowel cleansing, but they also include statements addressing those at risk for inadequate bowel prep quality.
The recommendations reflect evolving evidence on optimizing bowel preparation to enhance detection rates and patient outcomes while improving procedural efficiency, according to MSTFCRC authors. The objective in standardizing best practices for colonoscopy bowel prep, the team said, is to reduce the incidence of colorectal cancer through more effective screening.
