GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (On-demand)

ASGE guideline_bowel prep

Pdf Summary

The American Society for Gastrointestinal Endoscopy has issued guidelines on bowel preparation for colonoscopy. This includes recommendations for endoscopists to ensure the integrity of the procedure, improving diagnostic accuracy and reducing risks of adverse events. The guidelines underscore the importance of thorough bowel cleansing for complete visualization of the colon, specifying that inadequate cleaning can lead to missed lesions and increased procedural complications.<br /><br />Key factors predicting inadequate bowel preparation include prior history of inadequate preparation, language barriers, certain demographics, and medical conditions like diabetes and obesity. Effective preparation methods involve both dietary restrictions and cathartics. Clear liquids, preferably not red, are generally recommended a day before the procedure, though some studies suggest low-residue diets could be equally effective.<br /><br />A split-dose regimen, where part of the cathartic dose is taken the evening before and the remainder the morning of the colonoscopy, is recommended for better preparation and patient compliance. For afternoon procedures, preparations may occur entirely on the day of examination. The guideline also highlights the importance of verbal and written patient education, ideally in the patient's native language, to enhance the effectiveness of preparation.<br /><br />Several preparation types are reviewed, including high-volume polyethylene glycol (PEG) solutions, sulfate-free preparations, and low-volume combinations with other agents. Each has its own benefits and drawbacks, and careful selection considering patient-specific factors is advised.<br /><br />Documentation of bowel preparation quality during colonoscopy is critical and can be performed using validated scales such as the Aronchick and Boston Bowel Prep Score. The guidelines advocate for frequent review and update based on evolving evidence and technological advancements, aimed at standardizing procedures and improving patient outcomes. These recommendations aid in decision-making but do not replace clinician judgment on a case-by-case basis.

Keywords

colonoscopy guidelines

bowel preparation

endoscopists

diagnostic accuracy

bowel cleansing

split-dose regimen

patient education

preparation methods

polyethylene glycol

documentation quality