GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (On-Demand) | February 2026-USMSTF

USMSTF_optimizing bowel prep
Pdf Summary
The US Multi-Society Task Force on Colorectal Cancer (USMSTF), comprising the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy, has issued updated consensus recommendations (2025) to optimize bowel preparation quality for colonoscopy. Adequate bowel preparation—where the colon is sufficiently clean to assign standard screening or surveillance intervals—is fundamental for effective colonoscopy, improving adenoma detection rates and reducing colorectal cancer risk.<br /><br />Key recommendations include:<br /><br />1. Patient Education and Navigation: Strongly recommend verbal and written instructions covering all preparation steps. Suggest use of patient navigation, including telephone or electronic messaging, to improve preparation adequacy.<br /><br />2. Diet: Limit dietary modification to the day before colonoscopy for average-risk ambulatory patients, using low-residue or low-fiber diets or full liquids for early and midday meals. Extended dietary restrictions offer no additional benefit.<br /><br />3. Bowel Preparation Regimens: No single purgative has proven superior. Suggest low-volume (2 L) regimens over 4 L ones for average-risk patients due to improved tolerability without efficacy loss. High-risk patients or those with prior inadequate prep should receive enhanced regimens—including split-dose 4 L polyethylene glycol–electrolyte lavage solution plus bisacodyl, low-residue diet 2–3 days prior, switching to clear liquids day before.<br /><br />4. Timing: Strongly recommend split-dose regimens (half the dose evening before, remainder 4–6 hours before colonoscopy, completing at least 2 hours before procedure) for all patients. Same-day regimens acceptable alternatives for afternoon colonoscopies but inferior for morning cases.<br /><br />5. Adjuncts: Suggest adjunctive use of oral simethicone (≥320 mg) to reduce bubbles and possibly improve polyp detection. Routine use of other adjuncts not recommended due to limited evidence.<br /><br />6. Assessment during Colonoscopy: Suggest limited endoscope insertion to sigmoid colon when patients report inadequate prep before aborting procedures. Strongly recommend assessing bowel cleanliness after all washing and suctioning, using clear, standardized scales like the Boston Bowel Preparation Scale, and documenting adequacy to inform surveillance intervals.<br /><br />7. Salvage Maneuvers: Same-day interventions (e.g., enemas, additional purgative ingestion) may salvage inadequate preparations when feasible.<br /><br />8. Quality Monitoring: Strongly recommend routine tracking of bowel preparation adequacy at both individual endoscopist and unit levels, targeting ≥90% adequacy rates. Include canceled procedures for inadequate prep in these metrics.<br /><br />9. Post-Procedure Management: When prep is inadequate and not salvageable, recommend repeating colonoscopy within 12 months for screening or surveillance, sooner if for symptoms or abnormal non-colonoscopic screening tests. Modify prep regimens for repeat procedures.<br /><br />These consensus recommendations aim to improve colonoscopy quality, increase adenoma detection, reduce colorectal cancer risk, and enhance patient experience through tailored bowel preparation regimens, education, timing, and quality monitoring.
Keywords
US Multi-Society Task Force
colorectal cancer
bowel preparation
colonoscopy
adenoma detection
patient education
dietary recommendations
bowel prep regimens
split-dose timing
quality monitoring