GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual)

ASGE guideline_bowel prep
Pdf Summary
This guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an updated, evidence-based overview of bowel preparation before colonoscopy, emphasizing its critical role in procedural success, patient safety, and adenoma detection.<br /><br />Key points include:<br /><br />1. Importance of Adequate Preparation: Poor bowel cleansing impairs mucosal visualization, reducing adenoma detection and increasing procedural risks. Inadequate preparation accounts for 10-20% of incomplete colonoscopies, with factors such as prior inadequate prep, certain medical conditions (diabetes, stroke, dementia), age, obesity, male sex, medication use, and poor adherence to instructions being predictive.<br /><br />2. Patient Education: Effective verbal and written instructions in the patient's native language, supplemented by visual aids or technology (e.g., educational booklets, smartphone apps), improve preparation quality and outcomes.<br /><br />3. Dietary Modifications: A low-residue diet before colonoscopy, often preferred over clear liquid diets, enhances tolerance without compromising preparation quality.<br /><br />4. Timing of Preparation: Split-dose regimens—dividing bowel prep between the day before and the morning of the procedure—show superior cleansing quality, improved adenoma detection rates, and better patient tolerance compared with single-dose dosing. For afternoon colonoscopies, same-day preparations can be effective and better tolerated.<br /><br />5. Bowel Preparation Agents:<br /><br />   - High-volume polyethylene glycol-electrolyte solutions (PEG-ELS, 4L) remain the criterion standard.<br /><br />   - Low-volume PEG preparations combined with ascorbic acid or sports drinks are alternatives, though some safety concerns exist especially regarding electrolyte shifts.<br /><br />   - Oral sodium sulfate (OSS) preparations have shown comparable efficacy and better tolerability.<br /><br />   - Sodium phosphate and magnesium citrate are not recommended in elderly or patients with renal impairment due to risk of nephropathy and electrolyte disturbances.<br /><br />   - Combination agents like sodium picosulfate/magnesium citrate are approved but may have mild gastrointestinal side effects.<br /><br />6. Adjunctive Measures: Laxatives such as bisacodyl or senna may reduce required prep volume but carry risk of adverse effects; metoclopramide is not recommended; simethicone reduces bubbles and may improve visualization but does not affect prep quality.<br /><br />7. Documentation and Management: Endoscopists should document bowel preparation quality using validated scales (Aronchick, Ottawa, Boston). Inadequate prep necessitates repeat colonoscopy within one year, with immediate repeat sometimes possible following additional cleansing.<br /><br />8. Special Populations: Pediatric preparations vary and require individualized approaches.<br /><br />Recommendations emphasize individualized prep choice, patient education, use of split-dose or same-day regimens, avoidance of high-risk agents in vulnerable patients, and proper documentation. These measures aim to improve bowel cleansing efficacy, patient safety, and overall colonoscopy quality.
Keywords
bowel preparation
colonoscopy
adenoma detection
patient education
split-dose regimen
polyethylene glycol
oral sodium sulfate
low-residue diet
bowel cleansing quality
special populations