Improving Quality and Safety in the Endoscopy Unit (On-demand) | November 2025-Optimizing Bowel Preparation for Colonoscopy: Updated Guidance from the US Multi-society Task Force

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This updated guidance from the US Multi-Society Task Force, presented by Dr. Brian C. Jacobson, focuses on optimizing bowel preparation (prep) for colonoscopy, emphasizing the distinctions among the prep process (all patient steps before colonoscopy), the prep regimen (the purgative used), and prep quality (the cleanliness achieved). "Optimized prep" means the bowel is adequately clean to allow standard screening or surveillance intervals.<br /><br />The bowel prep process includes diet modifications, medication adjustments, physical and mental preparation, and purgative timing and administration. Failures in any step can reduce prep quality. There's a notable balance between ensuring patient comfort and meeting endoscopists' needs.<br /><br />For those at average risk of inadequate prep quality, the guidelines recommend verbal and written instructions supplemented by patient navigation (e.g., telephonic or virtual support). Diet adjustments should be limited to the day before colonoscopy, with low-residue or full liquids for breakfast and lunch. No specific purgative is mandated; however, split-dose regimens are preferred, with same-day purgatives acceptable for afternoon procedures but inferior for morning ones. Low-volume (2L) prep regimens are favored over 4L, given similar efficacy but better tolerability. FDA-approved purgatives include various formulations of polyethylene glycol (PEG), oral sodium sulfate, sodium picosulfate, and PEG-ascorbate.<br /><br />For higher-risk patients (identified by factors like age over 65, obesity, constipation, certain medical conditions or medications), prep requires enhanced communication, earlier dietary restrictions (limiting vegetables and legumes 2-3 days prior), possibly promotility agents (e.g., bisacodyl), and use of higher-volume prep regimens. Prior inadequate prep places a patient into this category.<br /><br />The guidelines also recommend drinking the second half of split-dose prep 4-6 hours before colonoscopy, finishing at least 2 hours prior. Simethicone (320 mg orally) as an adjunct may improve outcomes. The updated approach strives to improve prep quality through tailored regimens based on individual risk, balancing efficacy with patient tolerability and convenience.

Asset Subtitle

Brian C. Jacobson, MD, MPH, FASGE

Keywords

colonoscopy bowel preparation

prep process

prep regimen

prep quality

split-dose regimen

low-volume bowel prep

patient navigation

high-risk patients

diet modifications

simethicone adjunct