Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2018; 24(26): 2833-2843
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2833
Bowel preparation quality scales for colonoscopy
David Kastenberg, Gerald Bertiger, Stuart Brogadir
David Kastenberg, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
Gerald Bertiger, Hillmont GI, Flourtown, PA 19031, United States
Stuart Brogadir, Medical Affairs, Ferring Pharmaceuticals, Inc, Parsippany, NJ 07054, United States
Author contributions: Kastenberg D planned the first draft of the manuscript; all authors contributed to writing of the manuscript and approved the final version for submission.
Conflict-of-interest statement: David Kastenberg has received research support from and served as a consultant for Medtronic, and is on the advisory boards of Ferring Pharmaceuticals Inc. and Salix Pharmaceuticals. Gerald Bertiger has served as a consultant and has been a part of the speakers bureau for Ferring Pharmaceuticals Inc. Stuart Brogadir is an employee of Ferring Pharmaceuticals Inc. Editorial support was provided by The Curry Rockefeller Group, LLC, which was funded by Ferring Pharmaceuticals.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: David Kastenberg, MD, FACP, FACG, AGAF, Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, 132 South 10th Street, Suite 480, Philadelphia, PA 19107, United States.
Telephone: +1-215-9558900 Fax: +1-215-5032578
Received: March 13, 2018
Peer-review started: March 14, 2018
First decision: April 18, 2018
Revised: May 16, 2018
Accepted: May 26, 2018
Article in press: May 26, 2018
Published online: July 14, 2018

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.

Keywords: Colonoscopy, Bowel preparation, Aronchick scale, Ottawa Bowel Preparation Scale, Boston Bowel Preparation Scale

Core tip: Adequate bowel preparation is essential for proper visualization of the colonic mucosa to optimize lesion detection for a successful colonoscopy. Clinicians and researchers continue to use a variety of bowel preparation quality measures, including de novo, nonvalidated scales in clinical studies, leading to potential confusion, and creating difficulty when comparing bowel preparation quality results across clinical trials. Based on data evaluating different bowel preparation quality scales in the literature, and published criteria that define the most desirable measures to be used in such grading scales, the Boston Bowel Preparation Scale is currently recommended as standard.