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World J Gastrointest Endosc. Feb 16, 2013; 5(2): 39-46
Published online Feb 16, 2013. doi: 10.4253/wjge.v5.i2.39
Factors influencing quality of bowel preparation for colonoscopy
Ronald V Romero, Sanjiv Mahadeva
Ronald V Romero, Division of Gastroenterology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia
Sanjiv Mahadeva, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Author contributions: Romero RV and Mahadeva S solely contributed to this paper.
Correspondence to: Sanjiv Mahadeva, MD, MRCP, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
Telephone: +6-3-79494422 Fax: +6-3-79604190
Received: July 12, 2012
Revised: October 8, 2012
Accepted: December 1, 2012
Published online: February 16, 2013

Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a low-volume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients’ compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socio-economic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

Keywords: Bowel preparation, Colonoscopy, Risk factors, Quality