Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 10, 2016; 8(1): 4-12
Published online Jan 10, 2016. doi: 10.4253/wjge.v8.i1.4
Bowel cleansing before colonoscopy: Balancing efficacy, safety, cost and patient tolerance
Nicole M Harrison, Michael C Hjelkrem
Nicole M Harrison, Department of Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, United States
Michael C Hjelkrem, Department of Gastroenterology, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, United States
Author contributions: Harrison NM and Hjelkrem MC contributed solely to this paper.
Conflict-of-interest statement: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael C Hjelkrem, MD, Department of Gastroenterology, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, United States. mhjelkrem@yahoo.com
Telephone: +1-571-2312014
Received: June 23, 2015
Peer-review started: June 24, 2015
First decision: August 25, 2015
Revised: September 15, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: January 10, 2016
Abstract

Effective colorectal cancer screening relies on reliable colonoscopy findings which are themselves dependent on adequate bowel cleansing. Research has consistently demonstrated that inadequate bowel preparation adversely affects the adenoma detection rate and leads gastroenterologists to recommend earlier follow up than is consistent with published guidelines. Poor preparation affects as many as 30% of colonoscopies and contributes to an increased cost of colonoscopies. Patient tolerability is strongly affected by the preparation chosen and manner in which it is administered. Poor tolerability is, in turn, associated with lower quality bowel preparations. Recently, several new developments in both agents being used for bowel preparation and in the timing of administration have brought endoscopists closer to achieving the goal of effective, reliable, safe, and tolerable regimens. Historically, large volume preparations given in a single dose were administered to patients in order to achieve adequate bowel cleansing. These were poorly tolerated, and the unpleasant taste of and significant side effects produced by these large volume regimens contributed significantly to patients’ inability to reliably complete the preparation and to a reluctance to repeat the procedure. Smaller volumes, including preparations that are administered as tablets to be consumed with water, given as split doses have significantly improved both the patient experience and efficacy, and an appreciation of the importance of the preparation to colonoscopy interval have produced additional cleansing.

Keywords: Bowel preparation, Colonoscopy, Adenoma detection rate, MiraLAX, Polyethylene glycol, Sodium picosulfate, Oral sulfate solution

Core tip: Improvements in efficacy and tolerability of bowel preparation include new formulations that are more tolerable to patients without sacrificing efficacy or safety, and a better understanding of the ideal timing of bowel preparation administration.