Bowel preparation before colonoscopy – is there an optimal preparation?

Česká verzia

Authors: Kmochová K.; Zavoral M.; Suchánek Š.
Authors place of work: Interní klinika 1. LF UK a ÚVN – VFN Praha
Published in the journal: Gastroent Hepatol 2019; 73(5): 392-397
Category: Gastrointestinální onkologie: přehledová práce
doi: https://doi.org/10.14735/amgh2019392

Summary

Quality of bowel cleansing is essential for quality colonoscopy. The European Society of Gastrointestinal Endoscopy recommends that adequate bowel preparation should be reached in at least 90% of colonoscopies. Non-adequate bowel preparation occurs in 25% of colonoscopies, and it can cause periprocedural complications or reduce the detection of colorectal neoplasia. A very important consideration in the bowel preparation process is the patient’s education and motivation, and adherence to a low-fibre or a fluid diet on the day before colonoscopy. Compliance with the split-dose regime significantly improves the quality of bowel preparation and detection of colorectal neoplasia. The time between finishing the second half of the bowel preparation and colonoscopy should be no longer than 3–5 hours. The non-split regime can be used as an alternative regime for afternoon colonoscopy (same-day preparation). The quality of bowel cleansing should be evaluated in every colonoscopic report. For screening colonoscopy in the Czech Republic, it is obligatory to evaluate the quality of bowel preparation according to the Boston Bowel Preparation Scale. The most often used laxatives in CR are polyethylenglycol (4 l) and low volume solutions, such as oral sulphate solution, polyethylenglycol (2 l) and ascorbic acid, and sodium picosulfate and magnesium citric acid. According to previous studies, low volume solutions are as equally effective as polyethylenglycol (4 l). Prokinetics or enemas do not increase the quality of bowel cleansing and therefore their use is not recommended for bowel preparation. Addition of simeticon to a laxative can improve the quality of cleansing and also the detection of colorectal neoplasia.

Keywords:

colonoscopy – bowel preparation – quality of bowel preparation – quality of colonoscopy – detection of colorectal neoplasia

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