How to Achieve High Rates of Bowel Preparation Adequacy

  • Quinton HatchEmail author
  • Rubina Ratnaparkhi
  • Scott R. Steele


Effective colonoscopy is dependent on adequate bowel cleansing. A number of bowel preparation regimens have been advocated, with the gold standard being polyethylene glycol and balanced electrolytes. Nevertheless, a number of lower volume preparations have been adopted in hopes of increasing tolerability without sacrificing efficacy. More aggressive bowel preparations have been suggested for those at high risk for inadequate bowel cleansing. Techniques such as endoscopic jet lavage may be used to salvage an inadequate preparation; however, these methods are somewhat costly in terms of time. The adequacy of the preparation should be documented according to a validated cleansing scale.


Colonoscopy Endoscopy Bowel preparation Bowel cleansing Inadequate bowel preparation Cleansing scale 


  1. 1.
    Rex D, Bond J, Winawer S, et al; U.S. Multi-Society Task Force on Colorectal Cancer. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97:1296–308.Google Scholar
  2. 2.
    Hassan C, Fuccio L, Bruno M, et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2012;10:501–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Ness R, Manam R, Hoen H, et al. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–802.CrossRefPubMedGoogle Scholar
  4. 4.
    Saltzman J, Cash B, Pasha S, et al; ASGE Standards of Practice Committee. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81(4):781–94.Google Scholar
  5. 5.
    Marshall J, Pineda J, Barthel J, et al. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol electrolyte lavage for colonoscopy preparation. Gastrointest Endosc. 1993;39:631–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Fordtran J, Santa Ana C, Cleveland M. A low-sodium solution for gastrointestinal lavage. Gastroenterology. 1990;98:11–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Di Palma J, Marshall J. Comparison of a new sulfate-free polyethylene glycol electrolyte lavage solution versus a standard solution for colonoscopy cleansing. Gastrointest Endosc. 1990;36:285–9.CrossRefGoogle Scholar
  8. 8.
    Valiante F, Pontone S, Hassan C, et al. A randomized controlled trial evaluating a new 2-L PEG solution plus ascorbic acid vs 4-L PEG for bowel cleansing prior to colonoscopy. Dig Liver Dis. 2012;44:224–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Enestvedt B, Fennerty B, Zaman A, et al. MiraLAX vs. GoLytely: is there a significant difference in the adenoma detection rate? Aliment Pharmacol Ther. 2011;34:775–82.CrossRefPubMedGoogle Scholar
  10. 10.
    McKenna T, Macgill A, Porat G, et al. Colonoscopy preparation: polyethylene glycol with gatorade is as safe and efficacious as 4-L of polyethylene glycol with balanced electrolytes. Dig Dis Sci. 2012;57:3098–105.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Di Palma J, Rodriguez R, McGowan J, et al. A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol. 2009;104:2275–84.CrossRefPubMedGoogle Scholar
  12. 12.
    Katz P, Rex D, Epstein M, et al. A dual-action, low-volume bowel cleanser administered the day before colonoscopy: results from the SEE CLEAR II study. Am J Gastroenterol. 2013;108:401–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Rex D, McGowan J, Cleveland M, et al. A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for colonoscopy. Gastrointest Endosc. 2014;80:482–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Gurudu S, Ramirez F, Harrison M, et al. Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy. Gastrointest Endosc. 2012;76:603–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Kilgore T, Abdinoor A, Szary N, et al. Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc. 2011;73:1240–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Harewood G, Sharma V, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Cohen L. Advances in bowel preparation for colonoscopy. Gastrointest Endosc Clin N Am. 2015;25(2):183–97.CrossRefPubMedGoogle Scholar
  18. 18.
    Ibanez M, Parra-Blanco A, Zaballa P, et al. Usefullness of an intensive bowel cleansing strategy for repeat colonoscopy after preparation failure. Dis Colon Rectum. 2011;54(12):1578–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel prep for colonoscopy. Aliment Pharmacol Ther. 2007;25:373–84.CrossRefPubMedGoogle Scholar
  20. 20.
    MacPhail M, Hardacker K, Tiwari A, et al. Intraprocedural cleansing work during colonoscopy and achievable rates of adequate preparation in an open-access endoscopy unit. Gastrointest Endosc. 2015;81(3):525–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Hoffman A, Murthy S, Pompetzki L, et al. Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection. World J Gastroenterol. 2015;21(26):8184–94.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Kiesslich R, Schuster N, Hoffman A, et al. MedJet—a new CO2-based disposable cleaning device allows safe and effective bowel cleansing during colonoscopy: a pilot study. Endoscopy. 2012;44(8):767–71.CrossRefPubMedGoogle Scholar
  23. 23.
    Rigaux J, Juriens I, Devière J. A novel system for the improvement of colonic cleansing during colonoscopy. Endoscopy. 2012;44(7):703–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Horiuchi A, Nakayama Y, Kajiyama M, et al. Colonoscopic enema as rescue for inadequate bowel preparation before colonoscopy: a prospective observational study. Colorectal Dis. 2012;14:e735–e9.CrossRefPubMedGoogle Scholar
  25. 25.
    Fujii T. Bowel preparation with polyethylene glycol (PEG) injection after upper gastrointestinal endoscopy: a pilot study. Gastrointest Endosc. 2013;77(5):AB518.Google Scholar
  26. 26.
    Aronchick C, Lipshutz W, Wright S, et al. Validation of an instrument to assess colon cleansing (abstract). Am J Gastroeterol. 1999;94:2667.Google Scholar
  27. 27.
    Aronchick C, Lipshutz W, Wright S, et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc. 2000;52:346–52.CrossRefPubMedGoogle Scholar
  28. 28.
    Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc. 2004;59(4):482–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Lai E, Calderwood A, Doros G. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009;69(3):620–5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Quinton Hatch
    • 1
    Email author
  • Rubina Ratnaparkhi
    • 2
  • Scott R. Steele
    • 3
    • 4
  1. 1.Department of SurgeryMadigan Army Medical CenterTacomaUSA
  2. 2.Department of Colorectal SurgeryCase Western Reserve University School of MedicineClevelandUSA
  3. 3.Case Western Reserve University School of MedicineClevelandUSA
  4. 4.Department of Colorectal SurgeryCleveland ClinicClevelandUSA

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