Colon Cleansing for Colonoscopy: New Guidelines for Optimizing Outcomes David A. Johnson, MD Professor of Medicine; Chief of Gastroenterology, Eastern VA Medical School, Norfolk, Virginia October 15, 2014

The US Multi-Society Task Force on Colorectal Cancer has just released new evidence-based guidelines on how to improve and perform colon cleansing before a colonoscopy. This is a joint publication, and it is published in the October 2014 issues of The American Journal of Gastroenterology,[1] Gastrointestinal Endoscopy,[2] and Gastroenterology.[3]

I will give you an overview of this guideline and drill down on a couple of salient points. I encourage all of you who deal with bowel preparation (“prep”), including your nurses and schedulers, to read this document because it has some very important information. The committee reviewed the literature from 1980 to 2013 and, using an evidence-based approach, extracted all of the relevant articles and then graded the recommendations using the standard grading strategy.

Colon cleansing/bowel preps are inadequate in 20%-25% of patients presenting for colonoscopy. This has tremendous consequences, including inadequate detection of adenomas and other neoplasia and the need to repeat the colonoscopy earlier than would otherwise be required.

Split-Prep Is Best

The recommendation with the strongest evidence to support it is that split-dose prep is the standard of care. A split-dosing regimen means that part is given the evening before, and part is given the morning of the procedure. The committee overwhelmingly weighed in on this point. The split-dose prep should be routine; the exception is the same-day prep (the patient does the entire prep on the day of the examination). The split-dose prep has multiple advantages. It clearly leads to better bowel cleansing. Use of the split-dose prep also increases patient willingness to return for another colonoscopy. The committee recommended that the second dose be given on the morning of the colonoscopy, 4-6 hours before the start time of the exam, and completed within 2 hours of the exam. This meets the Anesthesia Society of America’s guideline[4] of allowing clear liquids up to 2 hours before the procedure.