New colonoscopy guidelines increase bowel prep quality expectations

Editor's Note

New consensus recommendations from the US Multi-Society Task Force on Colorectal Cancer (MSTFCRC) set a 90% adequacy benchmark for bowel preparation in colonoscopy, reinforcing the role of preparation in ensuring accurate screenings and reducing the risk of missed lesions. As detailed in a March 4 joint press release from the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE), the guidelines provide evidence-based strategies to optimize bowel cleansing before, during, and after colonoscopy.

According to the MSTFCRC, bowel preparation is a critical factor in colonoscopy quality, directly affecting the detection of precancerous lesions and overall procedural efficiency. Inadequate preparation can result in missed findings, procedural cancellations, and wasted resources. To improve prep effectiveness, the updated recommendations emphasize split-dose regimens, same-day alternatives for afternoon procedures, and the use of low-volume preps with adjunctive simethicone. The guidelines also highlight the importance of patient education, dietary modifications, and irrigation pumps to enhance cleansing during the procedure.

The new recommendations update prior guidance from 2014, refining best practices based on emerging evidence. The task force advises tailoring prep regimens to patient needs, considering factors such as comorbidities, prior prep effectiveness, and ease of access to necessary agents. For low-risk outpatients, a split-dose regimen—where the second portion is consumed 4 to 6 hours before the procedure and completed at least 2 hours prior—is deemed sufficient for morning colonoscopies. For afternoon procedures, a same-day regimen is an acceptable alternative.

In addition to prep timing and composition, the guidelines stress the importance of documentation and quality tracking. The task force calls for routine monitoring of adequate prep rates at both individual endoscopist and endoscopy unit levels, with a target of at least 90% of exams.

More details are available in the full consensus document, published in the journals of ACG, AGA, and ASGE.