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ASGE Updates Colonoscopy Preparation Guidelines

The colonoscopy is considered the gold standard of colon cancer screening tests, but like any other medical procedure, doctors are always seeking out areas for improvement. Recently, the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) announced changes to the guidelines for bowel prep before a colonoscopy. These changes aim to make the preparation process safer and more tolerable for patients.

Split-dosing
Traditional colonoscopy prep required patients to drink a gallon of solution the night before their exam, but doctors have found that the split-dose method is better tolerated by patients and more effective in cleansing the colon. With the split-dose method, patients drink half the prep solution the night before their colonoscopy and the other half 3 to 8 hours prior to the exam. Research has shown that split-dosing increases adenoma detection rates by five percent and improves prep quality sevenfold (Source: Mayo Clinic).


Low-volume preps
The updated recommendations suggest new bowel prep solutions that are lower in volume yet more effective in cleansing the colon.


Certain preps eliminated
Aqueous phosphosoda, one of the most commonly used prep solutions in the past, is no longer available due to safety concerns. Sodium phosphate and magnesium citrate-based regimens are no longer recommended due to the risk of renal or electrolyte disturbances. The committee also advised against using metoclopramide as an adjunct preparation.


Low-residue diet
Patients have traditionally been restricted to a clear liquid diet starting the day before a colonoscopy, but the new guidelines state that a low-residue diet is equally effective and preferred by patients. A low-residue diet restricts whole grains, nuts, seeds and raw fruits and vegetables. Patients are allowed refined grains, cooked or canned seedless vegetables, soft fruits without the peel, lean meats and eggs.


Documenting quality
The updated guidelines urge physicians to document the quality of bowel preps using validated scoring systems. Up to 30 percent of all patients undergoing colonoscopy have been reported to have inadequate bowel preparation which can result in missed lesions and increased risk during the procedure (Source: ClinicalTrials.gov). Patients who have a history of inadequate bowel preparations are more likely to experience inadequate preparations in the future, so it is important for physicians to identify these at-risk patients and consider more aggressive preparations or repeat screenings (Source: Healio).