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How to prepare your bowel before a colonoscopy, see what the latest European guidelines say

 Last Update: 2022-01-23
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Inadequate bowel preparation will seriously affect the quality of colonoscopy, especially reducing the detection rate of adenomas and advanced adenomas.
Prolonged hospital stay and increased medical expenses are closely related
.

Since the publication of the 2013 edition of the European Bowel Preparation Guidelines , a large body of new evidence-based medicine has emerged
.

To this end, the European Society for Gastrointestinal Endoscopy updated the guidelines for bowel preparation in July 2019 , including dietary restrictions, timing of medication, laxative choices, patient notification, and special circumstances.

Since the publication of the 2013 edition of the European Bowel Preparation Guidelines , a large body of new evidence-based medicine has emerged

1.
Dietary restrictions and patient notification

1 .
A low-fiber, low-residue diet is recommended before colonoscopy (strong recommendation, moderate-quality evidence)
.

Consistent with the old guideline, no specific recommendation was made for the number of days on a low-fiber diet before examination, and the recommendation level was changed from weak to strong

1 .

2 .

1 .

2 .

3 .

Third, the timing of medication

1 .
A split-dose bowel preparation regimen is recommended for elective colonoscopy (strong recommendation, high-quality evidence)
.

Consistent with legacy guidelines

1 .

2 .

3 .
We recommend starting the last dose of bowel preparation within 5 hours before colonoscopy and at least 2 hours before the procedure begins (strong recommendation, moderate-quality evidence) .
Older guidelines recommend that the interval between the last dose of bowel preparation and the colonoscopy should be minimized to no more than 4 hours .

The choice of laxatives

1 .
High-volume or low-volume polyethylene glycol ( PEG )-based regimens and non- PEG -based but clinically proven regimens are recommended for routine bowel preparation, such as low-volume PEG plus adjunctive drug regimens with 2L PEG + ascorbate / citrate Citrate / bisacodyl, magnesium citrate + sodium picosulfate , oral sulfate solution, etc.
(see Table 1 )
.
The choice of laxatives should be individualized in patients at risk for water-electrolyte imbalance (strong recommendation, moderate-quality evidence)
.

The old version recommends 4L PEG regimen for routine bowel preparation, and 2L PEG+ ascorbic acid or magnesium citrate + sodium picosulfate can be used as effective alternatives, especially for selective outpatient colonoscopy
.
The old guideline specifically mentioned that only PEG is recommended for bowel preparation in patients with renal failure.
For safety reasons, the new guideline more specifically lists each bowel preparation regimen and is not recommended for some special patients
.

2 .
Routine oral sodium phosphate for bowel preparation is not recommended (strong recommendation, low-quality evidence)
.
The old version of the guideline is not recommended for routine use due to safety concerns.
It is only recommended for patients who cannot tolerate other regimens and who have a low risk of side effects as assessed by physicians.
The new version of the guideline does not make specific recommendations
.

5.
Special patients

1 .
Applying any special bowel preparation is not recommended for patients with constipation (weak recommendation, low-quality evidence)
.
Add a recommendation
.

2 .
High-volume or low-volume PEG - based bowel preparation regimens are recommended for patients with inflammatory bowel disease (strong recommendation, high-quality evidence)
.
Older guidelines recommend the use of PEG , with a weak recommendation and moderate-quality evidence
.

3 .
There is insufficient evidence to establish for or against the use of specific bowel preparation regimens in pregnant or breastfeeding women
.
However, if there is a clear indication for colonoscopy, a PEG regimen can be considered, while a tap water enema is preferred for sigmoidoscopy (insufficient evidence to define benefit or risk)
.
Consistent with legacy guidelines
.

4 .
The PEG regimen is recommended for bowel preparation for emergency enteroscopy with lower gastrointestinal .
Consistent with legacy guidelines .

4 .
The PEG regimen is recommended for bowel preparation for emergency enteroscopy with lower gastrointestinal .
Consistent with legacy guidelines .
Digestion

6.
Inadequate bowel preparation :

Management , Inpatients, and Risk Factors

Management , Inpatient and Risk Factor Management

1 .
Repeat colonoscopy as early as 1 year is recommended in patients with inadequate bowel preparation , unless clinically contraindicated (strong recommendation, moderate-quality evidence) .
Add a recommendation .

2 .
After additional bowel preparation (using laxatives or enemas), it is recommended that the colonoscopy be repeated the same day or the next day
.
The next bowel preparation regimen should be individualized based on the probable cause of failure (weak recommendation, very low-quality evidence)
.
The old guideline also recommended endoscopic irrigation, but the new guideline does not make specific recommendations, emphasizing individualized selection
.

3 .
Specialized oral or written instructional instructions for inpatients and clinical staff caring for inpatients are recommended to improve the quality of bowel preparation (strong recommendation, moderate-quality evidence)
.
The old recommendation recommended that health care professionals be informed about bowel preparation orally and in writing, not just written instructions
.
The new guidelines emphasize not just patient education, but also clinical staff caring for inpatients
.

4 .
There is insufficient evidence to recommend the use of specialized prediction models of insufficient bowel preparation for clinical practice
.
Risk factors for inadequate bowel preparation include patient baseline characteristics (increasing age and male gender), clinical disease (constipation, diabetes , hypertension , cirrhosis, stroke , etc.
) and drug use (narcotics and tricyclic antidepressants) )
etc.
The old guideline also does not recommend the use of models to predict patients with inadequate bowel preparation to adjust bowel preparation regimens, and both old and new guidelines consider the current evidence to be insufficient
.

references:

1.
Hassan C, et al.
Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019.
Endoscopy, 2019, doi: 10.
1055/a-0959-0505.

2.
Hassan C, et al.
Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline.
Endoscopy, 2013;45(2):142-150.

2.
Hassan C, et al.
Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline.
Endoscopy, 2013;45(2):142-150.
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