Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Abstract

Background and aim: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the choice amongst regimens available for cleansing the colon in preparation for colonoscopy. Methods: This Guideline is based on a targeted literature search to evaluate the evidence supporting the use of bowel preparation for colonoscopy. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. Results: The main recommendations are as follows. (1) The ESGE recommends a low-fiber diet on the day preceding colonoscopy (weak recommendation, moderate quality evidence). (2) The ESGE recommends a split regimen of 4?L of polyethylene glycol (PEG) solution (or a same-day regimen in the case of afternoon colonoscopy) for routine bowel preparation. A split regimen (or same-day regimen in the case of afternoon colonoscopy) of 2?L PEG plus ascorbate or of sodium picosulphate plus magnesium citrate may be valid alternatives, in particular for elective outpatient colonoscopy (strong recommendation, high quality evidence). In patients with renal failure, PEG is the only recommended bowel preparation. The delay between the last dose of bowel preparation and colonoscopy should be minimized and no longer than 4 hours (strong recommendation, moderate quality evidence). (3) The ESGE advises against the routine use of sodium phosphate for bowel preparation because of safety concerns (strong recommendation, low quality evidence).

Colon capsule endoscopy: toward the future

“…Sodium phosphate can accelerate the bowel transit time of the capsule but may cause serious complications such as acute renal failure and electrolyte imbalance. Patients who are at risk of sodium phosphate toxicity need to undergo alternative booster preparations such as magnesium citrate [19][20][21]. Gastrografin, which is a contrast medium for the digestive tract, is an alternative to sodium phosphate in the bowel preparation regimen for CCE [22].…”

Comparison of Four Different Colonic Preps in 3595 Patients at A University Center: A Real Life Experience

“…The timing of the bowel preparation has also been shown to play an important role in increasing effectiveness [10,11] . Six organizations have issued guidelines that endorse split-dose (SD) over day-prior dose (DPD) regimen [6,[12][13][14][15][16] . Patient satisfaction and…”

Predicting Suboptimal Bowel Preparation: Taking It Up a PEG

“…The European Society of Gastrointestinal Endoscopy (ESGE) guidelines [8] recommend a split-dose regimen of a 4L PEG solution (or a same-day regimen for afternoon colonoscopy) as first-line for routine bowel cleansing before colonoscopy with PEG as the only recommended agent in patients with renal failure. Nevertheless, data from a previous meta-analysis show that patients have more difficulty completing PEG-based regimens than SPS-or NaP-based regimens.…”