Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Main Recommendations

ESGE recommends a low fiber diet on the day preceding colonoscopy.

Strong recommendation, moderate quality evidence.

ESGE recommends the use of enhanced instructions for bowel preparation.

Strong recommendation, moderate quality evidence.

ESGE suggests adding oral simethicone to bowel preparation.

Weak recommendation, moderate quality evidence.

ESGE recommends split-dose bowel preparation for elective colonoscopy.

Strong recommendation, high quality evidence.

ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing.

Strong recommendation, high quality evidence.

ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure.

Strong recommendation, moderate quality evidence.

ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.
Strong recommendation, moderate quality evidence.

• References

• 1 Sulz MC, Kröger A, Prakash M. et al. Meta-analysis of the effect of bowel preparation on adenoma detection: early adenomas affected stronger than advanced adenomas. PLoS One 2016; 11: e0154149
• 2 Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol 2014; 109: 1714-1723
• 3 Clark BT, Protiva P, Nagar A. et al. Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men. Gastroenterology 2016; 150: 396-405 quiz e14-15
• 4 Hsu C-M, Lin W-P, Su M-Y. et al. Factors that influence cecal intubation rate during colonoscopy in deeply sedated patients. J Gastroenterol Hepatol 2012; 27: 76-80
• 5 Radaelli F, Meucci G, Sgroi G. et al. Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol 2008; 103: 1122-1130
• 6 Aslinia F, Uradomo L, Steele A. et al. Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital. Am J Gastroenterol 2006; 101: 721-731
• 7 Bugajski M, Wieszczy P, Hoff G. et al. Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2018; 67: 1958-1964
• 8 Johnson MR, Grubber J, Grambow SC. et al. Physician non-adherence to colonoscopy interval guidelines in the Veterans Affairs healthcare system. Gastroenterology 2015; 149: 938-951
• 9 Anderson JC, Baron JA, Ahnen DJ. et al. Factors associated with shorter colonoscopy surveillance intervals for patients with low-risk colorectal adenomas and effects on outcome. Gastroenterology 2017; 152: 1933-1943.e5
• 10 Yadlapati R, Johnston ER, Gregory DL. et al. Predictors of inadequate inpatient colonoscopy preparation and its association with hospital length of stay and costs. Dig Dis Sci 2015; 60: 3482-3490
• 11 Rex DK, Imperiale TF, Latinovich DR. et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002; 97: 1696-1700
• 12 Kingsley J, Karanth S, Revere FL. et al. Cost effectiveness of screening colonoscopy depends on adequate bowel preparation rates – a modeling study. PLoS One 2016; 11: e0167452
• 13 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 14 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
• 15 Atkins D, Best D, Briss PA. et al. ; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490
• 16 Dumonceau J-M, Hassan C, Riphaus A. et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy. Endoscopy 2012; 44: 626-629
• 17 Wu K-L, Rayner CK, Chuah S-K. et al. Impact of low-residue diet on bowel preparation for colonoscopy. Dis Colon Rectum 2011; 54: 107-112
• 18 Walter J, Francis G, Matro R. et al. The impact of diet liberalization on bowel preparation for colonoscopy. Endosc Int Open 2017; 05: E253-E260
• 19 Flemming JA, Green J, Melicharkova A. et al. Low-residue breakfast during the preparation for colonoscopy using a polyethylene glycol electrolyte solution: a randomised non-inferiority trial. BMJ Open Gastroenterol 2015; 2: e000029
• 20 Scott SR, Raymond PL, Thompson WO. et al. Efficacy and tolerance of sodium phosphates oral solution after diet liberalization. Gastroenterol Nurs 2005; 28: 133-139
• 21 Melicharkova A, Flemming J, Vanner S. et al. A low-residue breakfast improves patient tolerance without impacting quality of low-volume colon cleansing prior to colonoscopy: a randomized trial. Am J Gastroenterol 2013; 108: 1551-1555
• 22 Butt J, Bunn C, Paul E. et al. The White Diet is preferred, better tolerated, and non-inferior to a clear-fluid diet for bowel preparation: A randomized controlled trial. J Gastroenterol Hepatol 2016; 31: 355-363
• 23 Jung YS, Seok HS, Park DI. et al. A clear liquid diet is not mandatory for polyethylene glycol-based bowel preparation for afternoon colonoscopy in healthy outpatients. Gut Liver 2013; 7: 681-687
• 24 Nguyen DL, Jamal MM, Nguyen ET. et al. Low-residue versus clear liquid diet before colonoscopy: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 2016; 83: 499-507.e1
• 25 Avalos DJ, Sussman DA, Lara LF. et al. Effect of diet liberalization on bowel preparation. South Med J 2017; 110: 399-407
• 26 Song G-M, Tian X, Ma L. et al. Regime for bowel preparation in patients scheduled to colonoscopy: low-residue diet or clear liquid diet? Evidence from systematic review with power analysis.. Medicine (Baltimore) 2016; 95: e2432
• 27 Thukral C, Tewani SK, Lake AJ. et al. Results of a community-based, randomized study comparing a clear liquid diet with a low-residue diet using a magnesium citrate preparation for screening and surveillance colonoscopies. J Clin Gastroenterol 2019; 53: 34-39
• 28 Samarasena JB, Reataza M, Kwak N. et al. Single day low residue diet prior to colonoscopy shows improved tolerance and bowel preparation quality over clear liquid diet: interim results from a U.S. multicenter randomized controlled trial. Gastrointest Endosc 2016; 83: AB172
• 29 Gimeno-García AZ, de la Barreda HeuserR, Reygosa C. et al. Impact of a 1-day versus 3-day low-residue diet on bowel cleansing quality before colonoscopy: a randomized controlled trial. Endoscopy 2019; Epub ahead of print
• 30 Seow-En I, Seow-Choen F. A prospective randomized trial on the use of Coca-Cola Zero® versus water for polyethylene glycol bowel preparation before colonoscopy. Colorectal Dis 2016; 18: 717-723
• 31 Altinbas A, Aktas B, Yilmaz B. et al. Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning. Ann Nutr Metab 2013; 63: 83-87
• 32 Choi HS, Shim CS, Kim GW. et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum 2014; 57: 1220-1227
• 33 Ergül B, Filik L, Koçak E. et al. Efficacy and safety of gum chewing in adjunct to high-dose senna for bowel cleansing before colonoscopy: A single-blind randomized controlled trial. Saudi J Gastroenterol 2014; 20: 356
• 34 Fang J, Wang S-L, Fu H-Y. et al. Impact of gum chewing on the quality of bowel preparation for colonoscopy: an endoscopist-blinded, randomized controlled trial. Gastrointest Endosc 2017; 86: 187-191
• 35 Lee J, Lee E, Kim Y. et al. Effects of gum chewing on abdominal discomfort, nausea, vomiting and intake adherence to polyethylene glycol solution of patients in colonoscopy preparation. J Clin Nurs 2016; 25: 518-525
• 36 Guo X, Yang Z, Zhao L. et al. Enhanced instructions improve the quality of bowel preparation for colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc 2017; 85: 90-97.e6
• 37 Jeon SC, Kim JH, Kim SJ. et al. Effect of sending educational video clips via smartphone mobile messenger on bowel preparation before colonoscopy. Clin Endosc 2019; 52: 53-58
• 38 Gálvez M, Zarate A, Espino H. et al. A short telephone-call reminder improves bowel preparation, quality indicators and patient satisfaction with first colonoscopy. Endosc Int Open 2017; 05: E1172-E1178
• 39 Walter B, Klare P, Strehle K. et al. Improving the quality and acceptance of colonoscopy preparation by reinforced patient education with short message service: results from a randomized, multicenter study (PERICLES-II). Gastrointest Endosc 2019; 89: 506-513
• 40 Back SY, Kim HG, Ahn EM. et al. Impact of patient audiovisual re-education via a smartphone on the quality of bowel preparation before colonoscopy: a single-blinded randomized study. Gastrointest Endosc 2018; 87: 789-799.e4
• 41 Banerjee R, Chaudhari H, Shah N. et al. Addition of lubiprostone to polyethylene glycol(PEG) enhances the quality & efficacy of colonoscopy preparation: a randomized, double-blind, placebo controlled trial. BMC Gastroenterology 2016; 16: 133
• 42 Sofi AA, Nawras AT, Pai C. et al. Lubiprostone plus PEG electrolytes versus placebo plus PEG electrolytes for outpatient colonoscopy preparation: a randomized, double-blind placebo-controlled trial. Am J Ther 2015; 66: 105-110
• 43 Grigg E. Lubiprostone used with polyethylene glycol in diabetic patients enhances colonoscopy preparation quality. World J Gastrointest Endosc 2010; 1: 263-267
• 44 Kim HJ, Kim TO, Shin BC. et al. Efficacy of prokinetics with a split-dose of polyethylene glycol in bowel preparation for morning colonoscopy: a randomized controlled trial. Digestion 2012; 86: 194-200
• 45 Tajika M, Niwa Y, Bhatia V. et al. Efficacy of mosapride citrate with polyethylene glycol solution for colonoscopy preparation. World J Gastroenterol 2012; 18: 2517-2525
• 46 Corleto VD, Antonelli G, Coluccio C. et al. Efficacy of prucalopride in bowel cleansing before colonoscopy: Results of a pilot study. World J Gastrointest Endosc 2017; 9: 558-560
• 47 Tajika M, Niwa Y, Bhatia V. et al. Can mosapride citrate reduce the volume of lavage solution for colonoscopy preparation?. World J Gastroenterol 2013; 19: 727-735
• 48 Wu L, Cao Y, Liao C. et al. Systematic review and meta-analysis of randomized controlled trials of simethicone for gastrointestinal endoscopic visibility. Scand J Gastroenterol 2011; 46: 227-235
• 49 Pan P, Zhao S-B, Li B-H. et al. Effect of supplemental simethicone for bowel preparation on adenoma detection during colonoscopy: A meta-analysis of randomized controlled trials. J Gastroenterol Hepatol 2019; 34: 314-320
• 50 Yeh J-H, Hsu M-H, Tseng C-M. et al. The benefit of adding oral simethicone in bowel preparation regimen for the detection of colon adenoma: A systematic review and meta-analysis: simethicone and colon adenoma detection. J Gastroenterol Hepatol 2019; 34: 830-836
• 51 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy 2018; 50: 1205-1234
• 52 RE: Use of simethicone and other non-water soluble additives with Olympus flexible endoscopes, June 29, 2018. http://medical.olympusamerica.com/sites/us/files/pdf/Customer-Letter-Use---of-simethicone-and-lubricants.pdf . Accessed December 15, 2018
• 53 Lever EL, Walter MH, Condon SC. et al. Addition of enemas to oral lavage preparation for colonoscopy is not necessary. Gastrointest Endosc 1992; 38: 369-372
• 54 Gustafsson UO, Segelman J, Ljungqvist O. et al. Can nutritional supplements and rectal enema be used as bowel cleansing for colonoscopy? – Results of a randomized controlled pilot study. Scand J Gastroenterol 2014; 49: 485-491
• 55 Martel M, Barkun AN, Menard C. et al. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology 2015; 149: 79-88
• 56 Manes G, Repici A, Hassan C. MAGIC-P study group. Randomized controlled trial comparing efficacy and acceptability of split- and standard-dose sodium picosulfate plus magnesium citrate for bowel cleansing prior to colonoscopy. Endoscopy 2014; 46: 662-669
• 57 Schultz C, Müller J, Sauter J. et al. Superiority of a split-dose regimen of sodium picosulfate/magnesium citrate (SPMC) in comparison to a prior-day schedule (AM/PM) for colonoscopy preparation. A randomized single-blinded study. J Gastrointest Liver Dis 2016; 25: 295-302
• 58 Kiesslich R, Schubert S, Mross M. et al. Efficacy and safety of PICOPREP tailored dosing compared with PICOPREP day-before dosing for colon cleansing: a multi-centric randomised study. Endosc Int Open 2017; 05: E282-E290
• 59 Mohamed R, Hilsden RJ, Dube C. et al. Split-dose polyethylene glycol is superior to single dose for colonoscopy preparation: results of a randomized controlled trial. Can J Gastroenterol Hepatol 2016;
• 60 Jung YS, Lee CK, Eun CS. et al. Low-volume polyethylene glycol with ascorbic acid for colonoscopy preparation in elderly patients: a randomized multicenter study. Digestion 2016; 94: 82-91
• 61 Horton N, Garber A, Hasson H. et al. Impact of single- vs. split-dose low-volume bowel preparations on bowel movement kinetics, patient inconvenience and polyp detection: a prospective trial. Am J Gastroenterol 2016; 111: 1330-1337
• 62 Radaelli F, Paggi S, Hassan C. et al. Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme. Gut 2017; 66: 270-277
• 63 Pohl J, Halphen M, Kloess HR. et al. Impact of the quality of bowel cleansing on the efficacy of colonic cancer screening: a prospective, randomized, blinded study. PLoS One 2015; 10: e0126067
• 64 Gurudu SR, Ramirez FC, Harrison ME. et al. Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy. Gastrointest Endosc 2012; 76: 603-608.e1
• 65 Jover R, Zapater P, Polanía E. et al. Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies. Gastrointest Endosc 2013; 77: 381-389.e1
• 66 Radaelli F, Paggi S, Repici A. et al. Barriers against split-dose bowel preparation for colonoscopy. Gut 2017; 66: 1428-1433
• 67 Avalos DJ, Castro FJ, Zuckerman MJ. et al. Bowel preparations administered the morning of colonoscopy provide similar efficacy to a split dose regimen: a meta analysis. J Clin Gastroenterol 2018; 52: 859-868
• 68 Cheng Y-L, Huang K-W, Liao W-C. et al. Same-day versus split-dose bowel preparation before colonoscopy: a meta-analysis. J Clin Gastroenterol 2018; 52: 392-400
• 69 Shah H, Desai D, Samant H. et al. Comparison of split-dosing vs. non-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy. World J Gastrointest Endosc 2014; 6: 606-611
• 70 Kotwal VS, Attar BM, Carballo MD. et al. Morning-only polyethylene glycol is noninferior but less preferred by hospitalized patients as compared with split-dose bowel preparation. J Clin Gastroenterol 2014; 48: 414-418
• 71 Chan W-K, Azmi N, Mahadeva S. et al. Split-dose vs. same-day reduced-volume polyethylene glycol electrolyte lavage solution for morning colonoscopy. World J Gastroenterol 2014; 20: 14488-14494
• 72 Siddiqui AA, Yang K, Spechler SJ. et al. Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. Gastrointest Endosc 2009; 69: 700-706
• 73 Seo EH, Kim TO, Park MJ. et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study. Gastrointest Endosc 2012; 75: 583-590
• 74 Bucci C, Rotondano G, Hassan C. et al. Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc 2014; 80: 566-576.e2
• 75 Shaukat A, Malhotra A, Greer N. et al. Systematic review: outcomes by duration of NPO status prior to colonoscopy. Gastroenterol Res Pract 2017;
• 76 Xue S, Chen H, Cheng C. et al. Gastric residual volume after split-dose bowel preparation versus conventional single-dose regimen before anesthetic colonoscopy. BioMed Res Int 2017;
• 77 Huffman M, Unger RZ, Thatikonda C. et al. Split-dose bowel preparation for colonoscopy and residual gastric fluid volume: an observational study. Gastrointest Endosc 2010; 72: 516-522
• 78 Tandon K, Khalil C, Castro F. et al. Safety of large-volume, same-day oral bowel preparations during deep sedation: a prospective observational study. Anesth Analg 2017; 125: 469-476
• 79 Alghamry A, Ponnuswamy SK, Agarwal A. et al. Split-dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing?. J Dig Dis 2017; 18: 160-168
• 80 Prieto-Frías C, Muñoz-Navas M, Betés MT. et al. Split-dose sodium picosulfate–magnesium citrate colonoscopy preparation achieves lower residual gastric volume with higher cleansing effectiveness than a previous-day regimen. Gastrointest Endosc 2016; 83: 566-573
• 81 American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017; 126: 376-393
• 82 Martel M, Barkun AN, Menard C. et al. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology 2015; 149: 79-88
• 83 Enestvedt BK, Tofani C, Laine LA. et al. 4-Liter split-dose polyethylene glycol is superior to other bowel preparations, based on systematic review and meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 1225-1231
• 84 Rutherford CC, Calderwood AH. Update on bowel preparation for colonoscopy. Curr Treat Options Gastroenterol 2018; 16: 165-181
• 85 Patel N, Mori A. Bowel preparation. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019–. 2018 Dec 18
• 86 Xie Q, Chen L, Zhao F. et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy. PLoS One 2014; 9: e99092
• 87 Corporaal S, Kleibeuker JH, Koornstra JJ. Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy. Scand J Gastroenterol 2010; 45: 1380-1386
• 88 Kwon JE, Lee JW, Im JP. et al. Comparable efficacy of a 1-L PEG and ascorbic acid solution administered with bisacodyl versus a 2-L PEG and ascorbic acid solution for colonoscopy preparation: a prospective, randomized and investigator-blinded trial. PloS One 2016; 11: e0162051
• 89 Moon CM, Park DIl, Choe YG. et al. Randomized trial of 2-L polyethylene glycol + ascorbic acid versus 4-L polyethylene glycol as bowel cleansing for colonoscopy in an optimal setting. J Gastroenterol Hepatol 2014; 29: 1223-1228
• 90 Singh H, Turner D, Xue L. et al. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA 2006; 295: 2366-2373
• 91 Baxter NN, Goldwasser MA, Paszat LF. et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009; 150: 1-8
• 92 Rivas JM, Perez A, Hernandez M. et al. Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs. 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy. World J Gastroenterol 2014; 20: 10620-10627
• 93 Zorzi M, Valiante F, Germanà B. et al. Comparison between different colon cleansing products for screening colonoscopy. A noninferiority trial in population-based screening programs in Italy. Endoscopy 2016; 48: 223-231
• 94 Mathus-Vliegen EMH, van der Vliet K, Wignand-van der Storm IJ. et al. Split-dose bowel cleansing with picosulphate is safe and better tolerated than 2-l polyethylene glycol solution. Eur J Gastroenterol Hepatol 2018; 30: 709-717
• 95 Seo SI, Kang JG, Kim HS. et al. Efficacy and tolerability of 2-L polyethylene glycol with ascorbic acid versus sodium picosulfate with magnesium citrate: a randomized controlled trial. Int J Colorectal Dis 2018; 33: 541-548
• 96 Kojecky V, Matous J, Keil R. et al. A head-to-head comparison of 4-L polyethylene glycol and low-volume solutions before colonoscopy: which is the best? A multicentre, randomized trial. Int J Colorectal Dis 2017; 32: 1763-1766
• 97 Choi H-S, Chung J-W, Lee JW. et al. Polyethylene glycol plus ascorbic acid is as effective as sodium picosulfate with magnesium citrate for bowel preparation: A randomized trial. J Dig Dis 2016; 17: 268-273
• 98 Haas S, Andersen LM, Sommer T. Randomized controlled trial comparing Moviprep^® and Phosphoral^® as bowel cleansing agents in patients undergoing colonoscopy. Tech Coloproctol 2014; 18: 929-935
• 99 Ell C, Fischbach W, Layer P. et al. Randomized, controlled trial of 2 L polyethylene glycol plus ascorbate components versus sodium phosphate for bowel cleansing prior to colonoscopy for cancer screening. Curr Med Res Opin 2014; 30: 2493-2503
• 100 Spada C, Cesaro P, Bazzoli F. et al. Evaluation of Clensia^® , a new low-volume PEG bowel preparation in colonoscopy: Multicentre randomized controlled trial versus 4 L PEG. Dig Liver Dis 2017; 49: 651-656
• 101 Kump P, Hassan C, Spada C. et al. Efficacy and safety of a new low-volume PEG with citrate and simethicone bowel preparation for colonoscopy (Clensia): a multicenter randomized observer-blind clinical trial vs. a low-volume PEG with ascorbic acid (PEG-ASC). Endosc Int Open 2018; 6: E907-E913
• 102 Schreiber S, Baumgart D, Drenth J. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy 2019; 51: 73-84
• 103 DeMicco MP, Clayton LB, Pilot J. et al. Novel 1 L polyethylene glycol-based bowel preparation NER1006 for overall and right-sided colon cleansing: a randomized controlled phase 3 trial versus trisulfate. Gastrointest Endosc 2018; 87: 677-687.e3
• 104 Bisschops R, Manning J, Clayton L. et al. Colon cleansing efficacy and safety with 1 L NER1006 versus 2 L polyethylene glycol + ascorbate: a randomized phase 3 trial. Endoscopy 2019; 51: 60-72
• 105 Clark RE, Godfrey JD, Choudhary A. et al. Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis. Ann Gastroenterol 2013; 26: 319-324
• 106 Repici A, Cestari R, Annese V. et al. Randomised clinical trial: low-volume bowel preparation for colonoscopy – a comparison between two different PEG-based formulations. Aliment Pharmacol Ther 2012; 36: 717-724
• 107 Cesaro P, Hassan C, Spada C. et al. A new low-volume isosmotic polyethylene glycol solution plus bisacodyl versus split-dose 4 L polyethylene glycol for bowel cleansing prior to colonoscopy: A randomised controlled trial. Dig Liver Dis 2013; 45: 23-27
• 108 Tae CH, Jung S-A, Na S-K. et al. The use of low-volume polyethylene glycol containing ascorbic acid versus 2 L of polyethylene glycol plus bisacodyl as bowel preparation for colonoscopy. Scand J Gastroenterol 2015; 50: 1039-1044
• 109 Valiante F, Bellumat A, De Bona M. et al. Bisacodyl plus split 2-L polyethylene glycol-citrate-simethicone improves quality of bowel preparation before screening colonoscopy. World J Gastroenterol 2013; 19: 5493-5499
• 110 Brahmania M, Ou G, Bressler B. et al. 2 L versus 4 L of PEG3350 + electrolytes for outpatient colonic preparation: a randomized, controlled trial. Gastrointest Endosc 2014; 79: 408-416.e4
• 111 Kang SH, Jeen YT, Lee JH. et al. Comparison of a split-dose bowel preparation with 2 liters of polyethylene glycol plus ascorbic acid and 1 liter of polyethylene glycol plus ascorbic acid and bisacodyl before colonoscopy. Gastrointest Endosc 2017; 86: 343-348
• 112 Mehta JB, Singhal SB, Mehta BC. Ascorbic-acid-induced haemolysis in G-6-PD deficiency. Lancet 1990; 336: 944
• 113 Lopez Morra HA, Fine SN, Dickstein G. Colonic ischemia with laxative use in young adults. Am J Gastroenterol 2005; 100: 2134-2136
• 114 Baudet J-S, Castro V, Redondo I. Recurrent ischemic colitis induced by colonoscopy bowel lavage. Am J Gastroenterol 2010; 105: 700-701
• 115 Ajani S, Hurt RT, Teeters DA. et al. Ischaemic colitis associated with oral contraceptive and bisacodyl use. BMJ Case Rep 2012;
• 116 Tan JJY, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy – a meta-analysis. Colorectal Dis 2006; 8: 247-258
• 117 van Lieshout I, Munsterman ID, Eskes AM. et al. Systematic review and meta-analysis: Sodium picosulphate with magnesium citrate as bowel preparation for colonoscopy. United European Gastroenterol J 2017; 5: 917-943
• 118 Jin Z, Lu Y, Zhou Y. et al. Systematic review and meta-analysis: sodium picosulfate/magnesium citrate vs. polyethylene glycol for colonoscopy preparation. Eur J Clin Pharmacol 2016; 72: 523-532
• 119 Pisera M, Franczyk R, Wieszczy P. et al. The impact of low- versus standard-volume bowel preparation on participation in primary screening colonoscopy: a randomized health services study. Endoscopy 2019; 51: 227-236
• 120 Weir MA, Fleet JL, Vinden C. et al. Hyponatremia and sodium picosulfate bowel preparations in older adults. Am J Gastroenterol 2014; 109: 686-694
• 121 Bertiger G, Jones E, Dahdal D. et al. Serum magnesium concentrations in patients receiving sodium picosulfate and magnesium citrate bowel preparation: an assessment of renal function and electrocardiographic conduction. Clin Exp Gastroenterol 2015; 8: 215-224
• 122 Ze EY, Choi CH, Kim JW. Acute gastric injury caused by undissolved sodium picosulfate/magnesium citrate powder. Clin Endosc 2017; 50: 87-90
• 123 Rex DK, Di Palma JA, Rodriguez R. et al. A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc 2010; 72: 328-336
• 124 Yang H-J, Park S-K, Kim JH. et al. Randomized trial comparing oral sulfate solution with 4-L polyethylene glycol administered in a split dose as preparation for colonoscopy. J Gastroenterol Hepatol 2017; 32: 12-18
• 125 Kwak MS, Cha JM, Yang H-J. et al. Safety and efficacy of low-volume preparation in the elderly: oral sulfate solution on the day before and split-dose regimens (SEE SAFE) Study. Gut Liver 2019; 13: 176-182
• 126 Di Palma JA, Rodriguez R, McGowan J. et al. A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol 2009; 104: 2275-2284
• 127 Lee HH, Lim C-H, Kim JS. et al. Comparison between an oral sulfate solution and a 2 l of polyethylene glycol+ascorbic acid as a split dose bowel preparation for colonoscopy. J Clin Gastroenterol 2018; doi: 10.1097/MCG.0000000000001137
• 128 Kim B, Lee SD, Han KS. et al. Comparative evaluation of the efficacy of polyethylene glycol with ascorbic acid and an oral sulfate solution in a split method for bowel preparation. Dis Colon Rectum 2017; 60: 426-432
• 129 Rex DK, DiPalma JA, McGowan J. et al. A comparison of oral sulfate solution with sodium picosulfate: magnesium citrate in split doses as bowel preparation for colonoscopy. Gastrointest Endosc 2014; 80: 1113-1123
• 130 Moulin B, Ponchon T. A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity. Endosc Int Open 2018; 6: E1206-E1213
• 131 Markowitz GS, Stokes MB, Radhakrishnan J. et al. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J Am Soc Nephrol 2005; 16: 3389-3396
• 132 Brunelli SM. Association between oral sodium phosphate bowel preparations and kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009; 53: 448-456
• 133 Wexner SD, Beck DE, Baron TH. et al. A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc 2006; 63: 894-909
• 134 Balaban DH. Guidelines for the safe and effective use of sodium phosphate solution for bowel cleansing prior to colonoscopy. Gastroenterol Nurs 2008; 31: 327-334
• 135 Rex DK, Vanner SJ. Colon cleansing before colonoscopy: does oral sodium phosphate solution still make sense?. Can J Gastroenterol 2009; 23: 210-214
• 136 Marshall JB, Pineda JJ, Barthel JS. et al. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation. Gastrointest Endosc 39: 631-634
• 137 Hookey LC, Vanner S. Recognizing the clinical contraindications to the use of oral sodium phosphate for colon cleansing: a case study. Can J Gastroenterol 2004; 18: 455-458
• 138 Russmann S, Lamerato L, Marfatia A. et al. Risk of impaired renal function after colonoscopy: a cohort study in patients receiving either oral sodium phosphate or polyethylene glycol. Am J Gastroenterol 2007; 102: 2655-2663
• 139 Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008; 8: 117
• 140 Markowitz GS, Perazella MA. Acute phosphate nephropathy. Kidney Int 2009; 76: 1027-1034
• 141 Belsey J, Crosta C, Epstein O. et al. Meta-analysis: the relative efficacy of oral bowel preparations for colonoscopy 1985–2010. Aliment Pharmacol Ther 2012; 35: 222-237
• 142 Juluri R, Eckert G, Imperiale TF. Meta-analysis: randomized controlled trials of 4-L polyethylene glycol and sodium phosphate solution as bowel preparation for colonoscopy. Aliment Pharmacol Ther 2010; 32: 171-181
• 143 Juluri R, Eckert G, Imperiale TF. Polyethylene glycol vs. sodium phosphate for bowel preparation: a treatment arm meta-analysis of randomized controlled trials. BMC Gastroenterol 2011; 11: 38
• 144 Hsu CW, Imperiale TF. Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. Gastrointest Endosc 1998; 48: 276-282
• 145 Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel preparation for colonoscopy. Aliment Pharmacol Ther 2007; 25: 373-384
• 146 Cheng J, Tao K, Shuai X. et al. Sodium phosphate versus polyethylene glycol for colonoscopy bowel preparation: an updated meta-analysis of randomized controlled trials. Surg Endosc 2016; 30: 4033-4041
• 147 Chaussade S, Schmöcker C, Toulemonde P. et al. Phosphate tablets or polyethylene glycol for preparation to colonoscopy? A multicentre non-inferiority randomized controlled trial. Surg Endosc 2017; 31: 2166-2173
• 148 Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy. Dis Colon Rectum 1997; 40: 100-104
• 149 Wruble L, Demicco M, Medoff J. et al. Residue-free sodium phosphate tablets (OsmoPrep) versus Visicol for colon cleansing: a randomized, investigator-blinded trial. Gastrointest Endosc 2007; 65: 660-670
• 150 Rex DK, Schwartz H, Goldstein M. et al. Safety and colon-cleansing efficacy of a new residue-free formulation of sodium phosphate tablets. Am J Gastroenterol 2006; 101: 2594-2604
• 151 Malik P, Balaban DH, Thompson WO. et al. Randomized study comparing two regimens of oral sodium phosphates solution versus low-dose polyethylene glycol and bisacodyl. Dig Dis Sci 2009; 54: 833-841
• 152 Law W-L, Choi H-K, Chu K-W. et al. Bowel preparation for colonoscopy: a randomized controlled trial comparing polyethylene glycol solution, one dose and two doses of oral sodium phosphate solution. Asian J Surg 2004; 27: 120-124
• 153 Ho SB, Hovsepians R, Gupta S. Optimal bowel cleansing for colonoscopy in the elderly patient. Drugs Aging 2017; 34: 163-172
• 154 Rex DK. Optimal bowel preparation – a practical guide for clinicians. Nat Rev Gastroenterol Hepatol 2014; 11: 419-425
• 155 Russmann S, Lamerato L, Motsko SP. et al. Risk of further decline in renal function after the use of oral sodium phosphate or polyethylene glycol in patients with a preexisting glomerular filtration rate below 60 mL/min. Am J Gastroenterol 2008; 103: 2707-2716
• 156 Lee JM, Keum B, Yoo IK. et al. Polyethylene glycol plus ascorbic acid for bowel preparation in chronic kidney disease. Medicine (Baltimore) 2016; 95: e4755
• 157 Parente F, Vailati C, Bargiggia S. et al. 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-litre polyethylene glycol as preparation for colonoscopy in chronic constipation. Dig Liver Dis 2015; 47: 857-863
• 158 Pereyra L, Cimmino D, González MallaC. et al. Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study. World J Gastroenterol 2013; 19: 5103-5110
• 159 Kunz L, Gillespie D. A comparison of bowel preparations for colonoscopy in constipated adults. Gastroenterol Nurs 2017; 40: 364-372
• 160 Yıldar M, Yaman İ, Başbuğ M. et al. A new approach in bowel preparation before colonoscopy in patients with constipation: A prospective, randomized, investigator-blinded trial. Turk J Surg 2017; 33: 29-32
• 161 Mathus-Vliegen E, Pellisé M, Heresbach D. et al. Consensus guidelines for the use of bowel preparation prior to colonic diagnostic procedures: colonoscopy and small bowel video capsule endoscopy. Curr Med Res Opin 2013; 29: 931-945
• 162 Hadjiliadis D, Khoruts A, Zauber AG. et al. Cystic fibrosis colorectal cancer screening consensus recommendations. Gastroenterology 2018; 154: 736-745.e14
• 163 Laine L, Kaltenbach T, Barkun A. et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148: 639-651.e28
• 164 Denters MJ, Schreuder M, Depla ACTM. et al. Patients’ perception of colonoscopy: patients with inflammatory bowel disease and irritable bowel syndrome experience the largest burden. Eur J Gastroenterol Hepatol 2013; 25: 964-972
• 165 Menees S, Higgins P, Korsnes S. et al. Does colonoscopy cause increased ulcerative colitis symptoms?. Inflamm Bowel Dis 2007; 13: 12-18
• 166 Lawrance IC, Willert RP, Murray K. Bowel cleansing for colonoscopy: prospective randomized assessment of efficacy and of induced mucosal abnormality with three preparation agents. Endoscopy 2011; 43: 412-418
• 167 Rejchrt S, Bures J, Siroký M. et al. A prospective, observational study of colonic mucosal abnormalities associated with orally administered sodium phosphate for colon cleansing before colonoscopy. Gastrointest Endosc 2004; 59: 651-654
• 168 Restellini S, Kherad O, Bessissow T. et al. Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease. World J Gastroenterol 2017; 23: 5994
• 169 Gould SR, Williams CB. Castor oil or senna preparation before colonoscopy for inactive chronic ulcerative colitis. Gastrointest Endosc 1982; 28: 6-8
• 170 Lazzaroni M, Petrillo M, Desideri S. et al. Efficacy and tolerability of polyethylene glycol-electrolyte lavage solution with and without simethicone in the preparation of patients with inflammatory bowel disease for colonoscopy. Aliment Pharmacol Ther 1993; 7: 655-659
• 171 Kim ES, Kim KO, Jang BI. et al. Crohn’s and Colitis Association in Daegu-Gyeongbuk (CCAiD). Comparison of 4-L polyethylene glycol and 2-L polyethylene glycol plus ascorbic acid in patients with inactive ulcerative colitis. Dig Dis Sci 2017; 62: 2489-2497
• 172 Manes G, Fontana P, de Nucci G. et al. Colon cleansing for colonoscopy in patients with ulcerative colitis: efficacy and acceptability of a 2-L PEG plus bisacodyl versus 4-L PEG. Inflamm Bowel Dis 2015; 21: 2137-2144
• 173 Kato S, Kani K, Kobayashi T. et al. Su1538 The safety and feasibility study of bowel cleaning agents MoviPrep^® versus Niflec^® for the patients with inflammatory bowel diseases undergoing colonoscopy and balloon enteroscopy: a single center randomized controlled trial. Gastrointest Endosc 2015; 81: AB320
• 174 Megna B, Weiss J, Ley D. et al. Clear liquid diet before bowel preparation predicts successful chromoendoscopy in patients with inflammatory bowel disease. Gastrointest Endosc 2019; 89: 373-379.e2
• 175 Cappell MS, Fox SR, Gorrepati N. Safety and efficacy of colonoscopy during pregnancy: an analysis of pregnancy outcome in 20 patients. J Reprod Med 2010; 55: 115-123
• 176 Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. N Engl J Med 2017; 376: 1054-1063
• 177 Strate LL, Gralnek IM. ACG Clinical guideline: Management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016; 111: 459-474
• 178 Pasha SF, Shergill A. et al. ASGE Standards of Practice Committee. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 2014; 79: 875-885
• 179 Pontone S, Palma R, Panetta C. et al. Polyethylene glycol-based bowel preparation before colonoscopy for selected inpatients: A pilot study. J Dig Dis 2018; 19: 40-47
• 180 Ben-Horin S, Bar-Meir S, Avidan B. The outcome of a second preparation for colonoscopy after preparation failure in the first procedure. Gastrointest Endosc 2009; 69: 626-630
• 181 Murphy CJ, Jewel Samadder N, Cox K. et al. Outcomes of next-day versus non-next-day colonoscopy after an initial inadequate bowel preparation. Dig Dis Sci 2016; 61: 46-52
• 182 Chokshi RV, Hovis CE, Colditz GA. et al. Physician recommendations and patient adherence after inadequate bowel preparation on screening colonoscopy. Dig Dis Sci 2013; 58: 2151-2155
• 183 Kim JW, Han JH, Boo S-J. et al. Rescue bowel preparation: same day 2 L polyethylene glycol addition, not superior to bisacodyl addition 7 days later. Dig Dis Sci 2014; 59: 2215-2221
• 184 Akgul G, Ozgur YeniovaA, Ozsoy Z. et al. Effect and tolerability of same-day repeat colonoscopy. J Invest Surg 2018; Oct 31: 1–7
• 185 Gimeno-García AZ, Hernandez G, Aldea A. et al. Comparison of two intensive bowel cleansing regimens in patients with previous poor bowel preparation: a randomized controlled study. Am J Gastroenterol 2017; 112: 951-958
• 186 Sohn N, Weinstein MA. Management of the poorly prepared colonoscopy patient: colonoscopic colon enemas as a preparation for colonoscopy. Dis Colon Rectum 2008; 51: 462-466
• 187 Horiuchi A, Nakayama Y, Kajiyama M. et al. Colonoscopic enema as rescue for inadequate bowel preparation before colonoscopy: a prospective, observational study. Colorectal Dis 2012; 14: e735-e739
• 188 Yang H-J, Park DI, Park S-K. et al. A randomized controlled trial comparing colonoscopic enema with additional oral preparation as a salvage for inadequate bowel cleansing before colonoscopy. J Clin Gastroenterol 2018; , Epub ahead of print
• 189 Rigaux J, Juriens I, Devière J. A novel system for the improvement of colonic cleansing during colonoscopy. Endoscopy 2012; 44: 703-706
• 190 Larsen M, Hills N, Terdiman J. The impact of the quality of colon preparation on follow-up colonoscopy recommendations. Am J Gastroenterol 2011; 106: 2058-2062
• 191 Hillyer GC, Basch CH, Lebwohl B. et al. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: results of a national survey. Int J Colorectal Dis 2013; 28: 73-81
• 192 Seong JH, Yoo JS, Lee KJ. et al. Formulation and management of poor bowel preparation: a survey study. Korean J Gastroenterol 2016; 68: 70
• 193 Maratt JK, Menees SB, Piper MS. et al. Patients are willing to repeat colonoscopy at a short interval when bowel preparation quality is suboptimal. Clin Gastroenterol Hepatol 2018; 16: 776-777
• 194 Gkolfakis P, Tziatzios G, Papanikolaou IS. et al. Strategies to improve hospitalized patients’ quality of bowel preparation for colonoscopy: systematic review and meta-analysis. Gastroenterol Res Pract 2019;
• 195 Ergen WF, Pasricha T, Hubbard FJ. et al. Providing hospitalized patients with an educational booklet increases the quality of colonoscopy bowel preparation. Clin Gastroenterol Hepatol 2016; 14: 858-864
• 196 Rosenfeld G, Krygier D, Enns RA. et al. The impact of patient education on the quality of inpatient bowel preparation for colonoscopy. Can J Gastroenterol 2010; 24: 543-546
• 197 Chorev N, Chadad B, Segal N. et al. Preparation for colonoscopy in hospitalized patients. Dig Dis Sci 2007; 52: 835-839
• 198 Lee YJ, Kim ES, Park KS. et al. Education for ward nurses influences the quality of inpatientʼs bowel preparation for colonoscopy. Medicine (Baltimore) 2015; 94: e1423
• 199 Chambers K, Whiteman K, Stephens K. et al. Improving inpatient colonoscopy preparation in a university hospital: an evidence-based practice project. Gastroenterol Nurs 2016; 39: 86-94
• 200 Shah-Khan SM, Cumberledge J, Reynolds GJ. Using the plan-do-study-act approach to improve inpatient colonoscopy preparation. BMJ Open Qual 2017; 6: e000230
• 201 Gandhi K, Tofani C, Sokach C. et al. Patient characteristics associated with quality of colonoscopy preparation: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 357-369.e10
• 202 Mahmood S, Farooqui SM, Tajammal R. et al. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Gastroenterology 2017; 152: S731
• 203 Hassan C, Fuccio L, Bruno M. et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2012; 10: 501-506
• 204 Gimeno-García A, Baute J, Hernandez G. et al. Risk factors for inadequate bowel preparation: a validated predictive score. Endoscopy 2017; 49: 536-543
• 205 Dik VK, Moons LMG, Hüyük M. et al. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score. Gastrointest Endosc 2015; 81: 665-672