USMSTF Guidance on Optimizing Bowel Preparation for Colonoscopy - Episode 3
2025 USMSTF Bowel Prep Guidance Updates
In the third segment of this 6-part RX Review, experts discuss key updates from the previous 2014 iteration of the USMSTF guidance.
Colorectal cancer is the second leading cause of cancer-related death in the United States, a stark reality that underscores the need for effective screening and prevention.
Each March, Colorectal Cancer Awareness Month serves as a reminder of the importance of early detection to reduce colorectal cancer’s significant impact. Colonoscopy remains the gold-standard screening tool, but its effectiveness relies heavily on adequate bowel preparation. Inadequate preparation can lead to missed lesions, prolonged procedures, and the need for repeat exams, diminishing its preventive power.
New guidance from the US Multi-Society Task Force on Colorectal Cancer (USMSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, provides clinical recommendations to address challenges related to bowel preparation for colonoscopy, focusing specifically on outpatients at low risk for inadequate bowel preparation.
In the third segment of this 6-part HCPLive RX Review, Brian Jacobson, MD, MPH, and Joseph Anderson, MD, highlight key changes from the previous 2014 iteration of the guidance.
Anderson begins by describing the recommendation of a 2-liter, low-volume bowel preparation for average-risk individuals undergoing colonoscopy, which has shown non-inferiority to traditional 4-liter preparations in trials. He notes that this recommendation does not extend to patients with predictors of inadequate bowel preparation but that the shift to a lower volume in average-risk patients is intended to enhance compliance, as patient adherence to bowel preparation can significantly impact exam quality.
He also mentions the updated guidelines include more flexible dietary recommendations before colonoscopy. Stricter low-residue diets, while potentially improving prep quality, can create additional barriers for patients—especially those balancing work or other obligations. Anderson says the more lenient approach in the guidance aims to reduce these barriers and improve overall compliance with bowel preparation.
Jacobson goes on to highlight the guidance supporting same-day bowel preparation for afternoon procedures, citing data suggesting that patients can take a 2-liter preparation in the morning and still achieve a high rate of adequate bowel cleanliness for a same-day procedure.
Moderator: Brian Jacobson, MD, MPH, an associate professor of medicine at Harvard Medical School and director of program development for gastroenterology at Massachusetts General Hospital
Panelist: Joseph Anderson, MD, a professor of medicine at Geisel School of Medicine at Dartmouth and a gastroenterologist at White River Junction VAMC
Editors’ note: Jacobson has relevant disclosures with Curis and Guardant Health. Anderson has no relevant disclosures.
References
Jacobson BC, Anderson JC, Burke CA, et al. Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology. doi:10.14309/ajg.0000000000003287
Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. doi:10.3322/caac.21763
