Colonoscopy’s Role in CRC Screening, The Importance of Adequate Bowel Preparation

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 first segment of this 6-part HCPLive RX Review, Brian Jacobson, MD, MPH, and Joseph Anderson, MD, discuss their work as co-authors on the recent USMSTF consensus statements and explain why adequate bowel preparation is so important in the context of colonoscopy.

Anderson begins by emphasizing the continued importance of colonoscopy as a cornerstone of colorectal cancer screening and prevention, particularly in the context of evolving noninvasive screening modalities. He highlights the comprehensive nature of colonoscopy, noting its dual role in both detecting and preventing colorectal cancer through polypectomy. While acknowledging the utility of noninvasive tests, both experts agree that colonoscopy remains the gold standard, acknowledging that even with noninvasive testing, a colonoscopy will still be required following a positive result.

The conversation then shifts to the critical role of bowel preparation in ensuring effective and complete exams. Anderson notes that inadequate preparation can result in missed lesions, increased healthcare costs, and the need for repeat procedures, undermining the value of the screening itself. He emphasizes that proper bowel preparation safeguards the efficacy of colonoscopy and protects patients from potential morbidity associated with incomplete exams.

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

1. 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

2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. doi:10.3322/caac.21763