USMSTF Guidance on Optimizing Bowel Preparation for Colonoscopy - Episode 2
Defining Adequate Bowel Preparation for Colonoscopy
In the second segment of this 6-part RX Review, experts discuss benchmarks for assessing adequate bowel preparation and the need for standardized scoring.
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 second segment of this 6-part HCPLive RX Review, Brian Jacobson, MD, MPH, and Joseph Anderson, MD, continue their discussion on the latest USMSTF consensus statements regarding bowel preparation for colonoscopy, focusing on updated benchmarks for assessing adequate bowel preparation and the importance of standardized scoring to ensure high-quality exams.
Jacobson describes the new guidance that recommends a target of 90% adequate bowel preparation—an increase from the 85% benchmark established in the 2014 guidance. Anderson goes on to explain what constitutes adequate bowel preparation and how it is defined, emphasizing that any scoring system utilized should evaluate preparation after cleaning to ensure proper visualization and effective interval recommendations.
The discussion also touches on the role of standardized scales for assessing the level of residual stool to gauge adequacy, ensuring consistent, clear documentation for future clinical decision-making.
Jacobson adds that improved preparation techniques, particularly split dosing, have significantly enhanced preparation quality, making the updated 90% target more attainable across practices and noting that his practice has been able to reach closer to 95%.
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, an associate 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
