Key Concepts in the USMSTF Bowel Preparation 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 final segment of this 6-part HCPLive RX Review, Brian Jacobson, MD, MPH, and Joseph Anderson, MD, discuss what they consider to be a key strength of the updated bowel preparation guidance—the inclusion of expert-driven key concepts where evidence is limited.

While the document is grounded in consensus statements supported by varying levels of evidence, Jacobson and Anderson note the key concepts offer practical guidance for real-world scenarios where robust data may be lacking.

Specifically, Jacobson highlights a key concept for inadequate colonoscopies recommending using the situation as an opportunity for shared decision-making with the patient. Physicians can discuss alternative colorectal cancer screening options, including noninvasive tests, rather than defaulting to a rescheduled colonoscopy.

Anderson agrees, emphasizing that the goal of the recommendations is to provide practical, user-friendly guidance for clinicians navigating real-world challenges. He notes that flexible sigmoidoscopy was historically a primary screening tool, with evidence demonstrating a reduction in left-sided colorectal cancer incidence among individuals screened with either rigid or flexible sigmoidoscopy. In cases of incomplete colonoscopy, he says revisiting this approach could be a viable option, ensuring patients remain engaged in screening rather than losing them to follow-up.

He also reinforces the overarching theme of the discussion: physicians already face significant demands, and inadequate bowel preparation should not create undue burdens. By incorporating alternative strategies—whether through noninvasive tests or leveraging partial colonoscopy findings—clinicians can maintain effective colorectal cancer screening while optimizing patient-centered care.

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