Colonoscopy is one of the most important preventative care measures for reducing the risk of colon cancer and is used widely for diagnostic evaluation of symptoms and other screening tests.1 Bowel preparation (cleansing) is necessary for direct visualization of the colonic mucosa for analysis and polyp removal during colonoscopy.2

The success of colonoscopy is linked closely to the adequacy of pre-procedure bowel cleansing.1 Insufficient bowel cleansing has been shown to decrease detection of small adenomas.2 It may also result in longer procedural time, lower cecal intubation rates, increased risk of electrocautery, and shorter intervals between examinations.1,2

Medical Unmet Need in Bowel Preparation for Colorectal Screening

Medical unmet need in colorectal screening infographic Medical unmet need in colorectal screening infographic

*Reasons for inadequate preparation range from patient-related factors (eg, noncompliance with preparation regimen, medical conditions that make bowel preparation difficult) to unit-specific factors (eg, extended wait times).

Based on a meta-analysis of 27 studies (OR, 0.53; 95%CI, 0.46–0.62; P<0.001).

Sources: *Johnson DA, et al. Am J Gastroenterol. 2014;109(10):1528-1545. Sulz MC, et al. PLoS One. 2016;11:e0154149.

Mechanisms and Methods of Bowel Cleansing

Osmotic laxatives and nondigestible and nonabsorbable polyethylene glycol (PEG) formulations are 2 of the most commonly used methods for bowel cleansing prior to colorectal screening.3 Osmotic laxatives employ compounds that actively draw water into the colon, causing a laxative effect.3 PEG formulations are commonly used in both low- and high-volume fluid bowel preparations and cleanse fecal debris due to the drag from excess fluid.3,4 Newer preparations aim to adequately clear the bowel without excess loss of fluids or electrolytes.3,4


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  1. Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2014;109(10):1528-1545.

  2. Kastenberg D, Bertiger G, Brogadir S. Bowel preparation quality scales for colonoscopy. World J Gastroenterol. 2018;24(26):2833-2843.

  3. Adamcewicz M, Bearelly D, Porat G, Friedenberg FK. Mechanism of action and toxicities of purgatives used for colonoscopy preparation. Expert Opin Drug Metab Toxicol. 2011;7(1):89-101.

  4. Reumkens A, van der Zander Q, Winkens B, et al. Electrolyte disturbances after bowel preparation for colonoscopy: systematic review and meta-analysis. Dig Endosc. 2022;34(5):913-926.


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