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Clinicians can use a range of methods to prepare the bowel for colonoscopy, the gold standard for imaging the mucosa of the colon to identify concerning lesions requiring excision or biopsy. Incomplete colonoscopies are defined by the inability to achieve effective cecal intubation and mucosal visualization. They occur in between 10 and 20 percent of all colonoscopies and frequently are due to inadequate bowel preparation. Studies have found that inadequate bowel preparation can lead to failed detection of cancerous lesions and is associated with an increased risk of procedural adverse events. Ideal preparation reduces patient discomfort and reduces shifts in fluid and electrolytes. This activity reviews the indications, contraindications, and techniques involved in performing effective bowel preparation and highlights the interprofessional team's role in the care of patients undergoing this procedure. Objectives: Identify the indications for bowel preparation. Describe the various methods for bowel preparation. Outline the contraindications to specific bowel preparations. Explain interprofessional team strategies for improving care coordination and communication to optimize bowel preparation, which will help prevent delays in performing colonoscopy. Access free multiple choice questions on this topic.

Clinicians can use a range of methods and efficacies to prepare the bowel for colonoscopy. Colonoscopy is currently the gold standard for imaging the mucosa of the colon to identify any concerning lesions for excision or biopsy. Reviews have shown that rates of incomplete colonoscopies, defined as the inability to achieve cecal intubation and mucosal visualization effectively, have ranged between 10% to 20%.[1][2][3] Poor bowel preparation can lead to failed detection of cancerous lesions and has been associated with an increased risk of procedural adverse events.[3][4] Many studies have identified risk factors for poor bowel preparation. These risk factors include previous poor bowel preparation, non-English speaking, Medicaid insurance, single, inpatient status, polypharmacy, suffering from obesity, advanced age, male gender, and comorbidities such as diabetes, stroke, dementia, and Parkinson disease.[5][6][7][8][9] Ideal preparation reduces patient discomfort and reduces shifts in fluid and electrolytes. Preparation should be safe, tolerable, and inexpensive.[10]

Interprofessional care for a patient undergoing bowel preparation is vital to ensure better preparation and colonoscopy outcomes. An interprofessional team consists of a primary care physician, gastroenterologist, nurses, and a pharmacist. With a team-based approach, a proper bowel preparation regimen can be selected based on the patient's medical history and potential side effects. A single dose versus a split-dose regimen can be selected to accommodate the patient's lifestyle. One study found that the utility of telephone reeducation about bowel preparation the day before a colonoscopy significantly improved the quality of bowel preparation and the rate of polyp detection.[32] [Level I]