Novel frontiers of agents for bowel cleansing for colonoscopy

Abstract

The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.

Keywords: Colonoscopy; Bowel preparation; Cleansing agents; Polyethylene glycol; Adequate cleansing; Constipation

Core Tip: Colonoscopy is the best modality for colorectal cancer (CRC) screening, preventing death from CRC through removal of adenomatous polyps and early detection of CRC. The accuracy of colonoscopy is related to quality of bowel preparation (BP). International guidelines underlined the methods to improve BP. In this review, we aimed to summarize the current strategy to increase bowel cleansing before colonoscopy.