INTRODUCTION
Colonoscopy is an endoscopic procedure used to examine the inner lining of the colon and the terminal ileum, which is considered the gold standard for diagnosing and treating colorectal diseases[1]. It plays a crucial role in screening and diagnosing colorectal lesions and has been extensively employed in clinical diagnosis and treatment for many years[2]. Bowel preparation refers to the cleansing of the colon using specific methods prior to certain medical examinations such as a colonoscopy, or surgical procedures such as colorectal surgery. The purpose of bowel preparation is to minimize fecal matter and gas within the bowel, thereby improving both the accuracy and safety of the subsequent medical procedure. In the context of colonoscopy, adequate bowel preparation is essential for achieving successful outcomes. However, studies have shown that approximately one-third of patients in China fail to complete adequate bowel preparation prior to necessary medical procedures[3]. Similarly, studies in New York and France revealed that 24% and 25% of the patients displayed suboptimal bowel preparation respectively[4,5]. Therefore, inadequate bowel preparation remains a pending issue, which highlights the need for effective bowel preparation protocols. Insufficient bowel cleansing before colonoscopy can result in a range of adverse outcomes that directly impair the physician's ability to visualize the intestinal mucosa. This may hinder accurate diagnosis, increase the risk of missed or mis-diagnosed lesions, prolong examination time, and raise the likelihood of complications such as perforation[6]. Furthermore, inadequate preparation may lead to unnecessary discomfort for patients and additional medical expenses due to repeat examinations. Numerous domestic and international guidelines and expert consensus documents have underscored the critical importance of proper bowel preparation[7,8]. Regrettably, although various clinical methods for bowel cleansing have been developed, there is no standardized or universally efficient approach. Therefore, this review aims to explore various strategies for bowel preparation prior to colonoscopy by examining aspects including medication, diet, exercise, and technological advancements (Figure 1). The goal is to provide scientific guidance for clinical practitioners in developing more efficient and personalized bowel preparation plans tailored to individual patients' needs, thereby enhancing patient satisfaction and comfort.
Figure 1 Routine methods for intestinal preparation and the expected outcomes.
BOWEL PREPARATION QUALITY ASSESSMENT TOOLS
The assessment of the quality of bowel preparation is necessary prior to colonoscopy in order to determine whether to proceed with colonoscopy or to promptly identify any deficiencies in bowel preparation. Inadequate bowel preparation is defined as the condition in which the bowel is not sufficiently clean to allow for the detection of polyps > 5 mm in diameter[9]. Currently, various assessment tools are available for evaluating bowel preparation. The Boston Bowel Preparation Scale (BBPS), the Ottawa Bowel Preparation Scale (OBPS), and the Aronchick Scale are the scales predominantly employed in clinical practice.
Boston bowel preparation scale
The BBPS, developed by Lai et al[10], demonstrated a weighted Kappa value of 0.74 (95%CI: 0.66-0.87). It divides the colon into three distinct segments: The right colon, consisting of the cecum and ascending colon, the transverse colon, including both the hepatic and splenic flexures, and the left colon, encompassing the descending colon, sigmoid colon, and rectum. The total BBPS score is calculated by the sum of the scores of the three colonic segments, with higher scores indicating better bowel preparation quality. A total BBPS score below 6, or a score less than 2 in any individual colonic segment, is deemed indicative of inadequate bowel preparation[11]. The BBPS has been validated across various ethnic and demographic groups, demonstrating high reliability and validity. As a result, it is one of the most recommended tools in clinical practice[12]. However, due to the inherent subjectivity of this scoring system, regular standardized training within a clinical setting is essential to minimize discrepancies in the assessment among different practitioners as much as possible.
OBPS
The Ottawa Bowel Preparation Classification was established by Rostom and Jolicoeur[13] in 2004. The OBPS evaluates colonic cleanliness (scored up to 12 points) and the volume of fluid present in the intestinal lumen (scored up to 2 points) for a maximum total score of 14 points. This scoring system is primarily based on whether irrigation or aspiration (Irrigation is an operation to improve the cleanliness of the intestine by injecting fluid into the intestinal lumen to soften, loosen, and wash away residual feces, mucus, or other impurities; Aspirations the operation of removing excessive liquid, gas or loose stool in the intestinal cavity through a negative pressure suction device to keep the surgical field clear) is necessary; therefore, assessments should be conducted before any aspiration or removal of bowel fluids. Each region is assigned a score ranging from 0 to 4, with a score of 4 indicating poor cleanliness. Higher scores suggest poorer bowel preparation, and an OBPS score > 7 is classified as inadequate bowel preparation[14]. The OBPS demonstrated strong reliability with kappa coefficients recorded at 0.92 (95%CI: 0.88-0.95) for the right colon, 0.88 (95%CI: 0.82-0.92) for the middle colon, and 0.89 (95%CI: 0.83-0.92) for the recto-sigmoid colon. This indicates that the OBPS possesses good reliability, making it one of the commonly utilized tools for assessing bowel cleanliness during clinical practice.
Aronchick scale
This scale, developed by Aronchick[15] and published solely as an abstract, evaluates bowel preparation based on the percentage of stool covering the colonic mucosa, with five distinct ratings: Excellent, good, fair, poor, and inadequate. The assessment is conducted prior to the aspiration of intestinal fluid or intestinal irrigation. Generally, average, poor and inadequate bowel preparations are considered insufficient for optimal outcomes. However, this scale has not been widely adopted in clinical practice due to difficulties in accurately assessing fecal coverage and evaluation of entire bowel segments without formal validation. In view of the existing problems of the scale, it is recommended to conduct segmented scoring, and multi-center study is recommended to verify the repeatability and clinical relevance of the scale.
Notable disparities exist among the three scales in terms of scoring range, scoring direction, and evaluation timing. Therefore, it is recommended that clinicians familiarize themselves with the similarities and differences between various assessment scales before selecting an appropriate scale for use. Additionally, variations in judgment may occur among different clinicians, highlighting the need to standardize the use of assessment tools and unify evaluation criteria to the greatest extent possible. Clinical medical staff should select suitable assessment tools based on patients’ specific conditions, accurately assess bowel preparation cleanliness, and promptly determine the optimal timing for colonoscopy, thereby saving time, reducing patient discomfort, and improving patient satisfaction.
SELECTION AND ADMINISTRATION OF PHARMACOLOGICAL AGENTS FOR BOWEL PREPARATION
Several pharmacological agents are used for bowel preparation, each exhibiting distinct mechanisms of action and physiological effects. The use of medication can significantly influence the quality of preparation; therefore, careful consideration and application of these drugs is crucial for successful outcomes. An ideal agent should facilitate rapid fecal clearance from the intestines without inducing disturbances in water or electrolyte balance, while also minimizing patient discomfort. Furthermore, it is essential that the cost of such medications remain economical. At present, pharmacological bowel preparation agents can be primarily categorized into electrolyte solutions such as general electrolytes and sodium phosphate, volumetric laxatives, including magnesium sulfate and polyethylene glycol, and lubricant laxatives like paraffin oil and glycerol[16]. Additionally, certain Chinese herbal medicines can also be used.
Bowel preparation using polyethylene glycol
Polyethylene glycol (PEG) is a polymer derived from inert ethylene oxide that functions as a volumetric laxative[17]. When administered orally with large volumes of liquid, PEG exerts no significant impact on intestinal absorption and secretion, thereby avoiding disturbances in water and electrolyte balance. Since PEG is not absorbed by the intestine, it can transport substantial amounts of water through the gastrointestinal tract, effectively softening feces and facilitating excretion to achieve optimal cleansing results. Furthermore, PEG is generally well tolerated by patients. Although its taste may be unpalatable, flavoring agents can be added to improve palatability. The dosage guidelines for PEG are straightforward, making it easy for patients to adhere to treatment protocols. PEG electrolyte powder is the most widely used agent for bowel preparation worldwide. However, there are differences in administration protocols[8]. PEG regimens can be categorized into high-volume and low-volume methods. According to European and American guidelines[7], intestinal preparation with PEG should include a variety of protocols, such as 4 L divided administration, 2 L combined with adjuvant preparations, and very low-volume 1 L PEG. Notably, the non-inferiority of very low-volume regimens, such as 1 L-PEG-ASC, has been validated by high-quality randomized controlled trials (RCTs), making it particularly suitable for high-risk populations. Studies have demonstrated that the 1 L PEG regimen is more effective in bowel preparation and enhances patient compliance[18,19]. Clinical decision-making must balance cleansing efficacy and patient tolerance. For instance, 1 L-PEG-ASC is preferred for patients with congestive heart failure, whereas 4 L PEG remains recommended for detailed examinations (e.g., inflammatory bowel disease evaluations). Bowel preparation success rates can reach 90%, accompanied by strong safety profiles. Chinese guidelines[8] recommend that general patients consume 3 L of PEG for bowel preparation; however, this method is often poorly accepted due to the large fluid volume and unpleasant taste. Consequently, most clinicians prefer low-volume 2 L PEG combined with other drugs to address the issue of excessive fluid intake. Currently, lactulose, mosapride, and linaclotide are commonly used in combination with PEG. Clinical trials have shown that combining PEG with these agents improves the quality of bowel preparation and enhances patient satisfaction[20-22]. Additionally, some RCTs indicate that lactulose outperforms PEG in terms of preparation quality and taste[23]. Thus, utilizing 2 L PEG combined with auxiliary drugs provides clinical staff with additional medication options, improving bowel preparation quality while reducing patient burden and discomfort. To further mitigate taste issues, studies suggest adding honey during PEG consumption, which not only neutralizes the taste but also prevents hypoglycemia risks associated with excessive intestinal cleansing[24]. Ultimately, the primary goal is to improve bowel preparation cleanliness while minimizing patient burden and discomfort. Therefore, medication regimens should be tailored according to patient preferences, physical conditions, and specific needs.
Medication regimen of PEG: The administration of PEG can be categorized into single-dose and split-dose regimens, which enable patients with varying needs and clinical conditions to select the most appropriate method. Single-dose administration involves the complete administration of the entire dose of PEG at once. According to expert consensus[8], this should begin 4-6 hours before the colonoscopy and be completed within 2 hours. In contrast, the split-dose regimen divides the PEG dosage into two parts, taken at different times before the procedure. For patients at risk of inadequate bowel preparation, an increased dose of PEG and a split-dose regimen may be recommended. The standard split-dose regimens for PEG currently include: (1) The 3 L PEG regimen, 1 L taken 10-12 hours before the examination and 2 L 4-6 hours before the examination on the day of the procedure; and (2) The 4 L PEG regimen, 2 L taken 10-12 hours before the examination and 2 L 4-6 hours before the examination on the day of the procedure. There are notable differences in efficacy between single-dose and split-dose regimens. A meta-analysis demonstrated that compared to single-dose administration, split-dose administration significantly improves both the quality of bowel preparation[25] and patient compliance. Therefore, when selecting the PEG dose and administration method, it is essential to consider both the patient's clinical condition and personal preferences to achieve optimal bowel preparation efficiency.
Utilization of alternative pharmacological agents for bowel preparation
General electrolyte solutions have also been employed for bowel preparation, which typically consist of sodium chloride, sodium bicarbonate, and potassium chloride dissolved in three liters of heated boiling water. Patients are instructed to consume entirely within four to six hours prior to surgery, ideally completing intake within one hour. However, due to the substantial volume of fluid ingested in a short timeframe, this approach often leads to gastrointestinal discomfort, thereby diminishing patient adherence. Another pharmacological agent used for bowel preparation is sodium phosphate, a hyperosmotic laxative that works by increasing fluid volume within the intestine by increasing the water content of feces, thereby promoting fecal elimination. Unlike PEG, sodium phosphate requires less fluid intake, resulting in higher patient compliance. Nevertheless, because it is a hypertonic solution, sodium phosphate may disturb water and electrolyte balance in certain populations. Thus, current international guidelines do not recommend the routine use of oral sodium phosphate for bowel preparation[7]. Furthermore, renal function should be assessed before administering oral sodium phosphate[9]. Magnesium sulfate may also be used for bowel preparation, valued for its ease of administration, favorable patient tolerance, and cost-effectiveness. Magnesium sulfate is a hypertonic solution that facilitates peristalsis and induces bowel movements. However, since magnesium sulfate is not absorbed in the intestine following oral administration, it too can lead to water and electrolyte imbalances, potentially resulting in side effects and clinical complications. Paraffin oil is a type of mineral oil that is indigestible and non-absorbable by the intestine. It facilitates the smoother passage of feces through the intestinal tract for effective bowel cleansing. However, when used alone, paraffin oil exhibits a delayed onset of action and limited efficacy, which may lead to increased patient discomfort and reduced overall satisfaction. Glycerol, by contrast, exhibits dual pharmacological effects in bowel preparation: It serves both as a lubricating softener and as a mildly stimulating laxative. Its mechanism primarily relies on its high osmotic pressure properties which stimulate peristalsis by stimulating the rectal wall while also providing local lubrication. Glycerol is easy to administer and has a rapid onset of action, typically inducing defecation within minutes. Given these attributes, glycerol is particularly well-suited for elderly patients who experience reduced intestinal motility. Castor oil, a traditional stimulating laxative, is still used as a laxative in some developing countries. Its laxative effect results from the hydrolysis of ricinoleic acid, which directly stimulates intestinal peristalsis and secretion, producing a rapid onset of action. However, it may cause abdominal pain and electrolyte disturbance, so it should be used with caution in elderly and frail patients. Recent studies have applied castor oil to colonoscopy capsule endoscopy, which can improve the performance of the examination and has good application effects[26]. Bisacridine is a stimulant laxative. After oral administration, it is hydrolyzed by bacterial enzymes into active metabolites in the colon, which directly stimulates the intestinal plexus, enhances intestinal peristalsis, and reduces water absorption, thereby promoting defecation. In Europe and North America, it is often used in combination with PEG as an adjuvant to reduce the dosage of PEG and improve the tolerance of PEG. However, it is less commonly recommended by Asian guidelines, which may be related to population differences in drug tolerance. Mannitol is a hypertonic sugar alcohol, which forms a hypertonic environment in the intestinal tract after oral administration, preventing water absorption and promoting intestinal secretion, thus producing catharsis. It is inexpensive and easy to administer; however, its fermentation in the gut can generate explosive gases such as methane, and it may cause side effects including nausea and vomiting. In addition to the aforementioned medications, Chinese herbal remedies such as senna leaf and Chengqi decoction have also been utilized for bowel preparation prior to colonoscopy. Some studies[27] have shown that there is no significant difference in catharsis effect between senna and PEG, but the adverse reactions of single use of senna are significantly higher than those of PEG, so the two are usually used together in clinical practice. Nonetheless, further research is needed to evaluate the safety and efficacy of senna-PEG combinations in bowel preparation prior to colonoscopy.
Different bowel preparation agents possess distinct advantages and disadvantages, and research has explored their application and safety profiles. Nevertheless, most of the existing studies focus on conventional populations, leaving a gap in discussions regarding special populations, including children and the elderly. Therefore, the choice of bowel preparation agent should be tailored to each patient to ensure both safety and efficacy. In addition, further experimental investigations into the effects of various drugs during bowel preparation across diverse populations should be conducted to provide additional guidance for clinical decision-making.
DIETARY MANAGEMENT DURING BOWEL PREPARATION
Dietary management is a key element of high-quality bowel preparation and plays an essential role in this process. A variety of dietary strategies are currently employed in clinical practice. While transparent liquid diets remain the standard recommendation[28], recent years have seen the emergence of alternatives such as low-residue diets, white diets, and diets utilizing pre-packaged foods. Each type of diet has its own effects and applications. Therefore, an ideal bowel preparation diet program should not only be effective but also well-tolerated by patients[29].
Low-residual diets
A low-residue diet is a dietary strategy designed to minimize the intestinal burden, primarily by restricting dietary fiber (with total fiber intake limited to less than 10 g per day[30]) and avoiding difficult-to-digest foods. Low-residual diets aim to reduce intestinal residue and mechanical irritation. Several studies[31,32] have indicated that low-fiber or low-residue diets can significantly improve patient tolerance without compromising the effectiveness of intestinal cleansing. Traditional guidelines recommend that patients adhere to a low-residual diet for three days prior to undergoing colonoscopy. However, recent studies[33,34] have demonstrated that employing a low-residue diet for just one day before the procedure yields result comparable to those achieved with a three-day regimen, while also improving patient tolerance and acceptance. Based on these findings, shortening the dietary preparation period may be a viable strategy for improving the bowel preparation experience. Nonetheless, current research has only focused on reducing the duration from three days to one day, without exploring alternative timing or dietary optimization strategies. Further clinical experimental studies are necessary to investigate the efficacy of other timing strategies and to assess patients' experiences in order to establish an optimal bowel preparation protocol that minimizes residual dietary intake.
White diet
White diet refers to white or creamy low-residue foods (i.e. small amounts of indigestible food ingredients), such as white rice, white bread, skinless chicken, tofu, etc. Study in Australia[35] demonstrated that patients who were allowed to consume a white diet without any restrictions one day prior to undergoing colonoscopy achieved an equivalent level of bowel preparation as the control group. The white diet was better tolerated by patients and these patients expressed a greater willingness to accept and choose this dietary option. Another study[36] demonstrated that individuals who adhered to a two-day white diet reported a higher level of overall satisfaction with their dietary experience. Additionally, participants noted significant reductions in bloating, weakness, hunger, and disruptions to daily activities. Although the white diet may extend the dietary preparation period, its flexibility in food choices and allowance for personal preference likely contribute to improved patient compliance and comfort. Implementing a strategy centered around a white food regimen during bowel preparation may enhance patient satisfaction and tolerance levels while optimizing bowel cleansing processes and improving colonoscopy success rates. The white diet only strictly restricts the color of food, so the use of white diet in bowel preparation before colonoscopy can be promoted globally. Due to regional and cultural differences, people from different countries and different beliefs can adjust the choice of food types according to their own preferences and standards. While there is no restriction on the quantity of food consumed within this framework, further investigation is warranted regarding whether variations in the portions of different types of white foods might influence bowel preparation outcomes. Specifically, determining which proportions can maximize efficiency during bowel preparation remains an area worthy of exploration.
Pre-packaged food
The use of pre-packaged food for bowel preparation involves standardized products specifically designed for bowel examinations. These foods are characterized by clear ingredient lists, minimal residue, a low fiber content, and ease of consumption and storage. The primary objective of consuming such foods is to minimize the accumulation of food residues in the intestine, thereby enhancing intestinal cleanliness and ensuring effective examination outcomes. Standardized pre-packaged low-residue diets utilize nutritional technology to remove dietary fiber and convert food into a powdered form that is more easily digested and absorbed[37]. This pre-packaged formula not only provides sufficient energy but also maintains a balanced ratio of the three macronutrients: Carbohydrates, fats, and proteins. Furthermore, this dietary regimen is rich in various vitamins and micronutrients, offering comprehensive nutritional support for the patient. Pre-packaged foods can easily be adjusted to meet specific nutritional goals based on individual patient needs and health conditions. This standardized pre-packaged food diet exhibits a safety profile comparable to traditional self-contained low-residue diets while demonstrating superior quality in bowel preparation as well as enhanced patient compliance and tolerance. Currently, the use of pre-packaged food for bowel preparation prior to colonoscopy is not yet widespread, however, it holds significant potential value for special populations, including diabetic patients or the elderly. The type and proportion of these foods can be tailored according to individual health requirements without compromising their well-being while successfully completing bowel preparation.
Although there are various dietary management strategies for bowel preparation prior to colonoscopy, these measures may inadvertently cause additional discomfort and unpleasant sensations for patients. Therefore, when selecting an appropriate dietary regimen, medical professionals should thoroughly consider the individual circumstances of each patient, including their health status, lifestyle habits, and personal preferences. This approach will facilitate the development of a scientifically sound and compassionate personalized dietary management plan.
EXERCISE INTERVENTION DURING BOWEL PREPARATION
Appropriate physical exercise plays a significant role in bowel preparation prior to colonoscopy. Several studies[38] have identified insufficient physical activity as an independent risk factor for inadequate bowel preparation, while moderate exercise has been shown to improve both patient tolerance and the overall quality of bowel preparation. A variety of exercise regimens are currently employed in clinical settings, including walking, yoga, and traditional Chinese medicine-based bowel-cleansing exercises.
Walking
Walking is a widely used and accessible form of exercise for bowel preparation due to its minimal time and space requirements. It is widely utilized for bowel preparation. Kim et al[39] conducted a randomized controlled trial utilizing a 3 L polyethylene glycol (PEG) regimen, where participants exercised for 5 minutes after ingesting 250 mL of laxatives over a total duration of 60 minutes, achieving an average of 3043 steps. The study found that the bowel preparation success rate in the exercise group surpassed that of the non-exercise group. However, conflicting evidence exists. Some studies[40] have reported that engaging in physical activity does not significantly enhance bowel preparation and may impose additional strain on patients. In one such study, participants were required to consume 1 L of laxative per dose and engage in 10 minutes of physical activity after each administration—repeating this cycle three times for a total of 30 minutes of exercise. Given that ingesting large volumes of liquid at once can be burdensome for patients and adhering to ten-minute bouts of exercise may render challenging, further clinical trials are essential to elucidate the relationship between laxative dose per session, timing, and intensity of physical activity. Such investigations aim to identify an optimal balance and combination conducive to effectively enhancing bowel preparation quality.
Yoga
Specific yoga poses have been shown to effectively stimulate intestinal peristalsis by promoting the twisting, compressing, and stretching of the abdominal organs, thereby aiding in the elimination of waste from the gastrointestinal tract[41]. In addition, yoga’s breathing techniques and meditation practice not only facilitate relaxation but also enhance intestinal function and alleviate anxiety prior to colonoscopy. However, although yoga serves as a beneficial exercise for both physical and mental health, it depends on professional guidance to ensure optimal training outcomes. Consequently, when incorporating yoga into bowel preparation protocols before colonoscopy, several limiting factors may arise. These include potential shortages of qualified yoga instructors or logistical challenges related to space and time requirements for patients participating in yoga practice. Additionally, the individualized nature of yoga necessitates adjustments based on each person's constitution and health status, and this variability can pose further barriers in the use of yoga as an effective aid for bowel preparation. Therefore, further exploration is needed regarding how best to implement yoga exercises in conjunction with bowel preparation strategies to maximize their benefits.
Bowel cleansing exercises
Bowel cleansing exercise is an exercise program composed of Baduanjin combined with gastrointestinal massage. Domestic studies[2] have shown that patients who perform bowel cleansing exercise combined with walking exercise have a higher degree of bowel preparation cleanliness than those who only engage in walking exercise intervention, and the level of discomfort experienced by patients is reduced. By performing bowel cleansing exercises, patients can effectively shorten the time required for the first defecation in the process of bowel preparation, so as to accelerate bowel clearance. This exercise method not only helps to improve the cleanliness of the intestine, but also promotes the improvement of intestinal function, making the whole bowel preparation process more efficient and comfortable. The Baduanjin exercise in the bowel cleansing exercise is a traditional Chinese qigong exercise that promotes the movement of qi and blood through slow movements, breathing regulation and mental guidance. It can not only strengthen muscles, improve cardiopulmonary function, regulate spleen and stomach, but also relieve anxiety and stress. It is easy to learn and is not limited by time and space. However, due to the difference in cultural background, current research only focuses on Chinese single-center research, with no research evidence from other countries and races. It is suggested that after cultural adjustment, the Baduanjin Qingbowel exercise should be applied to other countries and races, and be continuously optimized in combination with their local culture to overcome cultural barriers. At the same time, more targeted multi-center intervention studies with large samples of different ethnic groups should be further carried out to evaluate the universality of Baduanjin bowel cleansing exercise, so as to provide more sufficient evidence for the scientific and efficient bowel preparation of bowel cleansing exercise.
Special bowel preparation exercises
The programs for exercise interventions in bowel preparation continue to evolve. For example, chewing gum is regarded as a unique exercise form for bowel preparation. This behavior, akin to sham feeding, has been demonstrated to enhance gastrointestinal motility by stimulating the vagus nerve and increasing the secretion of gastrointestinal hormones[42]. Research studies[43,44] have indicated that chewing gum can accelerate laxative intake, reduce abdominal discomfort, and improve patient satisfaction and willingness to repeat bowel preparation procedures. However, some investigations[45] have presented an alternative perspective, suggesting that while chewing gum may improve patient comfort and satisfaction during bowel preparation, it does not appear to significantly affect the cleanliness of the procedure. Consequently, further clinical studies are warranted to validate the methodology, timing, and efficacy of chewing gum use in bowel preparation.
During bowel preparation, the regulation of exercise intensity is of paramount importance. It has been noted that vigorous high-intensity exercise may impair the normal emptying process of the gastrointestinal tract[46,47], particularly following meals or fluid intake. Additionally, strenuous physical activity is more likely to cause digestive discomforts such as bloating, belching, and reflux[48]. In contrast, engaging in moderate to mild exercise can stimulate the production of gastrointestinal hormones, enhance the protective mechanisms of the gastric mucosa, and promote intestinal peristalsis—factors beneficial for patients with inflammatory bowel disease or functional gastrointestinal disorders, who often require frequent colonoscopies[49]. Consequently, it is advisable to select a moderate- to low-intensity exercise regimen when designing a bowel preparation plan. In conclusion, while exercise intervention appears to be advantageous in bowel preparation, considerations regarding the type of exercise chosen, its intensity level, and duration should be tailored according to each patient's individual circumstances.
INTELLIGENT DEVELOPMENT OF BOWEL PREPARATION IN COLONOSCOPY
With the ongoing advancements in science and technology, along with the continuous evolution of digital health and artificial intelligence (AI), intelligent equipment is increasingly being integrated into the medical field. The utilization of such intelligent devices not only accelerates the development of medicine but also alleviates patient discomfort to some extent and enhances overall patient satisfaction. For example, in recent years, wearable technologies such as fitness trackers and virtual reality applications have shown significant clinical potential in health monitoring and therapeutic interventions[50]. Furthermore, intelligent solutions have been implemented in bowel preparation prior to colonoscopy, primarily aiding in bowel cleansing assessments and preoperative health education[8,51].
The utilization of AI in assessing bowel preparation prior to colonoscopy
AI has demonstrated the ability to provide real-time feedback regarding the quality of bowel preparation during colonoscopy[8]. By objective assessments of bowel cleanliness and monitoring, AI can accurately evaluate the color and clarity of a patient's stool prior to surgery, which serves as a basis for determining the degree of bowel cleanliness. The AI-based scoring system offers a more rapid and objective method for assessing intestinal cleanliness, thereby reducing both the workload and evaluation errors associated with endoscopists. Currently, numerous researchers have developed intelligent assessment tools such as evaluation systems and mobile applications that can be used to gauge bowel preparation cleanliness and whose effectiveness is supported by clinical trials[52-54]. Although a number of artificial intelligence systems have shown significant effects in the evaluation of bowel preparation before colonoscopy, their application remains limited to relatively small and specific patient populations. A large number of samples should be tested and continuously optimized before comprehensive promotion. In addition, regular maintenance and update of systems and equipment should be carried out to achieve the best evaluation effect. In general, the development of informatization provides many new ideas for the evaluation of bowel preparation before colonoscopy, and also brings convenience to clinicians. However, there are still few relevant studies, so further research is needed. The intelligent evaluation of bowel preparation before colonoscopy is worth continuous thinking and development.
Intelligent health education in bowel preparation
The quality of bowel preparation has a direct impact on the effectiveness of colonoscopy, and health education plays a crucial role in helping patients comprehend the significance of proper bowel preparation by enhancing patient cooperation and compliance. Traditional methods of health education regarding bowel preparation typically involve oral explanations, written materials, and telephone reminders. However, these methods often present information in a relatively simplistic manner that may be difficult for patients to fully understand and retain. With the advancement of technology, both the form and content of health education are evolving. Currently, AI educational robots have been introduced into clinical practice and these tools effectively address patient questions while catering to their specific needs. For more complex topics, information can be conveyed visually through videos, images, or audio presentations. This multimodal approach significantly enhances patients' comprehension and retention of essential knowledge related to bowel preparation[55]. Some scholars[56] have utilized virtual reality technology in health education prior to colonoscopy, providing patients with a more immersive experience that enhances the understanding of the entire examination process. This approach aims to improve the quality of bowel preparation by enhancing compliance. The development of intelligent health education should also be optimized across multiple dimensions, such as providing different content for people with different cultural backgrounds, different beliefs, and different educational levels, so as to ensure that diverse people can know and understand the related knowledge of bowel preparation. Despite the increasing richness in both form and content of health education, medical professionals must remain attentive to patients' psychological needs and levels of preoperative anxiety throughout the bowel preparation process for colonoscopy. Given that colonoscopy is an invasive procedure, patients often experience discomfort during the examination and may also feel anxious due to concerns about privacy. These factors frequently contribute to heightened fear and anxiety[57], which can adversely affect intestinal motility and emptying[58]. Therefore, accurate and effective health education has the potential to alleviate preoperative anxiety in certain patients, thereby enhancing their tolerance for the procedure and improving overall success rates in bowel preparation.
CONCLUSION
The quality of bowel preparation plays a crucial role in the effectiveness of colonoscopy. High-quality bowel preparation can significantly improve the detection rate of colorectal diseases, effectively minimize potential adverse reactions during the examination, and thereby alleviate patient discomfort. This article reviews current practices involving pharmacological agents, dietary management, exercise interventions, and advancements in intelligent technology related to bowel preparation prior to colonoscopy. Through an analysis of both domestic and international research trends, this article engages in an in-depth discussion of these aspects. Currently, there are various methods employed for bowel preparation in clinical practice, most of which have been demonstrated to be feasible and effective. However, medical professionals should develop individualized bowel preparation plans tailored to each patient's specific physical condition and actual needs to maximize the success rate of the procedure while enhancing patient comfort and satisfaction. With rapid advancements in science and technology, particularly those driven by developments in information technology, the traditional models of bowel preparation are undergoing continuous innovation. Consequently, the process leading up to colonoscopy is evolving towards greater intelligence, individualization, standardization, and efficiency.
