Abstract
Colorectal cancer (CRC) remains a major problem of global health. Screening colonoscopy is the gold standard in detection of CRC. A quality colonoscopy needs good indication, adequate bowel preparation, adequate examination time (30 to 45 minutes), a minimum 6 minutes time for mucosal examination during colonoscopy descent, a good centre adenoma detection rate. In 28-33% of the colonoscopies, the bowel preparation is unsatisfactory which leads to several hidden costs including the rise of preventable and treatable death rate regarding colorectal carcinoma. The ESGE (European Society of Gastrointestinal Endoscopy) recommends a maximum of 10% poor preparations, threshold that is diffi cult to reach in many centres. Newer low-volume laxative regimens for bowel cleansing are better in the fi elds of compliance and tolerability than the classic 4L PEG with 2L PEG-CS (Clensia ®) being one of the new promising low-volume formulas. The low fi bre diet is now preferred due to better compliance and tolerability.
Highlights
Large bowel preparation is a highly important step in the process of a successful colonoscopy
ESGE (European Society of Gastrointestinal Endoscopy, Germany, EU) and UEG (United European Gastroenterology, Austria, EU) are recommending a rate of adequate bowel preparation of at least 90% calculated on a daily basis for the entire endoscopy centre and for every practitioner in part[1]
Its main advantage is that it adds to the regular low volume regime 2L PEG and citrate, the de-foaming agent simethicone that is effective in cleaning the bubbles formed on the bowel mucosa which can hinder the detection of small lesions[3,4]
Summary
Large bowel preparation is a highly important step in the process of a successful colonoscopy. Its main advantage is that it adds to the regular low volume regime 2L PEG and citrate, the de-foaming agent simethicone that is effective in cleaning the bubbles formed on the bowel mucosa which can hinder the detection of small lesions[3,4]. Once the American Cancer Society (Georgia, USA) proposed the modification of the threshold age for colorectal cancer screening start from 50 to 4510, a significant number of patients being diagnosed with early stage CRC or even high-risk precancerous lesions at an earlier age. Most of those are small lesions, flat lesions difficult to spot even by an experimented endoscopist, if the preparation is not optimal[11]
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