The Clinical Importance of Adequate Bowel Preparation.

BACKGROUND: Adequate bowel preparation (BP) is the foundation to successful colonoscopy. Inadequate bowel preparation (IBP) leads to numerous consequences beyond just procedural inconvenience. IBP can obscure polyps, lesions or early signs of colorectal cancer (CRC) while increasing procedure length, shortening surveillance intervals and increasing health care costs. Efforts to improve BP quality, therefore, are critical for high-quality endoscopic examinations, which optimise the success of CRC screening programmes. Achieving adequate BP begins with clearly understanding and grading BP quality on every examination, aiming for a minimum threshold of adequate BP in > 90% of colonoscopies. Additionally, recognition of patient-specific risk factors for IBP allows for tailored instructions and utilisation of navigational and outreach tools along with enhanced educational materials towards optimising BP. Finally, understanding patient preferences and improving the patient experience can increase the chances of succeeding with not only completion of the index examination but also optimising compliance for any repeat examinations across screening, surveillance and diagnostic indications. METHODS: This manuscript will review the current evidence regarding the consequences of IBP, while discussing patient-specific risk factors and barriers to adequate BP, concluding with methods to improve BP adequacy and practical tips for clinicians.