The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Recent Advances in Colonic Preparation for an Accurate Colonoscopy – How to Improve Our Practice to Meet the Quality Criteria


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 difficult to reach in many centres. Newer low-volume laxative regimens for bowel cleansing are better in the fields 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 fibre diet is now preferred due to better compliance and tolerability. Conclusions: One of the easiest ways to improve colonoscopy quality is through improved compliance. Two of the most effective measures are using newer laxative bowel cleansing formulas (like 2L PEG-CS) and a low-fibre diet.