Optimal Bowel Preparation for Colonoscopy

Colorectal cancer is the third most cancer in the US and the second most cause of cancer deaths. The general lifetime risk of developing cancer in the United States is about 6%. Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. There are various screening tests available for the colon cancer. High sensitivity FOBT, flexible sigmoidoscopy and colonoscopy are the most commonly used ones. Flexible sigmoidoscopy only checks for polyps or cancer inside the rectum and lower third of the colon, while colonoscopy also checks for colon polyps or cancer inside the rectum and the entire colon. It is also used as a follow-up test if anything unusual is found during one of the other screening tests. Other screening tests being studied are virtual colonoscopy and stool DNA testthough currently these are not covered uniformly by the insurance companies. Colonoscopy is a very important screening test that is thought to be playing a pivotal role in the decline of the colorectal cancer rates in the developed countries by facilitating the early detection and the removal of the adenomatous polyps. Guidelines from national societies recommend routine screening for colorectal cancer starting the age of 50 years in patients at average risk. Adequate bowel preparation is important in assuring the quality and accuracy of the colonoscopy (see figure 1). However, preparing for a colonoscopy can be frustrating for the patients. It is the role of the care providers to take time to explain to the patients how exactly they should approach in order to avoid any failures and repeat exams which can be agonizing for the patient. Regardless of the preparation selected, the potential financial burden of a repeat colonoscopy and preparation can be huge. Specifically, the patient may be required to pay additional co-pay for each examination and the financial intermediary may deem repeat examinations unnecessary. In these instances, the patient may be responsible for payment in full for repeat examination incurred due to inadequate bowel preparation.1 This can be prevented by handing out patient instruction sheet along with the bowel preparation that can be used as a step by step guide before the colonoscopy. Patients should be motivated to ask questions or call doctor’s office if they have any trouble or do not understand the patient instructions. The most important factor affecting the quality of colonoscopy results is the extent of bowel cleansing. Patient tolerance of his/her colonoscopy bowel preparationregimen affects