Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019

Main Recommendations ESGE recommends a low fiber diet on the day preceding colonoscopy. Strong recommendation, moderate quality evidence. ESGE recommends the use of enhanced instructions for bowel preparation. Strong recommendation, moderate quality evidence. ESGE suggests adding oral simethicone to bowel preparation. Weak recommendation, moderate quality evidence. ESGE recommends split-dose bowel preparation for elective colonoscopy. Strong recommendation, high quality evidence. ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing. Strong recommendation, high quality evidence. ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure. Strong recommendation, moderate quality evidence. ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized. Strong recommendation, moderate quality evidence.