Current Status of Bowel Preparation for Colonoscopy in Japan: A Web-Based Survey of Endoscopists (PRESS Survey).

Key Takeaways for GI Nurses

• Low-volume PEG plus ascorbate solutions are currently the most widely used bowel-cleansing agents among Japanese endoscopists, followed by high-volume PEG and magnesium-based preparations—useful context for nurses educating patients on prep options and expected regimens.
• Nearly two-thirds of surveyed physicians (64.7%) reported encountering inadequate bowel preparation in more than 1 in 10 (or a similarly notable proportion of) cases, highlighting that suboptimal prep remains a persistent, widespread challenge even among high-volume proceduralists.
• Cleansing efficacy and safety were rated as the top priorities when selecting a bowel-cleansing agent—reinforcing that nursing assessments (renal function, constipation history) directly support physician decision-making on agent selection.
• Because constipation and renal function were specifically evaluated in this survey, nurses play a critical role in pre-procedure screening and tailoring prep instructions to reduce the risk of inadequate cleansing.

Clinical Relevance

This survey offers a valuable snapshot of real-world bowel preparation practices among high-volume colonoscopists in Japan, and while the practice landscape may differ from other countries, the underlying clinical challenges are universal. Inadequate bowel preparation directly compromises polyp and adenoma detection rates, increases procedure time, and often necessitates repeat colonoscopy—all of which have downstream effects on patient safety, satisfaction, and unit throughput. For GI nurses, this reinforces the importance of the pre-procedure phone call or in-person teaching session, where reinforcing dietary restrictions, prep timing (especially split-dosing), and hydration can make a measurable difference in bowel cleanliness scores.

The finding that constipation history and renal function were assessed by physicians as part of agent selection is a reminder that nursing intake assessments are not just administrative checkboxes—they meaningfully inform which bowel prep is safest and most effective for a given patient. Patients with chronic constipation, for example, may require adjunct measures (increased fluid intake, extended prep timing, or split-dose regimens) beyond a standard PEG-based protocol. Similarly, patients with renal impairment require careful consideration when magnesium-based agents are being considered, given the risk of electrolyte disturbances. Nurses who understand why certain agents are favored (efficacy and safety being top-ranked characteristics in this survey) can better communicate the rationale to patients and improve adherence.

From an operational standpoint, the finding that a majority of experienced endoscopists still encounter inadequate preps at a notable frequency suggests that facility-level quality improvement initiatives—standardized patient education materials, teach-back methods, and nurse-led prep coaching—remain essential even in high-volume centers. This data can support nursing leadership in advocating for dedicated pre-procedure education staffing or updated prep protocols, since even experienced physicians in a country with established colonoscopy programs report room for improvement.

Bottom Line

Despite advances in bowel-cleansing agents and widespread adoption of low-volume PEG-ascorbate regimens, inadequate bowel preparation remains a common and clinically significant problem—underscoring that nurse-led patient education, careful pre-procedure screening for constipation and renal function, and reinforcement of split-dose timing are frontline interventions that directly influence colonoscopy quality and diagnostic yield.