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

Key Takeaways for GI Nurses

• Low-volume polyethylene glycol (PEG) plus ascorbate solutions are now the most commonly selected bowel-cleansing agents among Japanese endoscopists, followed by high-volume PEG and magnesium-based preparations—reflecting a broader trend toward smaller-volume regimens that may improve patient tolerance and completion rates.
• Cleansing efficacy and safety were the top priorities physicians cited when choosing a bowel-cleansing agent, reinforcing that nursing education and patient instruction should emphasize both thorough colon cleansing and agent safety profiles (e.g., renal considerations).
• Nearly two-thirds of surveyed physicians (64.7%) reported encountering inadequate bowel preparation more than occasionally, highlighting those recurring gap in prep quality that nurses are well-positioned to address through patient education, split-dosing counseling, and pre-procedure screening.
• Constipation history and renal function were specifically assessed in this survey as factors influencing prep selection, underscoring the importance of nurses gathering and communicating this information during pre-procedure assessments.

Clinical Relevance

This survey offers a timely snapshot of real-world bowel preparation practices among high-volume endoscopists in Japan, and its findings have direct implications for nursing workflows in endoscopy units. The reported shift toward low-volume PEG-ascorbate formulations suggests that nurses should be prepared to counsel patients on newer, smaller-volume regimens—including proper timing, hydration reminders, and expected taste or tolerability differences compared with traditional high-volume PEG or magnesium-based preps. As agent selection increasingly hinges on both efficacy and safety, nursing staff play a critical role in reinforcing correct dosing instructions and screening for contraindications, particularly related to renal function and constipation history, which the survey specifically flagged as relevant clinical considerations.

The finding that a majority of physicians perceive inadequate bowel preparation as a recurring issue is particularly relevant to nursing practice. Poor prep quality directly affects procedure duration, cecal intubation rates, adenoma detection, and the potential need for repeat colonoscopy—all of which have downstream effects on unit scheduling, resource utilization, and patient satisfaction. Nurses conducting pre-procedure phone calls or in-person teaching sessions are often the last line of defense in ensuring patients understand split-dosing protocols, dietary restrictions, and the importance of completing the full prep regimen. This survey's data support strengthening standardized patient education materials and considering targeted interventions—such as teach-back methods or reminder calls—for patients at higher risk of inadequate preparation, including those with a history of constipation.

From a professional development standpoint, this survey underscores the value of staying current with evolving bowel prep formulations and national trends, even when practicing outside Japan. Understanding which agent characteristics (efficacy, safety, tolerability) drive physician preference can help nurses engage more effectively in interdisciplinary discussions about prep protocol selection, contribute to quality improvement initiatives targeting prep adequacy rates, and better anticipate patient concerns or questions during pre-procedure education.

Bottom Line

This Japanese survey confirms that low-volume PEG-ascorbate preparations are becoming the preferred bowel-cleansing agents among high-volume endoscopists, yet inadequate bowel preparation remains a frequent challenge reported by nearly two-thirds of physicians—reminding GI nurses that patient education, careful pre-procedure screening for risk factors like constipation and renal impairment, and reinforcement of proper prep instructions remain essential, high-impact nursing interventions for ensuring high-quality, safe colonoscopy outcomes.