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 preparations are now the most commonly used bowel-cleansing agents among Japanese endoscopists, followed by high-volume PEG and magnesium-based agents—reflecting a broader trend toward improving patient tolerability without sacrificing efficacy.
• Physicians consistently rank cleansing efficacy and safety as the top priorities when selecting a bowel-preparation agent, reinforcing that nursing education and patient counseling should emphasize both effective cleansing and minimizing adverse effects (e.g., electrolyte disturbances, dehydration).
• A notable proportion of physicians (64.7%) reported perceiving inadequate bowel preparation as a recurring problem, highlighting those bowel-prep failures remain a persistent, clinically significant issue even among high-volume endoscopy practices.
• Patient-specific factors such as constipation history and renal function are recognized by physicians as important considerations before colonoscopy—areas where pre-procedure nursing assessment and triage can directly influence prep quality and procedural safety.

Clinical Relevance

For endoscopy nurses, this survey underscores that bowel preparation is not a "one-size-fits-all" process, even in a system with well-established cleansing protocols. The finding that low-volume PEG-ascorbate formulations have become the preferred choice among experienced endoscopists suggests an opportunity for nursing teams to standardize patient education materials around these agents, focusing on dosing schedules, timing relative to the procedure, and strategies to improve adherence and tolerability. Since cleansing efficacy and safety are the top-valued agent characteristics from the physician perspective, nurses are well positioned to reinforce these same priorities during pre-procedure teaching, particularly by addressing common patient concerns about volume, taste, and gastrointestinal side effects that can undermine compliance.

The reported high frequency of inadequate bowel preparation is a critical operational signal. Even in a high-volume, physician-experienced sample, many respondents flagged this as a recurring challenge, which has direct implications for procedure scheduling, repeat colonoscopy rates, and overall unit efficiency. Nurses play a central role in identifying patients at higher risk for inadequate prep—such as those with chronic constipation, opioid use, or impaired renal function affecting fluid/electrolyte handling—and can proactively escalate bowel regimens, adjust diet instructions, or extend prep timelines for these individuals. Incorporating a brief, structured risk-assessment step into pre-procedure nursing intake (specifically addressing bowel habits and renal status) could help reduce the incidence of suboptimal preparation and the downstream costs of repeat procedures or missed pathology.

From a professional development standpoint, this survey highlights the value of ongoing staff education on emerging bowel-prep formulations and evolving best practices, since agent preferences are clearly shifting toward better-tolerated regimens. GI nursing teams should consider periodic in-services or protocol reviews to ensure their patient counseling and pre-procedure checklists remain aligned with current evidence and endoscopist preferences, particularly regarding renal function screening and constipation management before colonoscopy.

Bottom Line

This survey confirms that inadequate bowel preparation remains a common and clinically significant concern even among experienced endoscopists, and that agent selection is increasingly guided by efficacy and safety considerations—making nurse-led patient education, individualized risk assessment (especially for constipation and renal function), and reinforcement of proper prep adherence essential lev