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Key sources
The following summarized guidelines for the evaluation and management of colonoscopy are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG/CAG 2022), the European Society of Gastrointestinal Endoscopy (ESGE 2021), the American Gastroenterological Association (AGA 2021), the European Society of Gastrointestinal Endoscopy (ESGE/BSG 2021), and the American Society for Gastrointestinal Endoscopy (ASGE 2020; 2018; 2016).


1.Diagnostic procedures

Tissue sampling, IBD: consider performing segmental biopsies (at least 2 from each segment), placed in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum), in patients with clinical and endoscopic signs of colitis.
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  • Tissue sampling (premalignant and malignant lesions)

2.Medical management

Management of antiplatelet therapy, preprocedural, CAG/ACG: insufficient evidence to recommend for or against temporary interruption of the P2Y12 inhibitor in patients on single antiplatelet therapy with P2Y12 inhibitor agents undergoing elective endoscopic gastrointestinal procedures.
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  • Management of antiplatelet therapy (postprocedural)

  • Management of antiplatelet therapy (acute gastrointestinal bleeding)

  • Management of anticoagulant therapy (preprocedural)

  • Management of anticoagulant therapy (postprocedural)

  • Management of anticoagulant therapy (acute gastrointestinal bleeding)

3.Patient education

Preprocedural counseling: inform patients undergoing colonoscopy of the potential for adverse events, warning symptoms, and emergency contact information.
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4.Follow-up and surveillance

Post-procedural monitoring: consider obtaining systematic monitoring of delayed adverse events, including postprocedural bleeding, perforation, hospital readmission, 30-day mortality, and/or interval CRC cases, and report these adverse event rates at the endoscopy unit level.

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  • Surveillance colonoscopy

5.Quality improvement

Requirements for bowel preparation
Endoscopy units should measure bowel preparation quality routinely, at a minimum annually, on a unit level. Adequate bowel preparation, defined as a Boston Bowel Preparation Scale score ≥ 6, with each segment (the right colon including the cecum and ascending colon, the transverse colon including the hepatic and splenic flexures, and the left colon including the descending colon, sigmoid colon, and rectum) score ≥ 2, should be achieved in ≥ 90% (≥ 95% aspirational target) of screening and surveillance colonoscopies:
Unprepared colon segment with mucosa not seen due to solid stool that cannot be cleared
Portion of mucosa of the colon segment seen, but other areas of the colon segment not well seen due to staining, residual stool and/or opaque liquid
Minor amount of residual staining, small fragments of stool and/or opaque liquid, but mucosa of colon segment seen well
Entire mucosa of colon segment seen well with no residual staining, small fragments of stool or opaque liquid
The wording of the scale was finalized after incorporating feedback from three colleagues experienced in colonoscopy
Endoscopy units should use a split-dose bowel preparation as the standard preparation strategy in patients undergoing colonoscopy.

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  • Requirements for endoscopy devices

  • Requirements for infection control

  • Requirements for staffing members

  • Requirements for operator performance

  • Reporting