Innovative schemes of colonoscopy bowel preparation with oral lactulose: Optimizing traditional standards to improve colonoscopy quality.

The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy. The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas. Currently there are different colonoscopic preparation schemes, being the polyethylene glycol (PEG) based regimen one of the most used and recommended by the main international clinical guidelines. Nevertheless, PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing, leading to poor tolerability in may patients, particularly in an elderly population. Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability. New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results, showing excellent efficacy-safety profiles and high tolerability indexes. Lactulose regimens present other benefits such as low cost and wide availability. The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens, in order to consolidate this agent as a feasible "new player" in the field of colonoscopic preparation.