New Norgine data reveal gap between patient expectations and clinical reality in bowel preparation for colonoscopy[1]

22 October 2018






  • Almost nine in ten patients expect to drink 2L of bowel preparation fluid or less
  • Patient expectations of bowel preparation can clash with clinical practice
  • Findings present opportunity to improve colonoscopy quality and patient experience through innovation in bowel preparation


AMSTERDAM, The Netherlands. 22 October 2018, 11:00 CET. Norgine B.V. is presenting today new public survey data at United European Gastroenterology (UEG) Week 2018, which show that almost nine in ten people questioned across 5 major EU countries expect to drink two litres or less bowel preparation liquid before undergoing a colonoscopy.


These findings demonstrate that patient expectations of bowel preparation liquid volume will often not match the clinical reality, which typically requires three litres or more to prepare for a colonoscopy. [2][3][4]


Bowel preparation liquid is critically important to cleanse the bowel prior to a colonoscopy, helping to ensure the efficacy and cost-effectiveness of the procedure. [2][3][4] The volume of bowel preparation fluid has been shown to be a key factor affecting patients’ experience of the process and adherence to bowel cleansing instructions.[5][6][7]


These findings highlight the clear need and opportunities for advances that encourage increased bowel preparation adherence and a better patient experience, while also improving the efficacy and cost-effectiveness of colonoscopy.


Colonoscopy is an effective method for colorectal cancer screening and has been shown to reduce both the incidence and mortality of colorectal cancer when applied in the general population. Inadequate pre-colonoscopy bowel cleansing reduces the diagnostic accuracy of colonoscopy, particularly for the detection of smaller lesions and sessile polyps. This may result in repeat procedures, thereby increasing costs and potentially delaying the initiation of treatment, and potentially increasing resource requirement.[8],[9],[10] 


Bharat Amlani, Medical Director for Brands at Norgine, said: “Too often, the high volume of bowel preparation needed to be consumed prior to a colonoscopy does not match the patient expectations. This potentially undermines their experience of the whole procedure. Our findings make clear that the colonoscopy community must continue to work together to ensure these are as closely aligned as possible.”


He added: “Norgine is at the forefront of this drive, continuously innovating to improve the quality and patient experience of colonoscopy. This is essential in order to help prevent, identify and treat colorectal cancer amongst many other gastrointestinal diseases. The new availability of highly effective low volume bowel preparations such as the 1L polyethylene glycol PLENVU® can help close this perceptual gap whilst ensuring reliable cleansing success at a reduced fluid volume intake.”


Norgine is a market leader in providing bowel cleansing and colonoscopy products which aim to facilitate high quality colonoscopy. The survey was conducted as part of Scope for Change, Norgine’s campaign to bring the European colonoscopy community together to drive improvements over the coming months and years. This followed Norgine’s discussion paper, published in September 2017, Scope for change: what next for European colonoscopy services?[11]




Notes to Editors:


Survey methodology


An online survey was conducted by GfK in five European Union countries (EU5): France, Germany, Italy, Spain, and the UK. Questionnaire completion required ~6 minutes in total.


In one of the questions, respondents were asked, “Before a colonoscopy can be undertaken, the colon must be cleaned by the patient drinking a bowel preparation solution. How much of the bowel preparation liquid do you think a patient needs to drink prior to the procedure? ” One of the following responses could be selected: <0.5L, 0.5–1L, 1L, 2L, or >2L.

Reponses were summarised using descriptive statistics. The proportion of patients endorsing a particular response was compared between each country and the EU5 using the t-test with a 95% confidence level.




Among 53,795 invited persons across the EU5 countries, 18,650 (35%) responded to the survey and 2,500 (5%) completed the survey who had never had a colonoscopy and were matched to the national demographic profile.


Survey responses


The responses to the survey across the EU5 and within each country are shown below:



PLENVU®, Powder for Oral Solution (PEG 3350, Sodium Ascorbate, Sodium Sulfate, Ascorbic Acid, Sodium Chloride, and Potassium Chloride) is indicated in adults for bowel cleansing prior to any procedure requiring a clean bowel.


About Norgine


Norgine is a leading European specialist pharmaceutical company with a direct commercial presence in all major European markets. In 2017, Norgine’s total net product sales were EUR 345 million, up 17 per cent.


Norgine employs over 1,000 people across its commercial, development and manufacturing operations and manages all aspects of product development, production, marketing, sale and supply.


Norgine specialises in gastroenterology, hepatology, cancer and supportive care.


Norgine is headquartered in the Netherlands.


For more information, please visit

In 2012, Norgine established a complementary business Norgine Ventures, supporting innovative healthcare companies through the provision of debt-like financing in Europe and the US. For more information, please visit

NORGINE and the sail logo are trademarks of the Norgine group of companies.



Media contacts:

Isabelle Jouin, Communications, Norgine T: +44(0)7714061327

Jonny Greenberg, Account Director, Incisive Health T: +44(0)20 3435 6084

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[1] Amlani B et al. Public attitudes to colonoscopy: how much bowel preparation liquid must be drunk before a colonoscopy? #P0460. UEGW. Monday 22 October. 12:30 – 13:30 CET.


[2] Lebwohl B et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc 2011; 73(6): 1207–14;


[3] Kaminski M et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2017; 5(3): 309–34;


[4] Kingsley J et al. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates – A Modeling Study. PLoS One 2016; 11(12): e0167452;


[5] Hassan C et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol 2012; 10(5): 501–6;


[6] Ness RM et al. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001; 96(6): 1797–802;


[7] Chan WK et al. Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy. BMC Gastroenterol 2011; 11: 86;


[8] Bechtold ML, Mir F, Puli SR et al. Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization. Ann Gastroenterol 2016; 29: 137 – 146


[9] Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ 2014; 348: g2467


[10] Baxter NN, Warren JL, Barrett MJ et al. Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol 2012; 30: 2664 – 2669


[11] Norgine. Scope for change: what next for European colonoscopy services? Available at: