The escalation of colonoscopy from a merely clinical procedure to a population-level preventive intervention has been strictly related not only to its efficacy but also to its safety. To minimize the risk of potentially serious adverse events, endoscopists should focus not only on risk factors directly related to the technique itself but also on those not directly related to colonoscopy, such as bowel preparation or anesthesiologist assistance. In this context, awareness that bowel preparation may generate moderate to severe hypokalemia in a minority of patients represents an additional step forward, especially when we consider that reversal interventions are simple and effective. Thus, a high level of suspicion in high-risk patients is needed, and case-by-case potassium monitoring in patients with heart failure may be considered. However, additional data on the actual clinical consequences of hypokalemia possibly related to bowel preparation are necessary before any stronger recommendation can be made.
