Background <p>Colonoscopy is a key diagnostic and therapeutic procedure that requires optimal bowel preparation for safe and accurate visualization. Inadequate preparation reduces diagnostic yield, increases complications, and raises healthcare costs. Patient education plays a crucial role, with combined oral and written instructions shown to improve outcomes. In Malaysia, only about half of patients achieve adequate bowel preparation due to language barriers and inconsistent educational delivery. This study evaluates the effectiveness of a multilingual educational video in improving bowel preparation adequacy.</p> Methodology <p>This randomized controlled trial was conducted in the Department of General Surgery at Taiping Hospital. Patients were recruited from outpatient clinics and randomized into two groups: standard written instructions and a multilingual educational video. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included caecal intubation rate and adenoma detection rate (ADR).</p> Results <p>A total of 188 patients were included. The video group demonstrated better bowel preparation across all colonic segments. Adequate preparation was higher in the video group for the left colon (94.5% vs. 61.5%), transverse colon (92.2% vs. 55.6%), and right colon (70.4% vs. 18.9%). Caecal intubation (92.3% vs. 55.6%) and ADR (33.0% vs. 12.2%) also significantly improved.</p> Conclusion <p>A multilingual educational video improves bowel preparation quality and clinical outcomes, supporting its use to enhance colonoscopy effectiveness.</p>