Bowel Prep Trends: Has Split Dosing Been Accepted by the Mainstream?

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In early 2009, the American College of Gastroenterology revised its colorectal cancer screening guidelines for the first time in eight years, and one of the most noticeable changes was its recommendation to split the dose of bowel preps. What has happened since then? Has there been a wave of split dosing in response?

Previously, the accepted practice had patients take all of the bowel preparation prescription the day before the colonoscopy. In the new guidelines, the ACG said the best-established principle to enhance the effectiveness of bowel preps is to “split” the dose. This is when patients take half of the bowel prep prescription the night before the colonoscopy, and the other half the day of the procedure.

“When all of the bowel preparation is given on the day before examination and the interval between the last dose of preparation and the performance of colonoscopy is prolonged, the probability of poor preparation increased dramatically, particularly in the cecum and ascending colon,” the ACG wrote in the guidelines, which first appeared in the March 2009 issue of the American Journal of Gastroenterology.

The guidelines said that split dosing can be carried out with oral dosing of polyethylene glycol or sodium phosphate preparation. In addition, patients can ingest clear liquids until two hours before sedation, according to guidelines released by the American Society of Anesthesiologists.

So what has the on-the-ground response been to the split-dosing guidelines more than a year after their release? “It wasn’t a big deal,” said Ashley Layne, RN, a nurse manager for endoscopy departments at two hospitals in Richmond. “For the most part it was more of a safety issue. I think the doctors took to it well. People didn’t make a big deal out of it.”

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