“A recent meta-analysis of randomized studies using split-dose preparations suggested a significant improvement in the quality of preparation and patient compliance," said study lead author Suryakanth R. Gurudu, MD, Division of Gastroenterology and Hepatology, Mayo Clinic Arizona. "However, the effects of split-dose preparations on other quality indicators of colonoscopy, such as cecal intubation (colonoscopy completion) and adenoma detection rates, have not been evaluated, as far as we know. In our study, we have demonstrated, for the first time to our knowledge, that system-wide implementation of a split-dose preparation for colonoscopy significantly improves both polyp detection rates and adenoma detection rates as well as improves the quality of the preparation and colonoscopy completion rates. These results confirm the benefit of split-dose preparations and the importance of bowel preparation in the detection of colon polyps."
The primary aim of this study was to compare polyp detection rates (PDRs) and adenoma detection rates (ADRs) before and after implementation of split-dose preparations (SDP) as the preferred bowel preparation in a tertiary GI practice. Secondary goals were to compare the quality of the preparation and cecal intubation rates (colonoscopy completion rate) before and after implementation of the SDP. This was a retrospective study at Mayo Clinic Arizona.
Electronic medical records of all the patients who underwent colonoscopy from January 2009 to December 2009 (before SDP) and from October 2010 to March 2011 (after SDP) were reviewed. All patients who underwent colonoscopy for screening and surveillance of colon polyps and cancer were included in the study.
The bowel preparation choices for split dosing were four-liter PEG electrolyte solution or MoviPrep (Salix Pharmaceuticals Inc., Raleigh, NC). Patients were instructed to avoid eating a high-fiber diet for two days before taking the bowel preparation and to drink only clear liquids for the entire day before colonoscopy.
With the four-liter PEG solutions, patients were instructed to drink three liters the night before, starting at 6:00 pm, and one liter at least four hours before the scheduled procedure time on the day of the procedure. Patients using MoviPrep (after preparing the solution according to manufacturer’s specifications) were instructed to drink half of the volume the night before colonoscopy, starting at 6:00 pm, and the other half at least four hours before the scheduled procedure time on the day of the procedure. All patients were instructed to take nothing by mouth for at least three hours before the procedure. Patients who had an early morning procedure or long travel time to the endoscopy unit were offered the option of taking the entire preparation the night before (nonsplit dose).