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Split-dose superior to day-before bowel prep for colonoscopy
Split-dose bowel cleansing regimens were found to be superior to day-before preparations in terms of colon cleansing quality and patient preference in a recent meta-analysis.
Aiming to provide a more contemporary meta-analysis of bowel preparation regimens, researchers reviewed randomized trials published from 1980 to March 2014 that evaluated split-dose preparations vs. day-before preparations or split-dose preparations vs. another split-dose preparation using polyethylene glycol (PEG), sodium phosphate, picosulfate and oral sodium sulfate.
The primary outcome was bowel cleansing efficacy defined as the proportion of patients with adequate bowel prep, and secondary outcomes were side effects or complications, polyp or adenoma detection, patient willingness to repeat the procedure and time required for patients to resume daily activities.
Overall, 47 trials representing 13,487 patients were included in the analysis. The investigators found split-dose preparations provided superior colon cleansing quality compared with day-before preparations overall (OR = 2.51; 95% CI, 1.86-3.39). This superiority remained true for PEG preparations (OR = 2.6; 95% CI, 1.46-4.63), sodium phosphate preparations (OR = 9.34; 95% CI, 2.12-41.11) and picosulfate preparations (OR = 3.54; 95% CI, 1.95-6.45).
Intention-to-treat analysis showed that PEG split-dose preparations of 3 L or more provided superior bowel cleansing quality compared with lower-volume split-dose regimens (OR = 1.89; 95% CI, 1.01-3.46).
Patients were more often willing to repeat split-dose cleansing compared with day-before cleansing (OR = 1.9; 95% CI, 1.05-3.46), as well as a low-volume split-dose PEG preparation compared with a high-volume split dose PEG preparation (OR = 0.2; 95% CI, 0.09-0.45).
“Split-dose regimens yield the highest quality of colon cleansing across all types of colonic preparations,” the researchers concluded. “Willingness-to-repeat is enhanced by the use of split-dose vs. day-before regimens of any product, and by the adoption of low- vs. high-volume PEG split-dose regimens.
“Future research must focus on comparing split-PEG dosing of large and low-volumes, split-dose vs. same-day preparations, and direct evaluations of PEG-based vs. [picosulfate] and [oral sodium sulfate] preparations,” they added. – by Adam Leitenberger
Disclosure: One researcher reports consulting for Boston Scientific, Cook Inc., Olympus Canada and Pendopharm; and grant funding from Boston Scientific and Cook Inc.