This article is more than 5 years old. Information may no longer be current.
Split-dose bowel prep improves sessile-serrated polyp detection
Click Here to Manage Email Alerts
Split-dose bowel preparation regimens resulted in reduced intensity and duration of bowel movements, increased patient convenience, better bowel prep quality and higher sessile-serrated polyp detection, according to the results of a randomized controlled trial.
Carol A. Burke, MD, of the Cleveland Clinic Digestive Disease and Surgical Institute, and colleagues randomly assigned 341 outpatient colonoscopy patients (mean age, 54 years) to receive either a 2L single-dose or split-dose bowel prep regimen — defined as ingesting at least half of the prep on the day of the colonoscopy — and compared a number of different outcomes.
Carol A. Burke
“I designed the study to understand the kinetics of bowel movements induced by two different bowel preparation dosing schemes to determine if the physician and patient barriers to split-dose bowel preparation were valid,” Burke told Healio Gastroenterology.
Although studies have previously shown that split-dosing improves bowel prep quality and adenoma detection rates, many physicians and patients want to avoid split-dosing for two reasons, according to Burke.
“One is that the second dose ... has to be ingested about 4 hours prior to the procedure, which makes for sleep disruptions (a very early wake up) if you have an early colonoscopy time,” she said. “Additionally, patients perceive that they will have to find a bathroom on the road en route to the endoscopy center if they drink bowel prep the same day. Our study broke both of those perceptions.”
Patients who received a single-dose regimen had greater total duration (P = .041) and intensity (P < .001) of bowel movements.
In both groups, patients got a similar number of hours of sleep without a bowel movement (4.5 single dose vs. 5 split-dose), but significantly more patients who received a single-dose bowel prep woke up for bowel movements than patients who received a split-dose (66% vs. 49%; P < .001), and there was a trend toward more nocturnal bowel movements in patients who received a single-dose prep.
Moreover, only about 5% of patients stopped for a bowel movement on the way to the endoscopy center, with no difference between the two study arms.
“Important quality metrics were enhanced in the split-dose arm, too,” Burke said. “We found improved bowel preparation [P < .001], and over a fourfold increased sessile-serrated polyp detection rate [9.9% vs. 2.4%; P = .004]. The latter finding is so important because sessile serrated polyps (SSPs) are difficult to see and inconsistently detected by colonoscopists, yet they are a major cause for interval colon cancer.”
Finally, there were no differences in polyp or adenoma detection rates, nor in overall patient satisfaction.
“Our study is the first to demonstrate bowel movement kinetics in a [randomized controlled trial] of different bowel prep dosing regimens, and allows providers data to reassure their patients of the convenience of split-dosing and the important health benefit with the enhanced detection of SSPs,” Burke said. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts