S0307 Increased Utilization of Split-Dose Preparation Is Associated With a Higher ADR in the Community Setting

Abstract

INTRODUCTION: Adequate bowel preparation allowing for a good mucosal visualization is the cornerstone of a good screening colonoscopy. Traditionally, the entire preparation was given the evening before the colonoscopy. Split-dose preparation involves taking the first half the evening before the colonoscopy and the second half 4–5 hours before the scheduled procedure. The split-dose regimen is not only associated with better patient acceptability but achieves adequate preparation more often. Split-dose preparation is still not widely used in the community setting, especially by the providers who have been practicing longer and are used to giving all of the bowel-cleansing preparation the evening before the colonoscopy. This study aims to analyze the correlation between the use of split-dose preparation and the physician’s ADR. METHODS: We performed a retrospective study to analyze the association between frequency of split-dose preparation utilization and ADR. We included all average-risk individuals undergoing screening colonoscopies from Jan 1, 2019, to Dec 31, 2019, at three affiliated community endoscopy centers. A total of 14 physicians performed procedures at these endoscopy centers. The frequency of a physician’s utilization of split-dose preparation was determined by independently surveying the physician's schedulers and reviewing the patient's charts. A Pearson r test was performed where 0.05 two-tailed probability was used to assess statistical significance. RESULTS: A total of 5478 screening colonoscopies were performed during the study period with at least one adenoma detected during 2173 colonoscopies. A strong, linear correlation was found between the frequency of use of split-dose preparation and the physician’s reported ADR, r(12) = 0.83, P < .01. The mean ADR of the physicians who used the split-dose preparation by default was 1.45 standard deviations higher than the mean ADR of all of the physicians. CONCLUSION: This retrospective analysis showed a positive correlation between adherence to the split-dose regimen and the physician’s ADR. Prior studies have shown increased ADR leads to a decreased risk of interval colorectal cancer and fatal colorectal cancer. A simple shift to increased utilization of split-dose preparation would be a cost-effective way of improving the outcome of colorectal cancer screening. More efforts should be made by practices to use split-dose preparation as much as possible.Figure 1