Sa1119 Will Split Dosing of Bowel Preparation Improve Quality of Colonoscopy and Increase Colorectal Neoplasm Detection?

Abstract

BackgroundAdequate bowel preparation is an important element in screening colonoscopy. Bowel preparation with ingestion of polyethylene glycol(PEG)solution the evening before colonoscopy results in suboptimal cleansing and affects the diagnostic yield. The American College of Gastroenterology supports the concept of split dosing to enhance the efficacy of bowel preparation. AimsTo compare the efficacy of the bowel preparation with split dosing(SD)of polyethylene glycol(PEG)solution versus the conventional dosing(CD). MethodsCharts of 492 consecutive patients undergoing screening colonoscopy by a single endoscopist from January 2010 to October 2011 were reviewed. Of these, 243 patients had received SD bowel preparation(SD group)compared to 249 patients who had received CD bowel preparation(CD group).Data on patient demographics, quality of preparation,cecal intubation rate, polyp detection rate, adenoma detection rate and polyp histology were collected. Significant Colorectal Neoplasm(CRN)was defined as polyp > 1 cm in size,≥ 3 adenomas and those with villous histology. Right sided colon was defined as cecum, ascending colon, transverse colon. Left sided colon was defined as descending colon, sigmoid colon and the rectum. A weighted score was assigned to poor, sub-optimal and good quality of bowel preparation as determined by the endoscopist. Results: Table 1 lists the patient demographics in the two groups. Both groups were well-matched in terms of age, sex and ethnicity. Polyp detection rate was 40% in SD group vs.33% in CD group (p=0.09). There was no significant difference in adenoma detection rate (24% vs. 23%, p=0.87) and cecal intubation rate (98% vs. 97%, p=0.35) between two groups. Significant CRN detection rate on right side was 12% with SD group and 4% with CD group(p=0.028). On left side significant CRN detection rate was 7% with SD group and 6% with CD group. 2 colorectal cancers were detected in the SD group and none in CD group(Table 2). Bowel preparation score was 2.8 in SD group compared to 2.6 in CD group Conclusions: Both the groups had similar bowel preparation scores and cecal intubation rates. However, bowel preparation with split-dose PEG solution resulted in a trend towards a higher polyp detection rate though it did not meet statistical significance. The SD regimen was efficient in detecting more significant CRN on the right side compared to CD regimen. Table 1