Split-dose Bowel Preparation Research Articles

Split- versus single-dose preparation tolerability in a multiethnic population: decreased side effects but greater social barriers.

Background:This study was performed to compare patient-reported tolerability and its barriers in single- vs. split-dose 4-L polyethylene glycol (PEG) bowel preparation for colonoscopy in a large multiethnic, safety-net patient population.Methods:A cross-sectional, dual-center study using a multi-language survey was used to collect patient-reported demographic, medical, socioeconomic, and tolerability data from patients undergoing outpatient colonoscopy. Univariate and multivariate analyses were used to identify demographic and clinical factors significantly associated with patient-reported bowel preparation tolerability.Results:A total of 1023 complete surveys were included, of which 342 (33.4%) completed single-dose and 681 (66.6%) split-dose bowel preparation. Thirty-nine percent of the patients were Hispanic, 50% had Medicaid or no insurance, and 34% had limited English proficiency. Patients who underwent split-dose preparation were significantly more likely to report a tolerable preparation, with less severe symptoms, than were patients who underwent single-dose preparation. Multiple logistic regression revealed that male sex and instructions in the preferred language were associated with tolerability of the single-dose preparation, while male sex and concerns about medications were associated with tolerability of the split-dose preparation.Conclusions:In a large multiethnic safety-net population, split-dose bowel preparation was significantly more tolerable and associated with less severe gastrointestinal symptoms than single-dose preparation. The tolerability of split-dose bowel preparation was associated with social barriers, including concerns about interfering with other medications.

Comparison of the gastric residual volume between conventional single-dose and split-dose bowel preparation before colonoscopy under general anesthesia

Objective To explore the difference in gastric residual volume (GRV) between single-dose and split-dose bowel preparation before colonoscopy under general anesthesia. Methods From October 8th to December 30th in 2016, the out-patients undergoing gastroscopy and colonoscopy with anesthesia services on the same day were selected and divided into the traditional single-dose bowel preparation group and split-dose bowel preparation group. The GRV and intestinal preparation quality were compared between the two groups. T test was used for statistical analysis and multiple linear regression analysis was performed for the influence factors of GRV analysis. Results A total of 121 patients were enrolled, 60 patients in the spilt-dose bowel preparation group and 61 in the traditional single-dose bowel preparation group. The mean GRV of the split-dose bowel preparation group was (17.3±12.2) mL, which was lower than that of the single-dose bowel preparation group ((23.7±14.6) mL), and the difference was statistically significant (t=2.642, P=0.009). The score of intestinal preparation quality of the split-dose bowel preparation group was 8.05±0.85, which was higher than that of the single-dose bowel preparation group (7.67±1.19), and the difference was statistically significant (t=-2.002, P=0.048). Fasting time was related with GRV (odd ratios (OR)=1.732, 95% confidence interval (CI) 0.299 to 3.168, P=0.018). Conclusion The GRV of patients with split-dose bowel preparation before colonoscopy is lower than that of traditional single-dose bowel preparation, thus reducing the risk of aspiration during anesthesia. Key words: Split-dose bowel preparation; Gastric residual volume; Anesthetic colonoscopy

Split-Dose Bowel Preparation Reduces the Need for Early Repeat Colonoscopy Without Improving Adenoma Detection Rate.

Split-dose bowel preparation is associated with improved mucosal visualization and patient tolerance, becoming a standard of care. However, quality measures data associated with this preparation are limited. At our academic tertiary-care facility, we aim to study the effect of changing from single- to split-dose preparation on colonoscopy quality measures. A retrospective cohort study with quality indicators was conducted using electronic medical record data. Cases were identified via ICD9 code V76.51, "Special screening for malignant neoplasms of colon." Single-dose preparation data was collected from 9/1/13 to 8/31/14. Split-dose preparation was implemented 11/2014, and data were collected from 1/1/15 to 8/31/15. A total of 1602 colonoscopies in the single-dose group and 1061 colonoscopies in the split-dose group were analyzed. The Boston Bowel Preparation Scale was significantly improved in the split-dose group 8.64±SD 1.25 versus 8.25±SD 1.61, p<0.001. There was no significant difference in adenoma detection rate 40.7% (95% CI 37.8-43.7%) versus 40.5% (95% CI 38.1-42.9%), p=0.92; however, the rate for recommending an early repeat examination due to an inadequate bowel preparation was significantly decreased to 3.9% (95% CI 2.7-5.0%) versus 8.9% (95% CI 1.52-2.97%), p<0.001. While split-dose preparation significantly improves overall bowel cleanliness, there is no significant adenoma detection rate improvement with high baseline rate, suggesting a threshold which may not improve with enhanced preparations. Split-dose preparation significantly reduces the frequency with which inadequate preparation prompts an early repeat examination, which has important clinical implications on performance, costs, and patient experience, providing further evidence supporting split-dose preparation use.

Side Effects Do Not Influence Likelihood to Repeat Colonoscopy in Split versus Single Dose Bowel Preparation

Side Effects Do Not Influence Likelihood to Repeat Colonoscopy in Split versus Single Dose Bowel Preparation

Split Dose Bowel Preparation Prevents Missing Sessile Serrated Adenoma/Polyps When Colonoscopy Is Preceded by EGD

Split Dose Bowel Preparation Prevents Missing Sessile Serrated Adenoma/Polyps When Colonoscopy Is Preceded by EGD

Efficacy of Split Dose Bowel Preparation in Clinical Practice and Identification of Additional Barriers of Adequate Preparation Yet to Overcome

Efficacy of Split Dose Bowel Preparation in Clinical Practice and Identification of Additional Barriers of Adequate Preparation Yet to Overcome

Sessile Serrated Adenoma/Polyp (SSA/P) Detection Rate Comparing Screening and Surveillance Colonoscopy

Introduction: The adenoma detection rate (ADR) is recognized as an important quality measure for colonoscopy. The emerging appreciation of the role of the serrated pathway in colorectal neoplasia makes serrated polyp detection rate (SDR) another potential indicator of quality colonoscopy. We aim to provide data about SDR in different indications for colonoscopy at our institution. Methods: We performed a retrospective chart review of consecutive outpatient colonoscopies before and after implementation of split dose bowel preparation (split prep). We included complete colonoscopies with adequate bowel preparation performed on outpatients by academic gastroenterologists at a single VA medical center. The indications for colonoscopy included colorectal cancer screening, surveillance of polyps, FIT/FOBT positivity, IBD, and others. SDR was defined as the proportion of cases with at least one SSA/P. Collected data included patient demographics, procedural indication, and presence, number, size, histology, and anatomic location of polyps. JMP 13.1.0 was used for analysis. Results: 1100 patients were included. 93% were males with 50% African Americans and 49% Caucasians. Procedural indications included polyp surveillance (39%), screening (19.82%), FIT/FOBT positivity (17.82%), IBD (3.18%), and others (20.18%). ADR was highest in the FIT/FOBT positive group (72.96%), followed by surveillance colonoscopy (71.79%), screening group (53.21%), others (41.44%) and IBD (11.43%). The highest SDR was in the colorectal cancer screening group (16.51%), followed by polyp surveillance (11.42%), FIT/FOBT positivity (9.69%), IBD (8.57%), and others (6.31%). There was a non-statistically significant trend towards increased SDR in both screening and surveillance groups with implementation of split prep (screening 14.53% vs. 18.81%, P=0.40; surveillance 10.76% vs. 12.14%, P=0.66). Limitations: Retrospective design, single VA medical center, sample size, and very elevated ADR and SDR rates. Conclusion: Our results support current literature that ADR is significantly higher in surveillance colonoscopy for history of adenomas, as compared to screening colonoscopy. However, the rates of detection of SSA/P were not very different when comparing screening and surveillance groups, with a trend towards higher rates in screening cases (P=0.07) (Table 1), suggesting different risk factors for this neoplastic pathway.Table: Table. ADR and SDR in Screening and Surveillance Colonoscopies

Impact of Split Dose Bowel Preparation on Sessile Serrated Adenoma/Polyp Detection Rate

Impact of Split Dose Bowel Preparation on Sessile Serrated Adenoma/Polyp Detection Rate

Involvement of a GI Fellow in Colonoscopy Improves Adenoma Detection Rate (ADR)

Introduction: The success of colonoscopy in preventing CRC depends on the detection of precancerous lesions. Multiple factors that influence adenoma detection rate (ADR) have been identified. Few studies have evaluated the effect of fellow involvement on ADR. In our study, we looked at the influence of fellow involvement on ADR and compared it for gastroenterologists with variable baseline ADRs. Methods: We conducted a retrospective chart review of outpatient colonoscopies performed in a 17-month period fulfilling the following criteria: complete procedures performed by academic gastroenterologists in the endoscopy unit, with adequate bowel preparations, as part of a larger study evaluating the impact of switching to split-dose bowel preparation. JMP 13.1.0 was used for analysis. Results: A total of 1100 patients were included in the analysis. Indications were CRC screening (19.8%), polyp surveillance (39%), FIT positivity (17.8%), IBD (3.2%), and others (20.2%). Majority of patients were males (93%), and were equally split between African Americans (50%) and Caucasians (49%). Mean age was 62 years. Procedures were performed by 3 gastroenterologists with or without a fellow (Table 1). Fellow involvement led to detection of more polyps per subject (mean: 2.51 to 3.21; P<0.001), and more adenomas per subject (mean: 1.50 to 2.04; P<0.001). ADR improved significantly (55.0% to 64.6%; P=0.001). Improvement was also seen in detection of at least 3 adenomas (20.8% to 29.5%; P<0.001), and detection of <10mm adenomas (48.8% to 61%; P<0.001). Gastroenterologist 1 did not have significant improvement in ADR, while gastroenterologists 2 and 3 did (Table 1). This improvement was mainly driven by involvement of 3rd year fellows (Figure 1).Figure: Adenoma Detection Rate (ADR) by Level of Fellow Training and without Involvement of a Fellow.Table: Table. ADR for Each Gastroenterologist with the Impact of Fellow ParticipationConclusion: Involvement of fellows in performance of colonoscopies improves ADR and frequently results in change in recommendation of surveillance colonoscopy interval. This is mainly seen in gastroenterologists with an intermediate ADR and is likely the result of having additional eyes looking for polyps, especially when more experienced. This may also be related to an unconscious behavior of the supervising endoscopist leading to a more careful examination when a fellow is present. Another potential reason could be a relatively longer withdrawal time when a fellow is present, allowing more polyps to be detected. On the other hand, this improvement was not detected when the baseline ADR was high to begin with, making it less likely to miss polyps.

553 Comparison of Adenoma Detection Rate (ADR) and Sessile Serrated Polyp Detection Rate (SSP-DR) Between Small Volume Split Dose Bowel Preparation (Small-SDP) and Large Volume Split Dose Preparation (Large-SDP)

553 Comparison of Adenoma Detection Rate (ADR) and Sessile Serrated Polyp Detection Rate (SSP-DR) Between Small Volume Split Dose Bowel Preparation (Small-SDP) and Large Volume Split Dose Preparation (Large-SDP)

Sa1061 Split-Dose Bowel Preparation Does Not Increase Gastric Residual Volume as Compared With Day Prior Preparations: A Systematic Review and Network Meta-Analysis

Sa1061 Split-Dose Bowel Preparation Does Not Increase Gastric Residual Volume as Compared With Day Prior Preparations: A Systematic Review and Network Meta-Analysis

Tu1071 - Predictors of Patient Reluctance to Use Split Dose Bowel Preparation for Early Morning Colonoscopies

Tu1071 - Predictors of Patient Reluctance to Use Split Dose Bowel Preparation for Early Morning Colonoscopies

Gastric Residual Volume after Split-Dose Bowel Preparation versus Conventional Single-Dose Regimen before Anesthetic Colonoscopy.

The aim of this study was to compare gastric residual volume (GRV) in patients given a split-dose versus a conventional single-dose of polyethylene glycol (PEG) preparation before undergoing anesthetic colonoscopy. Methods. In a prospective observational study, we assessed GRV in outpatients undergoing same-day anesthetic gastroscopy and colonoscopy between October 8 and December 30 of 2016. Outpatients were assigned to the split-dose (1 L PEG in the prior evening and 1 L PEG 2–4 h before endoscopy) or single-dose (ingestion of 2 L PEG ≥ 6 h before endoscopy) regimen randomly. Bowel cleansing quality was assessed with the Boston Bowel Preparation Scale (BBPS). Results. The median GRV in the split-dose group (17 ml, with a range of 0–50 ml; N = 65) was significantly lower than that in the single-dose group (22 ml, with a range of 0–62 ml; N = 64; p = 0.005), with a better bowel cleansing quality (BBPS score 8.05 ± 0.82 versus 7.64 ± 1.21; p = 0.028). GRV was not associated with diabetes or the use of medications. Conclusions. GRV after a split-dose preparation and fasting for 2–4 hours is not larger than that after a conventional single-dose preparation and fasting for 6–8 hours. The data indicates that the split-dose bowel preparation might not increase the risk of aspiration.

Superiority of Split-Dose Bowel Preparations for Morning and Afternoon Colonoscopies: A Single Center Experience

Superiority of Split-Dose Bowel Preparations for Morning and Afternoon Colonoscopies: A Single Center Experience

Comparison of a split-dose bowel preparation with 2 liters of polyethylene glycol plus ascorbic acid and 1 liter of polyethylene glycol plus ascorbic acid and bisacodyl before colonoscopy

Recently, a low-volume polyethylene glycol formulation containing ascorbic acid (PEG-Asc) has proven as safe and effective as traditional 4-L PEG solutions for colonoscopy preparation. However, currently available aqueous purgative formulations are poorly tolerated. The aim of this study was to compare a split-dose 2-L PEG-Asc formulation and a 1-L PEG-Asc formulation with bisacodyl (10 mg) to determine the quality of bowel cleansing and patient tolerability. A single-center, randomized, observer-blinded study was performed between May 2015 and September 2015. Two hundred outpatients referred for colonoscopy were prospectively enrolled and assigned to either the split-dose 2-L PEG-Asc group or the 1-L PEG-Asc with bisacodyl 10-mg group. The Boston Bowel Preparation Scale (BBPS) and Aronchick Bowel Preparation Scale (ABPS) were used to evaluate bowel cleansing. The tolerability of the regimens and satisfaction of patients was determined based on a questionnaire. Two hundred patients received either 2-L PEG-Asc or 1-L PEG-Asc with bisacodyl. Regarding colon cleansing outcome (BBPS and ABPS), the 1-L PEG-Asc with bisacodyl group showed similar but non-inferior results compared with the 2-L PEG-Asc group on both BBPS (6.92 ± 1.63 vs 6.57 ± 1.37; P= .103) and ABPS (96% vs 95%; P= 1.000) scales. Tolerability was similar for both 1-L PEG-Asc with bisacodyl and 2-L PEG-Asc. 1-L PEG-Asc is a suitable alternative to low-volume bowel preparation for colonoscopy. Our study showed that the 1-L PEG-Asc plus bisacodyl preparation has comparable tolerability and results in adequate colon cleansing. Bowel preparation with bisacodyl and 1-L PEG-Asc is a suitable alternative to low-volume bowel preparation for colonoscopy. (Clinical trial registration number: NCT02980562.).

Video on Diet Before Outpatient Colonoscopy Does Not Improve Quality of Bowel Preparation: A Prospective, Randomized, Controlled Trial.

Successful outpatient colonoscopy (CLS) depends on many factors including the quality of a patient's bowel preparation. Although education on consumption of the pre-CLS purgative can improve bowel preparation quality, no study has evaluated dietary education alone. We have created an educational video on pre-CLS dietary instructions to determine whether dietary education would improve outpatient bowel preparation quality. A prospective randomized, blinded, controlled study of patients undergoing outpatient CLS was performed. All patients received a 4 l polyethylene glycol-based split-dose bowel preparation and standard institutional pre-procedure instructions. Patients were then randomly assigned to an intervention arm or to a no intervention arm. A 4-min educational video detailing clear liquid diet restriction was made available to patients in the intervention arm, whereas those randomized to no intervention did not have access to the video. Patients randomized to the video were provided with the YouTube video link 48-72 h before CLS. An attending endoscopist blinded to randomization performed the CLS. Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS). Adequate preparation was defined as a BBPS total score of ≥6 with all segment scores ≥2. Wilcoxon rank-sum and Pearson's χ2-tests were performed to assess differences between groups. Ninety-two patients were randomized (video: n=42; control: n=50) with 47 total video views being tallied. There were no demographic differences between groups. There was no statistically significant difference in adequate preparation between groups (video=74%; control=68%; P=0.54). The availability of a supplementary patient educational video on clear liquid diet alone was insufficient to improve bowel preparation quality when compared with standard pre-procedure instruction at our institution.

Endoscopy Lower.

Endoscopy Lower.

Influences on Compliance to Split-Dose Bowel Preparation: A Retrospective Survey

Introduction: Colonoscopy is the gold standard for the detection and removal of pre-cancerous lesions of the colon. Recent guidelines recommend the utilization of a split-dose bowel preparation to effectively improve fecal clearance, thereby increasing Adenoma Detection Rate (ADR). However, barriers that may impede patient compliance have not been well-studied or understood. Our preliminary study aims to shed light on potential impeding factors. Methods: Outpatients presenting for screening colonoscopy at our medical center were interviewed prior to their procedure. Interviews were conducted by three researchers with a predesigned survey. The endoscopist performing the procedure was blinded to the results of the survey. 62 patient data were collected. 5 were incomplete and a total of 57 were analyzed. Results: Our compliance rate of 66.6% was in agreement with current data reported in the literature (64-85%). Although not statistically significant, we demonstrated a trend towards improved bowel prep quality in patients who were compliant with split dosing. Similarly, higher ADR was found in patients who were compliant, and in patients with adequate or excellent bowel prep. Patients who had a prior colonoscopy with a non-split dose bowel prep showed a tendency for lower compliance rates (not statistically significant). Conclusion: Our preliminary study demonstrated a trend towards improved bowel preparation quality and ADR in patients that were compliant with the split-dose bowel prep. Certain factors that seemed to be associated with compliance (but were not statistically significant) include white race, not having a prior non-split dose bowel prep, and review of the instructions on administering the bowel prep with the scheduling provider. Further investigative studies targeted at understanding factors that may compromise non-compliance of bowel preparations will aid in the development and implementation of programs to address these barriers.Figure 1Figure 2Figure 3

Improvement in Adenoma Detection Rate in a High Risk Population Using Two Simple Interventions

Introduction: High quality colonoscopy is associated with favorable adenoma detection rates (ADR) and polyp detection rates (PDR), which improve outcomes related to colorectal cancer. Inadequate bowel preparation limits colonoscopy by impairing visualization, increasing cost, and decreasing PDR and ADR. Barriers to adequate bowel preparation include Medicaid health insurance, non-English primary language, lower educational background or health literacy, low patient motivation, and increased time to procedure. Using a Plan Do Study Act (PDSA) model, we implemented a split-dose bowel regimen and multi-lingual educational booklet, and achieved >90% prep adequacy. Here, we report the effect of improved bowel preparation on ADR in a diverse, high-risk population at a New York City public hospital. Methods: In 1/2014 we implemented a split-dose bowel preparation regimen (cycle 1). In 8/2014, we implemented a visual multi-language educational booklet in English, Spanish and Chinese (cycle 2). Individual patient data on polyps found and histopathology was collected during inception of the interventions from October 2013 to December 2014. Hospital data was collected for years 2013 and 2015, which included number of screening, colonoscopies and adenomas detected. Chi-square testing was performed in R (version 3.3.1) to evaluate the difference in ADR pre and post interventions. Results: There was an overall upward trend noted in PDR and ADR from October 2013 to December 2014 through each intervention cycle (Figure 1). Within this group, patients were similar in age (median = 57; p=0.56). Across the hospital, there were 1345 screening colonoscopies with 320 adenomas detected in 2013. Post intervention (2015) there was 1555 colonoscopies with 424 adenomas detected. An ADR of 24% was achieved in 2013 versus 27% in 2015 (p=0.0331).Figure 1Conclusion: Split-dose bowel preparation combined with a multi-language educational booklet to improve bowel preparation is associated with improved PDR and ADR in a high risk, ethnically diverse population. Utilizing the PDSA cycle we made a significant impact on two important quality markers, preparation adequacy and ADR.

Barriers to Split-Dose Bowel Prep

Split-dose and same-day bowel preparations are associated with better bowel cleansing for colonoscopy, particularly in the right colon, and with higher