Barriers against split-dose bowel preparation for colonoscopy

Radaelli, Franco; Paggi, Silvia; Repici, Alessandro; Gullotti, G.; Cesaro, Paola; Rotondano, G.; Cugia, Luigi; Trovato, C.; Spada, Cristiano; Fuccio, Lorenzo; Occhipinti, Pietro; Pace, F.; Fabbri, Carlo; Buda, Andrea; Manes, Gianpiero; Feliciangeli, Giuseppe; Manno, Mauro; Barresi, Luca; Anderloni, Andrea; Dulbecco, Pietro; Rogai, Francesca; Amato, Arnaldo; Senore, Carlo; Hassan, Cesare

doi:10.1136/gutjnl-2015-311049

Cited by 45 publications

(48 citation statements)

References 23 publications

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“…21,22 Other results showing that split-dose preparation was superior to day-before cleansing may have been caused by different time intervals between bowel cleansing and the examination. [23][24][25] In this study, it is possible that as all OSS regimens were prepared in a split-dose, this provided higher cleaning quality than PEG-AA, which was mainly prepared as a single-dose. The interval between the last dose of bowel preparation and the start time of colonoscopy would be helpful for the comparison.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation

et al. 2020

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Background/Aims: The quality of bowel preparation is one of the quality indicators for colonoscopy. The aim of this study was to compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol plus ascorbic acid (PEG-AA) for bowel preparation. Methods: The study involved 167 patients who underwent diagnostic colonoscopies. Inadequate bowel preparation was defined as any score of ≤1 in each colon section based on the Boston Bowel Preparation Scale. Multivariate logistic regression was used to compare the efficacy of OSS and PEG-AA. Subgroup analyses were performed based on patient characteristics. Results: Overall, 106 (63.5%) patients received OSS, and 61 (36.5%) patients received PEG-AA. The rate of inadequate bowel preparation was 12.3% in patients receiving OSS and 32.8% in patients receiving PEG-AA (p=0.001). OSS (odds ratio [OR] = 0.26; p=0.003) and morning examination (OR=0.11; p=0.038) were significantly associated with efficient bowel preparation. The efficacy of OSS compared with PEG-AA was only significant in patients ≥50 years of age vs. <50 years of age (OR=0.13; p=0.001 vs. OR=0.96; p=0.959) and female vs. male patients (OR=0.06; p=0.002 vs. OR=0.58; p=0.339). Conclusions: OSS was significantly more efficient for bowel preparation than PEG-AA, especially in patients ≥50 years of age and female patients. Morning examination led to a good quality of bowel preparation, irrespective of the preparation regimen. Clin Endosc 2020 Apr 24.

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Section: Discussionmentioning

confidence: 99%

Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation

et al. 2020

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“…Taking into account the increased time and required morning of commitment, our study suggests that split-dose preparation would be more likely to interfere with domestic responsibilities and existing morning medication regimens. Another recent study assessing split-dose regimen uptake also found that social factors, including morning appointments, travel time to endoscopy, and low education level, were associated with limited uptake of the split-dose regimen [ 31 ]. It may be important for health systems and providers to specifically address these social barriers to ensure bowel preparation tolerability, given that split-dose is currently the standard of care.…”

Section: Discussionmentioning

confidence: 99%

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

Perreault

Goodman

Larion

et al. 2018

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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.

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“…Split-dose for morning procedures has been shown to improve ADR and especially the quality of the preparation in the right bowel [27,28] . Although, this scheme is advocated by major societies [29,30] , its uptake has been suboptimal due to factors such as fear of increased aspiration risk, fecal incontinence, and low patient education [31] , even with the ASA guidelines advocating a 2-hour clear liquid fast for all forms of anesthesia in patients without risk factors for aspiration [32] .…”

Section: Discussionmentioning

confidence: 99%

Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours

Ferreira

Fidalgo

Palmela

et al. 2016

GE Port J Gastroenterol

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Background: Colorectal cancer (CRC) is the first cause of cancer-related mortality in Portugal. CRC screening reduces disease-specific mortality. Colonoscopy is currently the preferred method for screening as it may contribute to the reduction of CRC incidence. This beneficial effect is strongly associated with the adenoma detection rate (ADR). Aim: Our aim was to evaluate the quality of colonoscopy at our unit by measuring the currently accepted quality parameters and publish them as benchmarking indicators. Methods: From 5,860 colonoscopies, 654 screening procedures (with and without previous fecal occult blood testing) were analyzed. Results: The mean age of the patients was 66.4 ± 7.8 years, and the gender distribution was 1:1. The overall ADR was 36% (95% confidence interval [CI] 32-39), the mean number of adenomas per colonoscopy was 0.66 (95% CI 0.56-0.77), and the sessile serrate lesion detection rate was 1% (95% CI 0-2). The bowel preparation was rated as adequate in 496 (76%) patients. The adjusted cecal intubation rate (CIR) was 93.7% (95% CI 91.7-95.8). Most colonoscopies were performed under monitored anesthesia care (53%), and 35% were unsedated. The use of sedation (propofol or midazolam based) was associated with a higher CIR with an odds ratio of 3.60 (95% CI 2.02-6.40, p < 0.001). Conclusion: Our data show an above-standard ADR. The frequency of poor bowel preparation and the low sessile serrated lesion detection rate were acknowledged, and actions were implemented to improve both indicators. Quality auditing in colonoscopy should be compulsory, and while many units may do so internally, this is the first national report from a high-throughput endoscopy unit.

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Barriers against split-dose bowel preparation for colonoscopy

Abstract: NCT02287051; pre-result.

Cited by 45 publications

References 23 publications

Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation

Comparison of Oral Sulfate Solution and Polyethylene Glycol Plus Ascorbic Acid on the Efficacy of Bowel Preparation

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

Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours

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