Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study

Matro, Rebecca; Shnitser, Anastasia; Spodik, Maya; Daskalakis, Constantine; Katz, Leo; Murtha, Alexandra; Kastenberg, David

doi:10.1038/ajg.2010.160

Cited by 87 publications

(67 citation statements)

References 19 publications

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“…On the basis of data from previous studies [20][21][22] , a sample size of 200 patients was estimated to give an 80% power at a two-sided alpha of 0.05% to detect a 15% difference in the Ottawa bowel preparation quality scale. Bowel preparation scores measured by the Ottawa Scale were compared between the morning and splitdose groups using the Mann-Whitney U test.…”

Section: Discussionmentioning

confidence: 99%

“…Matro et al [22] compared the efficacy and tolerability of morning-only PEG to splitdose PEG for afternoon colonoscopy, and found both equivalent with respect to cleansing efficacy and polyp detection. Morning-only preparation was associated with lower incidence of abdominal pain, superior sleep quality, and less interference with work day prior to colonoscopy.…”

Section: Quality Of Bowel Preparationmentioning

confidence: 99%

“…However colonoscopies are often scheduled in the afternoon, and split dosing may not leave a clean colon by afternoon. A recent study by Matro et al [22] showing equal cleansing efficacy and tolerability of a morning dosing and split preparation when procedures are slated for the afternoon; this study did not include procedures scheduled in the morning.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of split-dosingvsnon-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

Shah

Desai

Samant

et al. 2014

WJGE

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AIM: To compare (using the Ottawa Bowel PreparationScale) the efficacy of split-dose vs morning administration of polyethylene glycol solution for colon cleansing in patients undergoing colonoscopy, and to assess the optimal preparation-to-colonoscopy interval. METHODS:Single-centre, prospective, randomized, investigator-blind stud in an academic tertiarycare centre. Two hundred patients requiring elective colonoscopy were assigned to receive one of the two preparation regimens (split vs morning) prior to colonoscopy. Main outcome measurements were bowel preparation quality and patient tolerability. RESULTS:Split-dose regimen resulted in better bowel preparation compared to morning regimen [Ottawa score mean 5.52 (SD 1.23) vs 6.02 (1.34); P = 0.017].On subgroup analysis, for afternoon procedures, both the preparations were equally effective (P = 0.756). There was no difference in tolerability and compliance between the two regimens. CONCLUSION:Overall, previous evening -same morning split-dosing regimen results in better bowel cleansing for colonoscopy compared to morning preparation. For afternoon procedures, both schedules are equally effective; morning preparation may be more convenient to the patient. Key words: Bowel preparation; Colonoscopy; Morning preparation; Split dose preparation; Preparation to colonoscopy interval Core tip: Split bowel reparation compared to single dose morning preparation resulted in a better bowel cleansing using the Ottawa Bowel Preparation Scale. The average score (± SD) using the Ottawa Scale was 6.02 ± 1.34 when morning preparation was given and 5.52 ± 1.23 when split preparation was given (P = 0.017). However, there was no statistical difference in the mean Ottawa score when the procedures were done in the afternoon with either the morning or the split preparation (6.09 vs 5.94, P = 0.756). Hence, AM only dosing is as effective as split dosing for patients scheduled for a colonoscopy in the afternoon.

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Section: Discussionmentioning

confidence: 99%

Section: Quality Of Bowel Preparationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of split-dosingvsnon-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

Shah

Desai

Samant

et al. 2014

WJGE

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“…definition, wide-angle endoscope 15,[21][22][23][24][25] ; narrow band imaging [26][27][28] ; transparent hood attached to the tip of the colonoscope 26,29,30 withdrawal time >6 min 31,32 or modified (e.g. split-dose) bowel preparation 33,34 . An optimal "colonoscopist-controlled" technique to enhance ADR and minimize "missed" right-sided lesions is desirable.…”

Section: Discussionmentioning

confidence: 99%

The water method combined with chromoendoscopy enhances adenoma detection

Leung¹,

Ransibrahmanakul²,

Toomsen³

et al. 2011

jig

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Background:The water method is easy-to-learn and improves colonoscopy outcomes. Dye-spray chromoendoscopy enhances ADR but has not been widely accepted for routine application in screening or surveillance colonoscopy. Hypothesis: With dye added to the water used in the water method, ADR can be enhanced compared with the water or air method alone. Objective: To compare ADR determined by the air method, water method alone, and water method with indigo carmine (0.008%) added. Design: Review of prospectively collected data in a performance improvement program. Setting: VA endoscopy unit. Patient: Screening or surveillance colonoscopy. Methods: Patients (n=50/group) underwent colonoscopy with each of the three methods. Water method involved warm water infusion in lieu of air insufflation coupled with removal of residual air by suction and residual feces by water exchange. ADR and procedural data were collected prospectively to monitor performance. Main Outcome Measurements: ADR. Results: ADR in the air method, water method alone and water method with indigo carmine were 36%, 40% and 62%, respectively. Water method with indigo carmine produced significantly higher ADR than the air or water method alone (p<0.05). Limitations: Non-randomized data, single VA site, retrospective comparison. Absence of significant difference between air and water methods could be a type II error due to small number of patients Conclusions: The approach with indigo carmine added to the water used in the water method yielded significantly higher ADR than the water or the air method alone. The data suggest that a prospective RCT to compare the different methods is warranted.

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“…A study compared the quality of cleansing with patient tolerance of 2 L of PEG-ELS, ad-Parra-Blanco A et al . Best preparation for colonoscopy [29] PEG 4 L vs PEG 2 L + ascorbate 72/72 Residual stool score significantly lower with PEG 4 L Corporaal et al [30] PEG 4 L vs PEG 2 L + ascorbate 149/158 PEG + ascorbate less effective in right colon cleansing Marmo et al [31] PEG 4 L vs PEG 2 L + ascorbate 435/433 PEG + ascorbate as effective as high-volume PEG-electrolyte solution but has superior palatability Ell et al [32] PEG 4 L vs PEG 2 L + ascorbate 153/155 PEG + ascorbate same efficacy and safety, better tolerance Gentile et al [33] PEG 4 L vs PEG 2 L + ascorbate 60/60 Similar efficacy Repici et al [34] PEG 2 L + ascorbate vs PEG 2 L + citrate + bisacodyl 202/203 PEG 2 L + citrate + bisacodyl more effective for bowel cleansing Bitoun et al [35] PEG 2 L + ascorbate vs NaP 169/171 PEG + ascorbate at least as efficacious as NaP, comparable efficacy, better tolerability profile Rex et al [22] 4 L PEG SF-ELS vs NaP 68/68 NaP superior bowel cleansing, similar tolerability Renaut et al [37] MC-SP vs NaP 32/41 MC-SP better tolerated, similar cleansing effectiveness Choi et al [38] NaP vs magnesium citrate + NaP (45 mL) 79/80 Both similar effectiveness Schmidt et al [39] MC-SP vs NaP 182/190 MC-SP better tolerance, similar cleansing effectiveness Hookey et al [40] MC-SP + bisacodyl vs MC-SP vs NaP 105/109/101 MC-SP + bisacodyl better colon cleansing in the right colon compared with two other groups Tjandra et al [42] MC-SP vs NaP 120/102 NaP better cleansing Katz et al [41] MC-SP vs PEG 2 L + 10 mg bisacodyl tablets 300/303 Similar quality of cleansing Rex et al [43] PEG 2 L + bisacodyl 5 ministered either on the same day or in a split dose fashion [56,57] . There was no difference in quality (with adequate bowel prep in > 90% patients in both groups).…”

Section: A Key Factor For Optimal Preparation: Timing Of Administrationmentioning

confidence: 99%

Achieving the best bowel preparation for colonoscopy

Parra‐Blanco¹,

Ruiz²,

Álvarez-Lobos³

et al. 2014

WJG

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Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here. Core tip: Bowel preparation for colonoscopy is a central issue related to the quality of the procedure. There are different agents for bowel preparation that can be administered with different schedules. We review the most commonly used agents, as well as new agents and combinations. Moreover, certain considerations should be taken into account for special populations in order to improve safety, efficacy and tolerance. Regimens for bowel preparation in special situations are discussed, such as for pedi...

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Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study

Cited by 87 publications

References 19 publications

Comparison of split-dosingvsnon-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

Comparison of split-dosingvsnon-split (morning) dosing regimen for assessment of quality of bowel preparation for colonoscopy

The water method combined with chromoendoscopy enhances adenoma detection

Achieving the best bowel preparation for colonoscopy

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