Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies

Bucci, Cristina; Rotondano, G.; Hassan, Cesare; Rea, Matilde; Bianco, Maria Antonia; Cipolletta, Livio; Ciacci, Carolina; Marmo, Riccardo

doi:10.1016/j.gie.2014.05.320

Cited by 144 publications

(110 citation statements)

References 39 publications

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“…In fact, the correct reporting of segmental bowel preparation is fundamental for detecting colonic lesions and for increasing the alertness of the endoscopist in future colonoscopies [17] . Our overall results for bowel preparation are similar to the published data on standard bowel preparation regimens, with a great improvement in these results after the introduction of the split-dose regimen for all our exams in late 2015 [18] . In the study period, a statistically significant improvement in "adequate" preparations was accomplished (67 vs. 72%; p = 0.004), but there was also a significant increase (4 vs. 6%; p = 0.008) in "poor" preparations, at this time with no obvious justification.…”

Section: Discussionsupporting

confidence: 86%

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Taveira

Areia

Elvas

et al. 2017

GE Port J Gastroenterol

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Background: Colonoscopy quality is a hot topic in gastroenterological communities, with several actual guidelines focusing on this aspect. Although the adenoma detection rate (ADR) is the single most important indicator, several other metrics are described and need reporting. Electronic medical reports are essential for the audit of quality indicators; nevertheless, they have proved not to be faultless. Aim: The aim of this study was to analyse and audit quality indicators (apart from ADR) using only our internal electronic endoscopy records as a starting point for improvement. Methods: An analysis of electronically recorded information of 8,851 total colonoscopies from a single tertiary centre from 2010 to 2015 was performed. Results: The mean patient age was 63.4 ± 8.5 years; 45.5% of them were female, and in 14.6% sedation was used. Photographic documentation was done in 98.4% with 10.7 photographs on average, and 37.4% reports had <8 pictures per exam. Bowel preparation was rated as adequate in 67%, fair in 27% and inadequate in 4.9% of cases. The adjusted caecal intubation rate (CIR) was 92%, while negative predictors were inadequate preparation (OR 119, 95% CI 84-170), no sedation (OR 2.39, 95% CI 1.81-3.15), female gender (OR 1.61, 95% CI 1.38-1.88) and age ≥65 years (OR 1.56, 95% CI 1.34-1.82). In 28% of patients, a snare polypectomy was performed, correlating with adequate preparation (OR 5.75, 95% CI 3.90-8.48), male gender (OR 1.82, 95% CI 1.64-2.01) and age ≥65 years (OR 1.25, 95% CI 1.13-1.37; p < 0.01) as positive predictors. An annual evolution was observed with improvements in photographic documentation (10.7 vs. 12.9; p < 0.001), CIR (91 vs. 94%; p = 0.002) and “adequate” bowel preparation (p = 0.004). Conclusions: There is much more to report than the ADR to ensure quality in colonoscopy practice. Better registry systematization and integrated software should be goals to achieve in the short term.

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Section: Discussionsupporting

confidence: 86%

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Taveira

Areia

Elvas

et al. 2017

GE Port J Gastroenterol

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“…A potential cause of noncompliance and adverse events, such as pulmonary aspiration, in elderly patients is the large volume of laxatives required [2] . Many studies have explored split-dose regimens to enhance patient compliance, and they have consistently shown that a split-dose regimen is superior to the traditional regimen of administering the entire preparation the day before the procedure [3][4][5] . Therefore, current guidelines strongly recommend the use of a split-dose regimen for colonoscopy [3] .…”

Section: Introductionmentioning

confidence: 99%

Low-Volume Polyethylene Glycol with Ascorbic Acid for Colonoscopy Preparation in Elderly Patients: A Randomized Multicenter Study

et al. 2016

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Background: Minimal data exist regarding the use of low-volume purgatives for elderly (≥65 years) patients. We aimed to investigate the bowel-cleansing efficacy and patient tolerability of split-dose 2 liters (L)-polyethylene glycol with ascorbic acid (2L-PEGA) in elderly outpatients undergoing colonoscopy. Methods: Patients who underwent morning colonoscopies were randomly assigned to one of 3 arms: single-dose 4L-PEG on the day before colonoscopy; split-dose 4L-PEG; or split-dose 2L-PEGA. The quality of bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS). Results: Of 230 patients enrolled, 198 were analyzed. The proportion of adequate bowel preparations in split-dose 2L-PEGA was higher than that in single-dose 4L-PEG (92.1 vs. 75.0%, p = 0.009) and similar to split-dose 4L-PEG. The mean BBPS scores for global and right colon preparation in the split-dose 2L-PEGA were comparable to split-dose 4L-PEG but higher than those in the single-dose 4L-PEG. The proportion of patients who ingested the entire volume of solution in 2L-PEGA was higher than that in single-dose 4L-PEG (96.8 vs. 80.9%, p = 0.011). Patients receiving 2L-PEGA expressed more willingness to repeat the same preparation than other groups. The rate of adverse events did not differ among the 3 groups. Conclusions: Split-dose 2L-PEGA was an effective, safe, and comfortable method for colonoscopy preparation in elderly outpatients.

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“…However, while both SP/MC and PEG regimens are widely considered to yield satisfactory cleansing when used in a split-dose manner [21,22], it is generally accepted that lowvolume preparations, including SP/MC, are better tolerated by patients [13,15].…”

Section: Discussionmentioning

confidence: 99%

Preparation regimen is more important than patient-related factors: a randomized trial comparing a standard bowel preparation before colonoscopy with an individualized approach

Voiosu

Tanțău

Voiosu

et al. 2017

Romanian Journal of Internal Medicine

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Background. Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen.Material and Methods. We conducted an endoscopist-blinded multicenter randomized control-trial. The Boston Bowel Prep Score (BBPS) was used to assess quality of bowel preparation and a 10 point visual analogue scale to assess patient comfort during bowel prep. Patients were randomised to either the standard regimens of split-dose 4L polyethylene-glycol (group A), split-dose sodium picosulphate/magnesium citrate (group B) or to either of the two depending on their responses to a 3-item questionnaire (individualized preparation, group C).Results. 185 patients were randomized during the study period and 143 patients were included in the final analysis. Patients in the individualized group had a median BBPS of 7 compared to a median of 6 in the standard group (p = 0.7). Also, there was no significant difference in patients' comfort scores, irrespective of study group or laxative regimen. However, on multivariable analysis, a split-dose 4L polyethylene-glycol was an independent predictor for achieving a BBPS>6 (OR 3.7, 95% CI 1.4-9.8), regardless of patient-related factors.Conclusion. The choice of laxative seems to be more important than patient-related factors in predicting bowel cleansing. Comfort during bowel prep is not influenced by the type of strategy used.

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Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies

Cited by 144 publications

References 39 publications

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever

Low-Volume Polyethylene Glycol with Ascorbic Acid for Colonoscopy Preparation in Elderly Patients: A Randomized Multicenter Study

Preparation regimen is more important than patient-related factors: a randomized trial comparing a standard bowel preparation before colonoscopy with an individualized approach

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