Same-Day Regimen as an Alternative to Split Preparation for Colonoscopy: A Systematic Review with Meta-Analysis

Abstract

Background. Split bowel preparation is the best regimen for colonoscopy. However, the same-day regimen can represent a valid alternative, but its use is limited by concerns about its cleansing ability, and to date, no convincing data support its use for routine colonoscopies. Aim. To evaluate the cleansing, compliance, and adverse event rates of the same-day compared to the split regimen. Results. A systematic literature search and meta-analysis was performed. Ten studies were included for a total of 1807 patients (880 in the same-day group and 927 in the split group). Overall, 85.3% patients in the same-day group vs. 86.3% in the split group had an adequate cleansing. Compliance was high for both, although patients were more compliant with the split than with the same-day prep (89.7% for same-day vs. 96.6% for split regimen). Sleep disturbance was more frequent in the split group, while nausea and vomit were more frequent in the same-day group. In the subgroup analysis, polyethylene glycol obtained a better cleansing rate when given as a split dose, with similar compliance and adverse events rates with both regimens. Conclusion. Split and same-day regimens are both useful in bowel cleaning before colonoscopy with a different pattern of adverse events and better compliance for split preparations. Endoscopists can consider the same-day preparation as a valid alternative, especially when the split preparation does not fit the patients’ needs.

Split dose bowel preparation before colonoscopy of PEG (Nulytely) in comparison to routine single dose bowel preparation

“…The ability to visualize the entire mucosal surface not only improves the rates of cecal intubation and polyp detection but also shortens the procedure time, thus optimizing procedural efficiency.Therefore, it is important to identify the predictors for inadequate bowel preparation. [ 15 ] Predictors of inadequate bowel preparations include male gender, inpatient status, diabetes mellitus, hypertension, cirrhosis, narcotic use, constipation, stroke, and low socioeconomic status. [ 16 17 18 19 20 21 22 23 24 25 26 ]…”

“…Many studies have revealed that being elderly[ 19 ] and male were associated with poor preparation, including for populations from the Middle East and Asia. [ 15 ] However, studies are conducted on either inpatient or outpatient bases, and it is well known that inpatient bowel preparation is associated with poor bowel preparation compared to outpatient appointments.…”

Correlation of Cleanliness among Different Bowel Segments during Colonoscopy: A Retrospective Study

“…Even if clinicians use many methods to improve intestinal cleanliness, such as WeChat, SMS, phone reminder, and laxatives, the intestinal cleanliness is improved to some extent [10][11][12][13][14][15]. Because intestinal cleanliness is the foundation of ADR, even the best new foundation must be achieved with good intestinal cleanliness [16,17].…”

Guía clínica de calidad en colonoscopia y polipectomía

“…Cuando el procedimiento de colonoscopia se realizará por la tarde, la ingesta de la preparación completa el mismo día del procedimiento puede ser una alternativa válida comparado con la preparación dividida, ya que no se han reportado diferencias significativas en el número de pacientes que logran una limpieza adecuada (85.3 vs. 86.3% respectivamente), a pesar de que el cumplimiento del tratamiento es mayor en aquellos que siguen una preparación dividida (89.7 vs. 96.6%) 44 .…”