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

Abstract

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.

Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group

“…The quality of bowel preparation is crucial for the overall efficacy of colonoscopy, with a suboptimal ADR and CIR related to an inadequate cleansing level and a higher risk of interval cancer. [18,19] In addition, a suboptimal cleansing level results in further costs and organizational issues since colonoscopy needs to be rescheduled or patients may be referred for alternative tests [20,21].…”

Water Exchange Versus Split-Dose Bowel Preparation and the ADR: Is WE There Yet?

“…In this issue of Digestive Diseases and Sciences, Wang et al [4] describe the effect of changing from a single-to a split-dose preparation on colonoscopy quality measures in a retrospective cohort study of quality indicators that relied on electronic medical record data. Cases were identified via the International Classification of Diseases (ICD)-9 code V76.51, "special screening for malignant neoplasms of colon."…”

Split-dose bowel preparation versus water exchange and adenoma detection rate: have we arrived there yet?

“…However, the evidence was insufficient to assess avoidance of a repeat colonoscopy or any improvement in polyp detection rate [ 4 ]. Wang et al [ 5 ] described the effect of changing from a single- to a split-dose preparation on colonoscopy quality measures in a retrospective cohort study based on electronic medical record data including quality indicators. The results included 1602 colonoscopies in the single-dose group and 1061 colonoscopies in the split-dose group.…”

“…These observation have important clinical implications for performance, costs, and patient experience, and provide evidence to support the use of split-dose preparation. There was no significant difference in ADR (40.7% vs. 40.5%, P=0.92), suggesting an ADR threshold over which improved bowel preparation would have little impact [ 5 ].…”