Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme

Abstract

NCT02178033.

Full-spectrum (FUSE) versus standard forward-viewing colonoscopy in an organised colorectal cancer screening programme

“…Perhaps the additional diagnostic value of FUSE was hampered by the very high value of ADR in the control group, the opposite being true in a non-FIT-positive population. In the same FIT-positive population, however, we have recently shown the efficacy of a split regimen in significantly increasing the mean ADR,31 suggesting the validity of this setting to test the additional efficacy of any improvement in the technique of colonoscopy. Fourth, the relationship between polyp miss rate in back-to-back studies and stratification of results by patient is unclear.…”

Barriers against split-dose bowel preparation for colonoscopy

“…First, the impact of patient-related barriers is clinically relevant. The adoption of a split regimen has been associated with a 30% higher detection rate of both neoplasia and advanced neoplasia in a high-quality randomised controlled trial,4 and in turn neoplasia detection rate has been strictly associated with the post-colonoscopy risk of interval cancer 18 19. Thus, the 38% rate of patients displaced from the split regimen indicated that patient-related barriers severely undermined the efficacy of colonoscopy in preventing colorectal cancer (CRC).…”

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

“…Although one recent randomized controlled trial (RCT) did report a significantly improved ADR with split-dose bowel preparation [5], there were important barriers to the use of split-dose [6]. In the report describing split-dose increasing ADR as the primary endpoint, 50-69-year-old subjects undergoing first colonoscopy after positive fecal immunochemical test were randomized 1:1 to receive low-volume 2L polyethylene glycol (PEG)-ascorbate solution in a "split-dose" (Split-Dose Group, SDG) or a "day-before" regimen (Day-Before Group, DBG) in 690 subjects.…”

“…In the report describing split-dose increasing ADR as the primary endpoint, 50-69-year-old subjects undergoing first colonoscopy after positive fecal immunochemical test were randomized 1:1 to receive low-volume 2L polyethylene glycol (PEG)-ascorbate solution in a "split-dose" (Split-Dose Group, SDG) or a "day-before" regimen (Day-Before Group, DBG) in 690 subjects. At per-patient analysis, ADR was [5]. These authors also evaluated the patient preference for the split-dose and day-before regimens and their association with patient-related factors using a 20-item questionnaire.…”