Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy

Abstract

Background Although split-dose bowel regimen is recommended in colon cancer screening and surveillance guidelines, implementation in clinical practice has seemingly lagged because of concerns of patient compliance. Objectives To assess patient compliance with the split-dose bowel regimen and assess patient- and preparation process–related factors associated with compliance and bowel preparation adequacy. Design Prospective survey cohort. Setting Tertiary care setting. Patients Average-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013. Main Outcome Measurements Split-dose bowel regimen patient-reported compliance and bowel preparation adequacy with the Boston Bowel Preparation Scale score. Results Surveys and Boston Bowel Preparation Scale score data were completed in 462 participants; 15.4% were noncompliant with the split-dose bowel regimen, and suboptimal bowel preparation (score < 5) was reported in 16% of all procedures. White (P = .009) and married (P = .01) subjects were least likely to be noncompliant, whereas Hispanic subjects and those who reported incomes of US$75,000 or less were most likely to be noncompliant (P = .004). Participants who were noncompliant with split-dosing were less likely to follow the other laxative instructions and more likely to have their colonoscopy appointment before 10:30 am. Compliance differed by bowel preparation type (P = .003, χ2 test), with those who used MiraLAX showing the highest compliance, followed by polyethylene glycol electrolyte solution and other bowel preparations. Noncompliance with split-dose bowel preparation (odds ratio 6.7; 95% confidence interval, 3.2–14.2) was the strongest predictor of suboptimal bowel preparation. Limitations Patient self-report, performed at tertiary care center. Conclusions Overall, 1 in 7 patients do not comply with a split-dose bowel regimen. Ensuring compliance with the split-dose bowel regimen will reduce the risk of a suboptimal bowel preparation. (Gastrointest Endosc 2014;79:811-20.)

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

“…However, a split-dose regimen can result in sleep disturbance and fecal incontinence during transit to the endoscopy center [3,6] . A recent study reported that 1 in 7 patients does not comply with a split-dose bowel regimen [7] . Although the use of split-dosage preparations is suggested for elderly patients [8] , supporting evidence is lacking for this population.…”

Colonoscopy in Colorectal Cancer Screening: Current Aspects

“…In this study, it was found that 1 in 7 individuals did not comply with a split dose bowel preparation. A compliance with the splitdose bowel regimen will reduce the risk of a suboptimal bowel preparation [43]. The results of another study, also, revealed that split-dose bowel preparation resulted in better bowel cleansing, and improved patient tolerance [44].…”

Evaluation of a Systematic Method for Risk Stratification and Management of Gastrointestinal Endoscopy Patients

“…The literature suggests that split dose preparations are more effective and better tolerated by patients in general [13,14]. On the other hand patient compliance with split dose prep can be an issue [15]. Keeping these factors in mind and especially noting that many our patients travel up to 3 hours for their procedures we chose to start spit dose preparations for colonoscopies starting after noon (12 PM).…”