Efficacy of single- versus split-dose polyethylene glycol electrolyte solution for morning colonoscopy: A randomized controlled study

Abstract

Background: Split-dose (SPD) regimen has been proved more effective than a single-dose (SID) regimen for various drug preparations; however, limited data have focused on morning colonoscopy. We implemented this study to compare the bowel cleanliness and tolerability of a same-day SID versus SPD 2 L polyethylene glycol electrolyte solution (PEG) for morning colonoscopy. Methods: Patients undergoing morning colonoscopy were randomized into two groups, SID or SPD. In the SID group, patients had to complete 2 L PEG between 4 and 6 am on the day of colonoscopy. In the SPD group, patients had to complete 1 L PEG between 8 and 9 pm on the day before followed by another 1 L PEG between 5 and 6 am on the day of colonoscopy. Colonoscopy was performed between 8 and 12 am under anesthesia. Investigators and endoscopists were blinded to the allocation. The primary end point was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes were polyp detection rate, compliance, tolerability, and patient satisfaction. Results: Overall, there were 147 and 148 patients in the SID and SPD group, respectively. The SPD group had a better quality of bowel preparation than the SID group with a total BBPS score of 7.25 ± 1.53 versus 6.71 ± 1.65 ( P = 0.005). No difference in the polyp detection rate was noted, although more polyps were detected in the SPD group. More patients felt acceptable with the bowel preparation regimen in the SPD group compared to the SID group (76% vs. 65%, P = 0.03). The adverse events were more commonly observed in the SID group, presented as nausea and vomiting. Conclusion: For morning colonoscopy, split-dose 2 L PEG is superior to single-dose 2 L PEG by improved bowel preparation, better tolerability, and patient satisfaction.

Could atmospheric temperature impact on adequate colon cleansing for colonoscopy? An observational, single-institution study

“…Similarly, Shan et al [30], in a randomized controlled trial on 295 patients, demonstrated that for morning colonoscopy, split-dose 2L PEG was superior to single-dose regimen in bowel preparation and patients tolerability and satisfaction.…”

“…Regarding procedure related risk factors, several studies have proposed that low-volume hyperosmolar PEG and split-dose regimen were associated with an higher rate of adequate bowel cleansing [25][26][27][28][29][30][31].…”

Split doses versus whole dose bowel preparation using polyethylene glycol for colonoscopy: A multicentric prospective Lebanese randomized trial between 2021 and 2023

“…Traditionally, the complete bowel‐cleansing preparation is administered in the evening before the colonoscopy. And, to avoid sleep disruption, it must be administered early in the evening, resulting in poor bowel cleansing reported as a 70% sufficient cleaning rate, 42 which was much lower in our center at 50% because we only utilized low‐volume 2 L PEG. The main cause of poor bowel cleanliness could be the long‐time interval between the last preparation intake and the time of the colonoscopy, which was supposed to be limited to 4–6 h. To meet the recommended interval time for the morning colonoscopy, patients had to get up at dawn.…”

Effects on BBPS score with bowel preparation time and dosage

“…[8] Separate 2 + 2L bowel preparation was superior to one-time 4 L (89.2% vs 62.5%; P < .001). [8] 2. Materials and Methods…”

“…[7] Separate-time bowel preparation quality was better than one-time bowel preparation, with an overall BBPS score of 7.25 ± 1.53 vs 6.71 ± 1.65 ( P = .005). [8] Separate 2 + 2L bowel preparation was superior to one-time 4 L (89.2% vs 62.5%; P < .001). [8]…”