Split-Dose Bowel Preparation Is Superior to Straight-Dose in Hospitalized Patients Undergoing Inpatient Colonoscopy

Abstract

Background: There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. Objective The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. Methods: A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. Results: Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). Conclusion: Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.

High volume, low volume, or pills, which way should we go? a review of bowel preparation for colonoscopy

“…Being admitted to the hospital is also associated with poor-quality bowel preparation because of the increased utilization of laxatives and opioids in the hospital [40 ▪ ]. A retrospective cohort study compared split-dose to single-dose PEG bowel preparation in hospitalized patients and found that the split-dose group had significantly higher BBPS scores and rates of adequate bowel preparation [41]. Another study looked at whether acuity of care affected bowel preparation quality and found that patients on the general medicine and telemetry floor had higher quality bowel preparation compared with those in the ICU [42].…”