Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.716
Peer-review started: November 4, 2017
First decision: November 30, 2017
Revised: December 29, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: February 14, 2018
Split-dose bowel regimen is considered standard of care for bowel preparation in national guidelines. Since it improves bowel preparation quality, we should see an increase in endoscopists’ compliance to guidelines.
Split-dose bowel regimen is recommended in national guidelines for colonoscopy bowel preparation. There is no data on how institution of split-dose bowel preparation can maximize the proportion of patients with an “excellent” bowel preparation and quantify the impact of “excellent” bowel preparation on increasing the likelihood of recommending an appropriate interval for repeat screening/surveillance colonoscopies.
To examine the impact of split-dose regimen on endoscopists’ compliance with guideline recommendations for timing of repeat colonoscopy in patients with normal colonoscopy or 1-2 small polyps (< 10 mm).
We conducted this retrospective study of colonoscopies performed in average-risk individuals aged 50 years or greater from two time periods, pre and post-split bowel preparation institution. Only patients with normal or 1-2 small polyps were included. Primary and secondary outcome measurements included: recommendation for timing of repeat colonoscopy and bowel preparation quality. Bivariate analysis and multivariable logistic regression analysis were utilized to assess the impact of split-dosing bowel preparation on both physician follow-up recommendation and bowel preparation quality.
After the institution of split-dose bowel regimen, there was a small, but significant increase in physician compliance to guideline recommendations in patients with normal colonoscopy and 1-2 small polyps. This correlated to the increase in both excellent and adequate bowel preparation. There was no measurable change in the amount of patients who had poor/inadequate bowel preparation.
In this current study, our research supports the use of split-dose bowel regimen to help optimize bowel preparation. Improvement of bowel preparation quality increases the likelihood of physician compliance for follow-up colonoscopy in patients with normal colonoscopy and 1-2 small polyps.
This study supports the use of split-dose bowel regimen for colonoscopy bowel preparation. Our study also acquired information on endoscopist compliance to CRC screening guidelines after the implementation of split-dose preparation in order to provide a new baseline for comparison. Improvement in endoscopist compliance can help make colonoscopy more cost-effective. It is crucial for endoscopists to abide by current guidelines, as recommending earlier colonoscopies not only exposes patients to excess procedural risk, but also drains limited resources that could be used for unscreened patients. This study provides pilot data for future endoscopist-based interventions.