Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2018; 24(6): 716-724
Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.716
Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists’ adherence to National Colorectal Cancer Screening and Surveillance Guidelines
Stacy Bartnik Menees, H Myra Kim, Philip Schoenfeld
Stacy Bartnik Menees, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI 48105, United States
Stacy Bartnik Menees, Division of Gastroenterology, Ann Arbor Veterans’ Administration Hospital, Ann Arbor, MI 48105, United States
H Myra Kim, Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI 48105, United States
H Myra Kim, Department of Biostatistics, University of Michigan, Ann Arbor, MI 48105, United States
Philip Schoenfeld, Division of Gastroenterology, John D. Dingell VA Medical Center, Detroit, MI 48201, United States
Author contributions: Menees SB conducted the data collection, analysis, and interpretation, and wrote and revised the manuscript; Schoenfeld P designed the research; Menees SB performed the research; Kim HM analyzed the data; Menees SB, Kim HM, and Schoenfeld P both contributed to draft revision.
Supported by the Michigan Institute for Clinical and Health Research MICHR T2 Translational Science Award Program Application (MICHR T2), No. UL1RR024986 to Menees SB.
Institutional review board statement: The Medical School Institutional Review Board (IRBMED) has reviewed and approved the study.
Conflict-of-interest statement: Dr. Schoenfeld has worked as a consultant and advisory board member for Salix Pharmaceuticals, Inc., which is the manufacturer of MoviPrep. Authors Menees and Kim have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Stacy Bartnik Menees, MD, MSc, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48105, United States.
Telephone: +1-734-2323739
Received: November 3, 2017
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
Research background

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.

Research motivation

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.

Research objectives

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).

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.