Menees SB, Kim HM, Schoenfeld P. Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists’ adherence to National Colorectal Cancer Screening and Surveillance Guidelines. World J Gastroenterol 2018; 24(6): 716-724 [PMID: 29456410 DOI: 10.3748/wjg.v24.i6.716]
Corresponding Author of This Article
Stacy Bartnik Menees, MD, MSc, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48105, United States. sbartnik@med.umich.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastroenterol. Feb 14, 2018; 24(6): 716-724 Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.716
Table 1 Utilized colonoscopy preparations
Bowel preparation
Diet and fluid instructions
Traditional dosing (night before)
Split dose-bowel preparation
PEG, HalfLytely, NuLYTELY, or TriLyte,
Clear liquid diet for lunch and dinner; Ingest other clear liquids between doses of laxative.
Take 8 oz. every 15 min until it is gone between 12 pm and 6 pm.
Between 5 pm and 6 pm the night before colonoscopy, drink one (8 oz.) glass of laxative and continue drinking one (8 oz). glass every 15 min until 2l (64 oz.) of the preparation solution is gone; Drink the final 2l (64 oz.) of prep solution 5 h before the patient needs to leave for the procedure.
MoviPrep,
Clear liquid diet for lunch and dinner; Ingest other clear liquids between doses of laxative.
Take 8 oz. every 15 min until it is gone between 12 pm and 6 pm.
Between 5 pm and 6 pm, begin drinking the preparation; The MoviPrep container is divided by 4 marks; Every 15 min drink the solution down to the next mark (about 8 oz.), until the full liter has been consumed; Over the course of the evening, drink an additional 0.5 L of clear liquids; The next day, drink the final liter (32 oz.) of preparation solution 5 h before the patient needs to leave for the procedure.
MiraLAX (PEG 3350) /Gatorade
Clear liquid diet for lunch and dinner; Ingest other clear liquids between doses of laxative.
Take 2 tablets of bisacodyl between 12 pm and 6 pm, 4 h later take 8 oz. of the MiraLAX/Gatrade mixed in 2 liters of Gatorade every 15 min until gone.
At 12 noon, take 2 Dulcolax tablets; Between 5 pm and 6 pm, drink one (8 oz.) glass of the Miralax/Gatorade solution and continue drinking one (8 oz.) glass every 15 min thereafter until half the mixture (32 oz.) is gone. The next day, drink the final liter (32 oz.) of preparation solution 5 h before the patient needs to leave for the procedure.
OsmoPrep
Clear liquid diet for lunch and dinner; Ingest other clear liquids between doses of laxative.
Take first set of 20 tablets between 12 noon and 6 pm; Take a dose of 4 tablets every 15 min with at least 8 ounces of clear liquid; The second set of 12 tablets was to be taken 10-16 h after in the same manner as described above.
Between 5 and 6 pm take 4 tablets with 8 oz. of any clear liquid every 15 min; The patient will take a total of 20 tablets and drink 40 oz. of clear liquids over a 1 h period. The next day, 5 h before the patient needs to leave for your procedure, take 4 tablets with 8 oz. of any clear liquid every 15 min; The patient will take a total of 12 tablets and drink 24 oz. of clear liquid over a 30-min period.
Table 2 Patient and procedure characteristics by study year: 2009 is prior to split dosing, and 2011 is after split dosing
Table 4 Adjusted1 odds ratios of guideline consistent recommendations in average-risk patients obtained from logistic regression models fit separately by each year
2009 Before split-dosing
2011 After split-dosing
OR
P value
95%CI
OR
P value
95%CI
Prep quality
Adequate or excellent
1.00
Good
0.55
0.001
(0.38, 0.78)
0.44
< 0.001
(0.32, 0.61)
Fair
0.04
< 0.001
(0.03, 0.06)
0.06
< 0.001
(0.04, 0.09)
Inadequate or Poor
0.17
< 0.001
(0.09, 0.30)
0.08
< 0.001
(0.05, 0.13)
Bowel prep type
MiraLAX/Gatorade
1.00
1.00
4L PEG, GoLYTELY, NuLYTELY, Colyte, TriLyte
0.65
0.013
(0.46, 0.91)
1.10
0.485
(0.84, 1.45)
Half-Lytely, Osmoprep, Moviprep, and others
0.62
0.032
(0.41, 0.96)
0.70
0.134
(0.44, 1.12)
Citation: Menees SB, Kim HM, Schoenfeld P. Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists’ adherence to National Colorectal Cancer Screening and Surveillance Guidelines. World J Gastroenterol 2018; 24(6): 716-724