Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the “gold standard” for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate.

To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.

We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.

A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs (P < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms (P > 0.05).

Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.

• Bowel preparation
• Colonoscopy
• Polyethylene glycol
• Same-day single-dose
• Split-dose
• Meta-analysis

• Colonoscopy
• bowel cleansing agents
• outcome

• Adherence
• Comparative
• Endoscopy
• Screening

• Adenoma/diagnosis
• Cathartics/adverse effects
• Colon
• Colonoscopy
• Humans
• Polyethylene Glycols/adverse effects

• Bowel preparation
• Polyethylene glycol
• Prucalopride

• Benzofurans/adverse effects
• Benzofurans/therapeutic use
• Cathartics/adverse effects
• Cathartics/therapeutic use
• Colonoscopy/methods
• Female
• Humans
• Male
• Middle Aged
• Polyethylene Glycols/therapeutic use
• Randomized Controlled Trials as Topic

Split bowel preparation is the best regimen for colonoscopy. However, the same-day regimen can represent a valid alternative, but its use is limited by concerns about its cleansing ability, and to date, no convincing data support its use for routine colonoscopies.

To evaluate the cleansing, compliance, and adverse event rates of the same-day compared to the split regimen.

A systematic literature search and meta-analysis was performed. Ten studies were included for a total of 1807 patients (880 in the same-day group and 927 in the split group). Overall, 85.3% patients in the same-day group vs. 86.3% in the split group had an adequate cleansing. Compliance was high for both, although patients were more compliant with the split than with the same-day prep (89.7% for same-day vs. 96.6% for split regimen). Sleep disturbance was more frequent in the split group, while nausea and vomit were more frequent in the same-day group. In the subgroup analysis, polyethylene glycol obtained a better cleansing rate when given as a split dose, with similar compliance and adverse events rates with both regimens.

Split and same-day regimens are both useful in bowel cleaning before colonoscopy with a different pattern of adverse events and better compliance for split preparations. Endoscopists can consider the same-day preparation as a valid alternative, especially when the split preparation does not fit the patients' needs.

• Appointments and Schedules
• Colonoscopy
• Drug Administration Schedule
• Female
• Humans
• Laxatives/administration & dosage
• Laxatives/adverse effects
• Male
• Middle Aged
• Patient Satisfaction
• Polyethylene Glycols/administration & dosage
• Polyethylene Glycols/adverse effects
• Prospective Studies
• Surveys and Questionnaires
• Treatment Outcome

• Bowel cleaning success
• Colonoscopy
• Meta-analysis
• Polyethylene glycol
• Randomized clinical trials
• Sodium picosulphate
• Tolerability

• Colonoscopy
• bowel preparation
• polyethylene glycol
• prucalopride

Colonoscopy procedures are commonly performed and have high success rates. However, poor or inadequate bowel preparation is one of the most common reasons for a repeated or failed colonoscopy. We therefore performed an observational study followed by propensity score modeling to evaluate and compare the quality of bowel preparation with the use of Aquanet bowel cleansing devices (BCDs) versus the use of oral sodium picosulfate solution.

We performed a prospective cross-sectional study to compare the quality of pre-endoscopic bowel preparation using a BCD with oral solution. Our major outcome of interest was the quality of bowel preparation as measured through the Boston bowel preparation (BBP) scale. Our main predictor was the method of bowel preparation. The bowel was prepared using either sodium picosulfate or the BCD.

A total of 314 participants were part of this study. The average age of the participants was 54 years and most of the participants were females (81%). Sodium picosulfate was associated with better scores at each segment. After propensity scoring with a 1:1 match and further adjusting for the unbalanced variable (age), we found that despite the apparent superior cleansing performance of sodium picosulfate over the BCD, the difference was not statistically significant.

This study reinforces previous reports regarding the quality, safety and comfort of BCDs, indicating that this technique should be considered for colonoscopy preparation. In the future, randomized controlled trials should be performed to validate these preliminary findings.

• Aquanet
• Bowel cleansing
• Clinical study
• Propensity score
• Sodium picosulfate

• Cathartics/administration & dosage
• Colonoscopy
• Drug Administration Schedule
• Humans
• Randomized Controlled Trials as Topic
• Treatment Outcome

• Ascorbic acid
• Colonoscopy
• Magnesium citrate
• Picosulfate sodium
• Polyethylene glycol

To compare the efficacy of fixed-time split dose and split dose of an oral sodium picosulfate for bowel preparation.

This is study was prospective, randomized controlled study performed at a single Institution (2013-058). A total of 204 subjects were assigned to receive one of two sodium picosulfate regimens (i.e., fixed-time split or split) prior to colonoscopy. Main outcome measurements were bowel preparation quality and subject tolerability.

There was no statistical difference between the fixed-time split dose regimen group and the split dose regimen group (Ottawa score mean 2.57 ± 1.91 vs 2.80 ± 2.51, P = 0.457). Cecal intubation time and physician’s satisfaction of inspection were not significantly different between the two groups (P = 0.428, P = 0.489). On subgroup analysis, for afternoon procedures, the fixed-time split dose regimen was equally effective as compared with the split dose regimen (Ottawa score mean 2.56 ± 1.78 vs 2.59 ± 2.27, P = 0.932). There was no difference in tolerability or compliance between the two groups. Nausea was 21.2% in the fixed-time split dose group and 14.3% in the split dose group (P = 0.136). Vomiting was 7.1% and 2.9% (P = 0.164), abdominal discomfort 7.1% and 4.8% (P = 0.484), dizziness 1% and 4.8% (P = 0.113), cold sweating 1% and 0% (P = 0.302) and palpitation 0% and 1% (P = 0.330), respectively. Sleep disturbance was two (2%) patients in the fixed-time split dose group and zero (0%) patient in the split dose preparation (P = 0.143) group.

A fixed-time split dose regimen with sodium picosulfate is not inferior to a split dose regimen for bowel preparation and equally effective for afternoon colonoscopy.

• Colonoscopy
• Bowel preparation
• Split dose preparation
• Sodium picosulfate
• Ottawa Bowel Preparation Scale

• Administration, Oral
• Adult
• Aged
• Cathartics/administration & dosage
• Cathartics/adverse effects
• Cecum/diagnostic imaging
• Cecum/drug effects
• Citrates/administration & dosage
• Citrates/adverse effects
• Colonoscopy/adverse effects
• Colonoscopy/methods
• Dizziness/chemically induced
• Dizziness/epidemiology
• Drug Administration Schedule
• Female
• Humans
• Male
• Middle Aged
• Nausea/chemically induced
• Nausea/epidemiology
• Organometallic Compounds/administration & dosage
• Organometallic Compounds/adverse effects
• Picolines/administration & dosage
• Picolines/adverse effects
• Prospective Studies
• Time Factors
• Treatment Outcome
• Vomiting/chemically induced
• Vomiting/epidemiology

• computed tomography enterography
• double-balloon enteroscopy
• tolerance and preference

• Colonoscopy
• bowel preparation
• bowel preparation agent
• effectiveness
• endoscopy
• meta-analysis
• sodium picosulphate
• systematic review
• tolerability

• bowel preparation regimens
• colonoscopy
• polyethylene glycols, ascorbic acid
• sodium picosulfate, magnesium citrate

• Adenoma detection rate
• Bowel preparation
• Sodium picosulphate
• Tolerability

• colonoscopy
• nausea
• picosulfate
• preparation
• side effect