Published online Dec 28, 2020. doi: 10.13105/wjma.v8.i6.462
Peer-review started: July 15, 2020
First decision: November 2, 2020
Revised: November 11, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: December 28, 2020
Quality of bowel preparation in afternoon colonoscopies has been a struggle. Currently, a choice of same-day preparation (SaD) or split-dose preparation (SpD) exists; however, randomized controlled trials’ results have varied.
To examine the outcomes of SaD and SpD for afternoon colonoscopies.
An extensive literature search was conducted using multiple databases. Only randomized controlled trials (RCTs) in adults that compared SaD to SpD with Ottawa bowel preparation score (OBPS) were included. Odds ratio (OR) or mean difference was used to analyze outcomes.
Eleven RCTs were included (n = 1846). No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD (OR 0.77; 95%CI: -0.57-1.03; P = 0.07; I2 = 5%). Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula (polyethylene glycol) (OR 0.83; 95%CI: 0.51-1.35; P = 0.46; I2 = 39%) as well as receiving same formula and volume (4 L polyethylene glycol) (OR 1.14; 95%CI: 0.65-2.01; P = 0.64; I2 = 0%).
In patients undergoing afternoon colonoscopies, SaD is comparable with SpD in terms of satisfactory bowel preparation. Further studies are needed to validate these results and determine the optimal formula and dosages.
Core Tip: Afternoon colonoscopies have considerably more inadequate bowel preparations than morning colonoscopies. Different bowel preparation regimens have been tried to help improve preparation quality in afternoon colonoscopies, including split-dose and same-day bowel preparations. Studies have shown conflicting results on which preparation regimen is optimal. Therefore, we conducted a meta-analysis on this subject and found that split-dose bowel preparation shows no difference in satisfactory bowel preparations vs same-day bowel preparation for afternoon colonoscopies. Therefore, either preparation may be utilized.