Split-Dose Preparations Are Superior to Day-Before Bowel Cleansing Regimens: A Meta-analysis

Area of Science:

• Gastroenterology
• Clinical Trials
• Medical Research

Background:

• Various colonoscopy preparation regimens exist, including polyethylene glycol (PEG), sodium phosphate, picosulfate, and oral sulfate solutions.
• Evaluating the efficacy of split-dose versus other colon preparation methods is crucial for optimizing colonoscopy procedures.

Purpose of the Study:

• To determine the efficacy of split-dose colon preparation regimens compared to other methods.
• To identify optimal products and preparation volumes for effective colon cleansing.
• To assess patient willingness to repeat preparation methods.

Main Methods:

• A meta-analysis of randomized trials published between January 1980 and March 2014 was conducted.
• Systematic searches of major databases (MEDLINE, EMBASE, Scopus, CENTRAL, ISI Web of knowledge) were performed.
• Primary outcome was bowel cleansing efficacy; secondary outcomes included side effects, procedure outcomes, and patient willingness to repeat.

Main Results:

• Split-dose preparations demonstrated significantly better colon cleansing than day-before preparations across various agents (PEG, sodium phosphate, picosulfate).
• Higher volume (≥3 L) PEG split-dose preparations showed improved cleanliness in intention-to-treat analysis.
• Patients showed a higher willingness to repeat split-dose preparations compared to day-before methods, especially low-volume ones.

Conclusions:

• Split-dose regimens enhance colon cleansing quality and are preferred by patients over day-before preparations.
• Further investigation is warranted for oral sulfate solution-based and low-volume PEG regimens.
• Optimizing colon preparation is key to improving colonoscopy effectiveness and patient experience.