Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an...

Area of Science:

• Gastroenterology
• Colorectal Cancer Screening
• Endoscopy

Background:

• Split-dose bowel preparation is known to improve bowel cleansing.
• Its impact on adenoma detection rate (ADR) remains uncertain.
• Evaluating split-dose vs. day-before regimens is crucial for optimizing colonoscopy effectiveness.

Purpose of the Study:

• To compare the efficacy of a split-dose bowel preparation regimen versus a traditional day-before regimen.
• To determine if the split-dose regimen improves the adenoma detection rate (ADR).
• To assess the detection of advanced adenomas and serrated lesions.

Main Methods:

• A multicentre, randomised, endoscopist-blinded study involving 690 participants aged 50-69.
• Participants were randomized to either a split-dose (SDG) or day-before (DBG) low-volume 2-L PEG-ascorbate regimen.
• Primary endpoint was the proportion of subjects with at least one adenoma.

Main Results:

• The split-dose group showed a significantly higher proportion of subjects with at least one adenoma (53.0% vs 40.9%).
• Detection rates for advanced adenomas were also significantly higher in the split-dose group (26.4% vs 20.0%).
• Per-polyp analysis revealed significantly more adenomas and advanced adenomas per subject in the split-dose group.

Conclusions:

• A split-dose bowel preparation regimen enhances the detection of clinically relevant neoplastic lesions during colonoscopy.
• This regimen improves the overall effectiveness of colorectal cancer screening.
• Strong recommendation for adopting a split-dose regimen in colonoscopy settings.