Barriers against split-dose bowel preparation for colonoscopy

Area of Science:

• Gastroenterology
• Endoscopy
• Patient Care

Background:

• Split-dose bowel preparation is recommended for elective colonoscopy due to higher adenoma detection rates.
• However, patient adoption of the split-dose regimen remains suboptimal, necessitating the identification of patient-related barriers.
• Understanding patient attitudes is crucial for improving the implementation of this effective bowel preparation method.

Purpose of the Study:

• To assess patient attitudes towards the split-dose bowel preparation regimen for colonoscopy.
• To identify patient-related factors associated with the uptake of the split-dose regimen.
• To evaluate the impact of appointment timing and patient demographics on split-dose regimen adherence.

Main Methods:

• A multicentre, prospective study involving outpatients scheduled for colonoscopy.
• Patients were offered a choice between split-dose and day-before bowel preparation (polyethylene glycol).
• A 20-item questionnaire explored split-dose uptake and associated patient-related factors.

Main Results:

• 61.7% of 1447 patients chose the split-dose regimen.
• Split-dose uptake significantly increased with later colonoscopy appointment times (27.3% for 8:00 AM to 96% for 2:00 PM).
• Factors inversely associated with split-dose uptake included early colonoscopy appointments, travel time >1 hour, low education, and female gender. Split regimen independently predicted adequate cleansing and polyp detection.

Conclusions:

• Patient acceptance of the split-dose regimen is suboptimal, particularly for early morning colonoscopy appointments.
• Strategies such as reorganizing colonoscopy schedules and patient educational initiatives are needed to improve compliance.
• Addressing patient-related barriers is essential for maximizing the benefits of split-dose bowel preparation.