Same-day Versus Split-dose Bowel Preparation Before Colonoscopy: A Meta-analysis.

Area of Science:

• Gastroenterology
• Clinical Trials
• Medical Research

Background:

• Split-dose regimens (SpDs) are recommended for bowel preparation, with same-day regimens (SaDs) as an alternative.
• Previous randomized trials comparing SaDs and SpDs yielded mixed results.
• A meta-analysis was conducted to clarify the efficacy of these two regimens.

Purpose of the Study:

• To compare the efficacy of same-day regimens (SaDs) versus split-dose regimens (SpDs) for bowel preparation.
• To evaluate preparation quality, cecal intubation rate (CIR), adenoma detection rate (ADR), and adverse effects.
• To determine if SaDs offer advantages over SpDs.

Main Methods:

• A systematic literature search was performed across multiple databases (MEDLINE/PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, Web of Science).
• Included randomized trials published between 1990 and 2016 comparing SaDs to SpDs in adults.
• Pooled odds ratios (ORs) were calculated for key outcomes.

Main Results:

• Fourteen trials were included in the meta-analysis.
• Adequate bowel preparation rates were similar: 79.4% for SaDs and 81.7% for SpDs (OR=0.92; 95% CI, 0.62-1.36).
• SaDs with bisacodyl demonstrated significantly better preparation quality (OR=2.45; 95% CI, 1.45-4.51) and improved patient sleep compared to SpDs.

Conclusions:

• Same-day regimens (SaDs) are comparable to split-dose regimens (SpDs) for bowel cleanliness, CIR, and ADR.
• SaDs, particularly with bisacodyl, may offer superior preparation quality and improved patient sleep.
• Further research is needed to optimize purgatives and dosages for bowel preparation.