Split-Dose Bowel Preparation Reduces the Need for Early Repeat Colonoscopy Without Improving Adenoma Detection Rate

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Screening

Background:

• Split-dose bowel preparation is a standard of care, improving visualization and patient tolerance.
• Limited data exists on quality measures associated with split-dose preparation.
• This study evaluates the impact of switching from single- to split-dose preparation on colonoscopy quality.

Purpose of the Study:

• To assess the effect of transitioning from single-dose to split-dose bowel preparation on colonoscopy quality measures.
• To compare bowel preparation quality, adenoma detection rates, and repeat examination recommendations between the two preparation methods.

Main Methods:

• Retrospective cohort study utilizing electronic medical record data.
• Colonoscopies for colorectal cancer screening (ICD9 code V76.51) were analyzed.
• Data collected before (9/1/13-8/31/14) and after (1/1/15-8/31/15) implementation of split-dose preparation.

Main Results:

• The split-dose group showed significantly improved Boston Bowel Preparation Scale scores (8.64 vs. 8.25, p < 0.001).
• No significant difference in adenoma detection rate was observed (40.7% vs. 40.5%, p = 0.92).
• Early repeat examinations due to inadequate preparation significantly decreased in the split-dose group (3.9% vs. 8.9%, p < 0.001).

Conclusions:

• Split-dose preparation enhances bowel cleanliness but does not significantly increase adenoma detection rates when baseline rates are high.
• Split-dose preparation substantially reduces the rate of repeat examinations for inadequate bowel preparation.
• These findings support the use of split-dose preparation due to its positive impact on efficiency, cost, and patient experience.