Same-Day Bowel Prep Best for Afternoon Colonoscopy

Megan Brooks

October 17, 2018

PHILADELPHIA — For patients scheduled for an afternoon colonoscopy, cleansing is better with same-day bowel preparation than with a split-dose regimen and is preferred by patients, results from a randomized controlled trial show.

Isabel Manzanillo-DeVore

The success of colonoscopy is closely linked to the quality of bowel preparation, said investigator Isabel Manzanillo-DeVore, DO, from Ascension St. John Providence in Madison Heights, Michigan.

Inadequate bowel cleansing can lead to "missed precancerous lesions and increased healthcare costs," she explained during her presentation here at the American College of Gastroenterology 2018 Annual Scientific Meeting.

Several studies have shown that split-dose preparations — one the evening before and one the morning of the procedure — are more effective than traditional same-day preparation on the morning of the procedure, according to the US Multi-Society Task Force on Colorectal Cancer (Gastroenterology. 2014;147:903-924). However, the recommendations do state that same-day preparation is acceptable for patients undergoing afternoon colonoscopy.

Manzanillo-DeVore and her colleagues assessed 262 patients at average risk for colon cancer scheduled for afternoon screening colonoscopy. Half were randomly assigned to same-day bowel prep and half were assigned to split-dose prep.

All patients were told to avoid high-residue foods (nuts, popcorn, raw vegetables) and to drink only clear liquids (no red or purple dyes) starting at noon the day before the procedure, as is standard practice.

In the same-day group, patients started bowel prep at 5:30 AM the day of the procedure and were instructed to finish the polyethylene glycol electrolyte (PEG) solution (4 liters) at least 4 hours before their appointment. In the split-dose group, patients drank half the PEG solution at 5:00 PM the day before the procedure and the other half at 5:30 AM the day of the procedure.

Boston Bowel Preparation Scale (BBPS) scores were significantly higher in the same-day group than in the split-dose group, as were ratings for ease of consumption and overall experience on a patient satisfaction survey.

"More patients in the same-day arm said they would ask for the same preparation again," Manzanillo-DeVore reported.

Table. Outcomes With the Two Bowel-Prep Regimens
Outcome Same-Day Prep Split-Dose Prep P Value
Ability to consume, % 94.7 93.1% .78
BBPS score 8.05 6.33 <.001
Ease of consumption 4.37 3.75 <.001
Overall experience 4.29 4.02 <.001
Would ask for same prep again, % 84.7% 51% <.001

"This is an important study because one of the major focuses of colonoscopy is quality and the ability to detect polyps," said Jordan Karlitz, MD, from Tulane University in New Orleans.

"Same-day was actually better on several measures, including ease of consumption and overall experience for the patient. And a higher percentage said they would ask for the same-day prep going forward," he noted.

"There will always be some people who need to schedule colonoscopy in the afternoon, as opposed to in the morning," Karlitz told Medscape Medical News. "This study shows that the best way to prep them, at least according to these parameters and this particular study, would be to do a same-day prep."

The study had no specific funding. Manzanillo-DeVore and Karlitz have disclosed on relevant financial relationships.

American College of Gastroenterology (ACG) 2018 Annual Scientific Meeting: Oral abstract 42. Presented October 9, 2018.

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