Split- vs. Single-Dose Bowel Preps: Impact on BM Intensity, Duration, and Polyp Detection

Study participants were either assigned a split-dose or single dose preparation before undergoing a colonoscopy
Study participants were either assigned a split-dose or single dose preparation before undergoing a colonoscopy

Split-dose (SPD) bowel preparation regimen led to reduced intensity and duration of bowel movements as well as less patient inconvenience, improved bowel preparation, and increased sessile-serrated polyp detection rates, compared with a single-dose (SID) preparation, study authors reported in the American Journal of Gastroenterology

Currently, there is not much data on bowel movement kinetics induced by bowel preparation. The difference in SID vs. SPD bowel preparations in regards to patient convenience has not been established. Nicholas Horton, MD, from the Cleveland Clinic, Cleveland, OH, and colleagues conducted a prospective trial (n=341) to compare bowel movement kinetics, sleep and travel disruptions, and polyp detection rates in patient undergoing colonoscopy assigned to SID or SPDs. 

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Study patients were randomized to 2L SID or SPD (SPD 1 and 2) bowel preparations. They completed surveys on the onset, duration, cessation, and intensity of bowel movements, as well as sleep and travel disruption while traveling to the endoscopy center. Colon cleansing quality and polyp histology were also documented. 

Of the total patients, over half experienced their first bowel movement within 60 minutes of starting the preparation. After dosing, 92% of SID and 66% of SPD1 patients achieved clear effluent (P<0.001) vs. 97% of SPD2 patients (P=0.028 vs. SID). Patients in the SID group also reported greater total duration (P=0.041) and intensity (P<0.001) of bowel movements. Also, more patients in the SID group woke up for bowel movements (65.9% vs. 48.8%; P<0.003). The quality of the bowel preparation was also better for the SPD group (P<0.001).  

Dr. Horton noted no differences in the need to stop driving on the way to the colonoscopy. No difference in the rate of adenoma detection was found but sessile-serrated polyp detection was higher in the SPD group vs. SID group (9.9% vs. 2.4%; P=0.004). 

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