Split-Dose Prep Provides Clearer Colonoscopy Results

It’s always a good thing when changes to medical guidelines improve the patient experience. It’s even better when these changes produce favorable medical results. Recent updates to the ASGE practice guidelines now recommend split-dosing the bowel prep solution before a colonoscopy, a change which is clearly preferable and more palatable for patients. But new research shows that these changes also improve the quality of bowel preparation, a factor which leads to clearer, more conclusive colonoscopy results.

A recent randomized study from the Cleveland Clinic found that use of the split-dose bowel preparation prior to a colonoscopy increased the detection rate for sessile serrated polyps (SSPs). These lesions are difficult to detect, due to the fact that they tend to be flatter and paler than typical adenomas and they are typically covered by a mucus cap.

Lead author Nicholas Horton, M.D., and his colleagues found that the detection rate of SSPs was 9.9 percent in patients who followed the split-dose prep method, compared to a 2.4 percent detection rate in patients who used a single-dose prep. Seventeen percent of the lesions were identified as SSRs in the split-dose patients. Only 4.4 percent were identified in the single-dose group. These findings were presented at the annual Digestive Disease Week.

"A total of 20 percent of all colorectal cancers are believed to have their origins from sessile serrated polyps as opposed to adenomas, and these lesions are considered more difficult to detect. They're usually in the proximal colon, they're flat and blend in with the mucosa, and their borders are commonly ill defined," Horton said.
While the findings of this study may encourage practitioners to prescribe the split-dose method for their patients, Horton says many doctors still adhere to the traditional single-dose preparation. "There's a reluctance on the part of primary care physicians ordering colonoscopies to order the split-dose preparation, because they consider the second dose an inconvenience for patients," he explained (Source: MedPage Today).

For more information about current colonoscopy preparation guidelines, please visit the American Society for Gastrointestinal Endoscopy Standards of Practice.