Split-dose bowel prep boosts polyp detection rates

  • Zawaly K & al.
  • Am J Gastroenterol
  • 1 jun. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • Split-dose bowel preparation prior to colonoscopy increases detection rates of adenoma, sessile serrated polyp (SSP), advanced adenoma, and right-sided adenoma over day-before regimens. 

Why this matters

  • Though split-dose bowel preparation cleans the colon better than day-before regimens, whether it leads to better polyp detection has been unclear.

Key results

  • Number of patients with ≥1 adenoma detected (risk ratios; 95% CIs):
    • Split-dose vs day-before:
      • 1.26 (1.10-1.44; 4 trials, n=1258);
      • Number needed to treat (NNT): 11.
    • Split-dose vs same-day (both 2 L polyethylene glycol [PEG]):
      • 1.22 (1.00-1.48; 3 trials, n=1155).
    • Split-dose vs same-day, and various split-dose regimens compared with each other:
      • No significant difference.
  • SSP detection, split-dose vs day-before:
    • 2.48 (1.24-5.09; 2 trials, n=1045).
  • Advanced adenoma detection, split-dose vs day-before (both 2 L PEG):
    • 1.53 (1.22-1.92; 3 trials, n=1155);
    • NNT, 12.
  • Right adenoma detection, split-dose vs day-before:
    • 1.54 (1.16-2.05; 2 trials, n=814).

Study design

  • Systematic review, meta-analysis of 28 randomized controlled trials comparing split-dose to other regimens for adults receiving colonoscopy (n=8842).
  • Outcome: number of patients with ≥1 adenoma detected. 
  • Funding: None.

Limitations

  • Trials did not report runway time.
  • Results with afternoon vs morning procedures could not be compared.