The Efficacy of Split-Dose Bowel Preparations for Polyp Detection: A Systematic Review and Meta-Analysis

Mar 14, 2019The American journal of gastroenterology

Effectiveness of Taking Bowel Prep in Two Doses for Finding Polyps: A Review and Analysis

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Abstract

Analysis of 28 trials involving 8,842 participants indicates that split-dose bowel preparations improve the detection of adenomas and advanced adenomas compared to day-before regimens.

Detection of adenomas is associated with an increased rate when using split-dose preparations compared to day-before methods (risk ratio 1.26).
Advanced adenomas are detected more frequently with split-dose regimens, showing a risk ratio of 1.53 compared to day-before preparations.
Splitting the dose may significantly enhance the detection of sessile serrated polyps (SSPs), with a risk ratio of 2.48 compared to day-before regimens.
No statistical differences in polyp detection were found between split-dose and same-day bowel preparations.
Among various split-dose regimens, no single regimen demonstrated superior effectiveness in polyp detection.

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INTRODUCTION: Split-dose bowel preparation leads to superior colon cleansing for colonoscopy. However, the magnitude of benefit in detecting colonic polyps is uncertain. We performed a systematic review to synthesize the data on whether using a split-dose bowel preparation regimen improves the detection of polyps when compared with other dosing methods or regimen products.

METHODS: We searched MEDLINE, EMBASE, and CENTRAL databases (from the inception to June 2017) for randomized controlled trials that assessed the following: split-dose vs day-before, split-dose vs same-day (as colonoscopy), or different types of split-dose regimens for patients undergoing colonoscopy. We excluded studies limited to inpatients, children, or individuals with inflammatory bowel disease. We compared the number of patients undergoing colonoscopy with recorded detection of polyps, adenomas, advanced adenomas, sessile serrated polyps (SSPs), right colonic adenomas, right colonic polyps, or right colonic SSPs.

RESULTS: Twenty-eight trials fulfilled the inclusion criteria (8,842 participants). Of the seven trials comparing split-dose vs day-before bowel preparation regimens, there was an increased detection rate of adenomas (risk ratio (RR) 1.26, 95% confidence intervals (CIs): 1.10-1.44; 4 trials; 1,258 participants), advanced adenomas (RR 1.53, 95% CI: 1.22-1.92; 3 trials; 1,155 participants), and SSPs (RR 2.48, 95% CI: 1.21-5.09; 2 trials; 1,045 participants). Pooled estimates from 8 trials (1,587 participants) evaluating split-dose vs same-day bowel preparations yielded no evidence of statistical difference. For various split-dose vs split-dose trials, 14 fulfilled the criteria (5,496 participants) and no superior split-regimen was identified.

CONCLUSIONS: Compared with day-before bowel preparation regimens, split-dose bowel preparations regimens increase the detection of adenomas, advanced adenomas, and have the greatest benefit in SSP detection.

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The Efficacy of Split-Dose Bowel Preparations for Polyp Detection: A Systematic Review and Meta-Analysis

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