Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2018; 24(6): 716-724
Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.716
Split-dose bowel preparation improves adequacy of bowel preparation and gastroenterologists’ adherence to National Colorectal Cancer Screening and Surveillance Guidelines
Stacy Bartnik Menees, H Myra Kim, Philip Schoenfeld
Stacy Bartnik Menees, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI 48105, United States
Stacy Bartnik Menees, Division of Gastroenterology, Ann Arbor Veterans’ Administration Hospital, Ann Arbor, MI 48105, United States
H Myra Kim, Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI 48105, United States
H Myra Kim, Department of Biostatistics, University of Michigan, Ann Arbor, MI 48105, United States
Philip Schoenfeld, Division of Gastroenterology, John D. Dingell VA Medical Center, Detroit, MI 48201, United States
Author contributions: Menees SB conducted the data collection, analysis, and interpretation, and wrote and revised the manuscript; Schoenfeld P designed the research; Menees SB performed the research; Kim HM analyzed the data; Menees SB, Kim HM, and Schoenfeld P both contributed to draft revision.
Supported by the Michigan Institute for Clinical and Health Research MICHR T2 Translational Science Award Program Application (MICHR T2), No. UL1RR024986 to Menees SB.
Institutional review board statement: The Medical School Institutional Review Board (IRBMED) has reviewed and approved the study.
Conflict-of-interest statement: Dr. Schoenfeld has worked as a consultant and advisory board member for Salix Pharmaceuticals, Inc., which is the manufacturer of MoviPrep. Authors Menees and Kim have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stacy Bartnik Menees, MD, MSc, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48105, United States. sbartnik@med.umich.edu
Telephone: +1-734-2323739
Received: November 3, 2017
Peer-review started: November 4, 2017
First decision: November 30, 2017
Revised: December 29, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: February 14, 2018
Processing time: 94 Days and 12.9 Hours
Abstract
AIM

To quantify the impact of split-dose regimen on endoscopists’ compliance with guideline recommendations for timing of repeat colonoscopy in patients with normal colonoscopy or 1-2 small polyps (< 10 mm).

METHODS

A retrospective chart review of all endoscopy reports was undertaken in average-risk individuals > 50 years old with a normal screening colonoscopy and 1-2 small polyps. Data were abstracted from two time periods, pre and post-split-dose bowel preparation institution. Main outcome measurements were recommendation for timing of repeat colonoscopy and bowel preparation quality. Bivariate analysis by χ2 tests and Student’s t-tests were performed to assess differences between the two cohorts. Multivariable logistic regression was used with guideline consistent recommendations as the dependent variables and an indicator for 2011 cohort as the primary predictor.

RESULTS

Four thousand two hundred and twenty-five patients were included in the study; 47.0% (1987) prior to the institution of split dose bowel preparation, and 53.0% (2238) after the institution of split dose bowel preparation. Overall, 82.2% (n = 3472) of the colonoscopies were compliant with guideline recommendations, with a small but significantly increased compliance rate in year 2011 (83.7%) compared to year 2009 (80.4%, P = 0.005), corresponding to an unadjusted odds ratio of 1.25 (95%CI: 1.07-1.47; P = 0.005). Colonoscopies with either “Adequate” or “Excellent” had increased from 30.6% in year 2009 to 39.6% in year 2011 (P < 0.001). However, there was no significant difference in poor/inadequate category of bowel preparation as there was a mild increase from 4.6% in year 2009 to 5.1% in year 2011 (P = 0.50).

CONCLUSION

Split-dose bowel regimen increases endoscopists’ compliance to guidelines in average-risk patients with normal colonoscopy or 1-2 small polyps.

Keywords: Colorectal cancer screening; Bowel preparation; Colonoscopy; Average-risk

Core tip: We evaluated the impact of split-dose regimen on endoscopists’ compliance with guideline recommendations for timing of repeat colonoscopy in patients with normal colonoscopy or 1-2 small polyps (< 10 mm). We retrospectively evaluated 4255 patients who underwent colonoscopy during two time periods, pre and post the institution of split-dose bowel preparation. We found that split-dose bowel regimen increased endoscopists’ compliance to guidelines in average risk patients with normal colonoscopy or 1-2 small polyps. Additionally, bowel preparation quality with either “Adequate” or “Excellent” had increased between the two time periods.