Several studies have clearly shown that split-dosing bowel preparations (giving half the preparation the evening before colonoscopy and half on the morning of the procedure) is superior to day-before dosing with regard to both cleansing efficacy and tolerability (JW Gastroenterol Jun 24 2011). In other studies, same-day dosing has provided better cleansing compared with evening-before dosing for afternoon colonoscopy (JW Gastroenterol Dec 3 2010) and equivalent cleansing and better tolerability compared with split-dosing (JW Gastroenterol Oct 1 2010). To further explore the merits of this strategy, researchers in the U.K. conducted a nonrandomized, single-blind study of same-day versus split-dose bowel-cleansing regimens in 227 patients who underwent afternoon screening colonoscopy.
In the split-dose group, 95 consecutive patients, recruited during a 6-month period, were given three sachets of sodium picosulphate at noon and 5:00 PM the day before the procedure and at 8:00 AM the morning of the procedure. In the same-day group, 132 consecutive patients, recruited during the succeeding 6-month period, were given sodium picosulphate at 7:00 AM and 10:00 AM the morning of the procedure.
The same-day group achieved better-quality bowel preparation than the split-dose group (P=0.005) and experienced fewer adverse events (P=0.002) and less disruption of daily activities (P<0.001). In addition, patients strongly preferred the same-day regimen.
Comment: This trial is the second to demonstrate a preference for same-day dosing for bowel preparation when patients are scheduled for afternoon colonoscopy. The study has certain weaknesses, in that it was not randomized and the split-dose regimen involved one dose being given at noon the day before colonoscopy (in most split-dose regimens, the first dose is taken the evening before the procedure). Nevertheless, the case continues to build for same-day bowel preparation when patients are scheduled for afternoon colonoscopy.
— Douglas K. Rex, MD
Published in Journal Watch Gastroenterology February 10, 2012
