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Splitting the dose of a bowel-cleansing laxative — taking one dose on the day before a colonoscopy and the other on the day of the procedure — has been shown to be an effective method of bowel preparation. To further evaluate the efficacy of split-dose versus evening-before preparation and to assess the role of “runway time” (the interval time between the last ingestion of preparation and the beginning of colonoscopy), investigators in Italy conducted a meta-analysis of 29 randomized colonoscopy studies. The studies involved 4040 patients who underwent evening-before preparation and 3679 who underwent split-dose preparation.
The superiority of split-dose preparation was maintained when colonoscopy was performed within 3 hours from the end of the purge ingestion. The rate difference in the degree of bowel cleansing between split-dose and evening-before preparation decreased after a 4- to 5-hour interval, and was not significant after more than 5 hours.
Bucci C et al. Optimal bowel cleansing for colonoscopy: Split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc 2014 Oct; 80:566. (http://dx.doi.org/10.1016/j.gie.2014.05.320)
Comment
This study provides valuable information to clinicians designing specific bowel-preparation protocols. In our unit, we ask patients to begin the second dose of preparation within 4 to 5 hours of their scheduled colonoscopy time and to complete it by 3 hours prior to colonoscopy. These recommendations would be consistent with a plan for maintaining the benefits of split-dosing identified in this meta-analysis.