Docs should consider split-dose prep for colonoscopy patients

Over the last decade, the use of colonoscopy for cancer screening has increased steadily--it's estimated that as many as 15 million procedures are performed annually in the U.S. So it's clear that colonoscopy plays a central role in the prevention and diagnosis of colon cancer.

The procedure's success as a screening modality depends on the ability to purge the colon of fecal material so that a gastroenterologist can get an unobstructed view of the bowel wall. Of course, that's easier said than done. In fact, according to one study, inadequate bowel cleansing occurs in up to 27 percent of all colonoscopies, leading to missed adenomas and polyps.

The problem is that ingesting the bowel preparation--such as polyethylene glycol (PEG)--in order to purge the colon is not a pleasant experience. It can cause nausea in patients and lead to their inability to fully comply with the steps necessary to cleanse their bowels.

While various techniques have been suggested for improving the efficacy of these bowel-cleansing preparations, split-dose preparation seems to show the most promise. In fact, it's a concept supported by the American College of Gastroenterology.

A study published last year in Gastrointestinal Endoscopy found that bowel preparation with split-dose PEG (as compared to full-dose PEG) decreased patient nausea, increased patient compliance and improved the number of satisfactory bowel preparations.

Now, a more recent study has found that not only does split dose improve the overall quality of the bowel preparation, more importantly, it improves adenoma detection rates.

In a commentary accompanying the study, Lawrence Cohen, M.D., of Mount Sinai School of Medicine, reminds his fellow gastroenterologists that they're all probably accustomed to hearing their patients ask, "If they can put a man on the moon, why can't they make a better bowel preparation?"

Although it pales in comparison to the scientific efforts that led to Neil Armstrong's  first moonwalk, Cohen points out that the split-dose regiment represents a significant advance in colonoscopy and cancer prevention. 

Hopefully, gastroenterologists will take his advice, assess the quality of the colonoscopies they perform, and evaluate whether split-dose can help them improve their adenoma detection rates. - Mike