Parsa N, Grisham EA, Cockerell CJ, Matteson-Kome ML, Bysani RV, Samiullah S, Nguyen DL, Tahan V, Ghouri YA, Puli SR, Bechtold ML. Split-dose vs same-day bowel preparation for afternoon colonoscopies: A meta-analysis of randomized controlled trials. World J Meta-Anal 2020; 8(6): 462-471 [DOI: 10.13105/wjma.v8.i6.462]
Corresponding Author of This Article
Matthew L Bechtold, AGAF, FACG, FACP, FASGE, MD, Attending Doctor, Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, 5 Hospital Drive, Columbia, MO 65212, United States. bechtoldm@health.missouri.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
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/
World J Meta-Anal. Dec 28, 2020; 8(6): 462-471 Published online Dec 28, 2020. doi: 10.13105/wjma.v8.i6.462
Split-dose vs same-day bowel preparation for afternoon colonoscopies: A meta-analysis of randomized controlled trials
Nasim Parsa, Eric A Grisham, Courtney J Cockerell, Michelle L Matteson-Kome, Ramakrishna V Bysani, Sami Samiullah, Douglas L Nguyen, Veysel Tahan, Yezaz A Ghouri, Srinivas R Puli, Matthew L Bechtold
Nasim Parsa, Eric A Grisham, Courtney J Cockerell, Michelle L Matteson-Kome, Ramakrishna V Bysani, Sami Samiullah, Veysel Tahan, Yezaz A Ghouri, Matthew L Bechtold, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
Douglas L Nguyen, Division of Gastroenterology, Heart of the Rockies Regional Medical Center, Colorado Springs, CO 80907, United States
Srinivas R Puli, Division of Gastroenterology, University of Illinois - Peoria, Peoria, IL 61604, United States
Author contributions: Parsa N, Cockerell CJ, and Bechtold ML designed the meta-analysis; Parsa N, Grisham EA, Cockerell CJ, and Bysani RV acquired the data; Matteson-Kome ML, Samiullah S, Nguyen DL, and Bechtold ML analyzed and interpreted the data; Parsa N, Grisham EA, Cockerell CJ, and Bysani RV drafted the manuscript; Samiullah S, Nguyen DL, Tahan V, Ghouri YA, Puli SR, and Bechtold ML critically revised the manuscript; and Matteson-Kome ML, Nguyen DL, Puli SR, and Bechtold ML provided statistical expertise.
Conflict-of-interest statement: The authors have no conflicts of interest for this manuscript.
PRISMA 2009 Checklist statement: The authors adhered to the PRISMA guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Matthew L Bechtold, AGAF, FACG, FACP, FASGE, MD, Attending Doctor, Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, 5 Hospital Drive, Columbia, MO 65212, United States. bechtoldm@health.missouri.edu
Received: July 15, 2020 Peer-review started: July 15, 2020 First decision: November 2, 2020 Revised: November 11, 2020 Accepted: November 21, 2020 Article in press: November 21, 2020 Published online: December 28, 2020 Processing time: 166 Days and 4.5 Hours
Abstract
BACKGROUND
Quality of bowel preparation in afternoon colonoscopies has been a struggle. Currently, a choice of same-day preparation (SaD) or split-dose preparation (SpD) exists; however, randomized controlled trials’ results have varied.
AIM
To examine the outcomes of SaD and SpD for afternoon colonoscopies.
METHODS
An extensive literature search was conducted using multiple databases. Only randomized controlled trials (RCTs) in adults that compared SaD to SpD with Ottawa bowel preparation score (OBPS) were included. Odds ratio (OR) or mean difference was used to analyze outcomes.
RESULTS
Eleven RCTs were included (n = 1846). No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD (OR 0.77; 95%CI: -0.57-1.03; P = 0.07; I2 = 5%). Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula (polyethylene glycol) (OR 0.83; 95%CI: 0.51-1.35; P = 0.46; I2 = 39%) as well as receiving same formula and volume (4 L polyethylene glycol) (OR 1.14; 95%CI: 0.65-2.01; P = 0.64; I2 = 0%).
CONCLUSION
In patients undergoing afternoon colonoscopies, SaD is comparable with SpD in terms of satisfactory bowel preparation. Further studies are needed to validate these results and determine the optimal formula and dosages.
Core Tip: Afternoon colonoscopies have considerably more inadequate bowel preparations than morning colonoscopies. Different bowel preparation regimens have been tried to help improve preparation quality in afternoon colonoscopies, including split-dose and same-day bowel preparations. Studies have shown conflicting results on which preparation regimen is optimal. Therefore, we conducted a meta-analysis on this subject and found that split-dose bowel preparation shows no difference in satisfactory bowel preparations vs same-day bowel preparation for afternoon colonoscopies. Therefore, either preparation may be utilized.
