Barriers against split-dose bowel preparation for colonoscopy

F. Radaelli, S. Paggi, Alessandro Repici, G. Gullotti, Paola Cesaro, G. Rotondano, L. Cugia, Cristina Maria Trovato, Cristiano Spada, Lorenzo Fuccio, P. Occhipinti, Fabio Pace, C. Fabbri, Andrea Buda, Gianpiero Manes, Giuseppe Feliciangeli, Mauro Manno, Luca Sebastiano Barresi, Andrea Anderloni, P. DulbeccoFrancesca Rogai, Arnaldo Amato, Carlo Senore, Cesare Hassan

Research output: Contribution to journalArticle

Abstract

Objective Although split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim was to assess patients' attitude towards split regimen and patient-related factors associated with its uptake. Design In a multicentre, prospective study, outpatients undergoing colonoscopy from 8:00 to 14:00 were given written instructions for 4 L polyethylene glycol bowel preparation, offering the choice between split-dose and day-before regimens and emphasising the superiority of split regimen on colonoscopy outcomes. Uptake of split regimen and association with patient-related factors were explored by a 20-item questionnaire. Results Of the 1447 patients (mean age 59.2 ±13.5 years, men 54.3%), 61.7% and 38.3% chose a split-dose and day-before regimens, respectively. A linear correlation was observed between time of colonoscopy appointments and split-dose uptake, from 27.3% in 8:00 patients to 96% in 14:00 patients (p1 h (OR 0.55, 95% CI 0.38 to 0.79), low education level (OR 0.72, 95% CI 0.54 to 0.96) and female gender (OR 0.74, 95% CI 0.58 to 0.95) were inversely correlated with the uptake of split-dose. Overall, the risk of travel interruption and faecal incontinence was slightly increased in split regimen patients (3.0% vs 1.4% and 1.5% vs 0.9%, respectively; p=NS). Split regimen was an independent predictor of adequate colon cleansing (OR 3.34, 95% CI 2.40 to 4.63) and polyp detection (OR 1.46, 95% CI 1.11 to 1.92). Conclusion Patient attitude towards split regimen is suboptimal, especially for early morning examinations. Interventions to improve patient compliance (ie, policies to reorganise colonoscopy timetable, educational initiatives for patient and healthcare providers) should be considered. Trial registration number NCT02287051; pre-result.

Original languageEnglish
JournalGut
DOIs
Publication statusE-pub ahead of print - Apr 19 2016

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Colonoscopy
Fecal Incontinence
Patient Compliance
Polyps
Health Personnel
Adenoma
Multicenter Studies
Appointments and Schedules
Colon
Outpatients
Prospective Studies
Education

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Radaelli, F., Paggi, S., Repici, A., Gullotti, G., Cesaro, P., Rotondano, G., ... Hassan, C. (2016). Barriers against split-dose bowel preparation for colonoscopy. Gut. https://doi.org/10.1136/gutjnl-2015-311049

Barriers against split-dose bowel preparation for colonoscopy. / Radaelli, F.; Paggi, S.; Repici, Alessandro; Gullotti, G.; Cesaro, Paola; Rotondano, G.; Cugia, L.; Trovato, Cristina Maria; Spada, Cristiano; Fuccio, Lorenzo; Occhipinti, P.; Pace, Fabio; Fabbri, C.; Buda, Andrea; Manes, Gianpiero; Feliciangeli, Giuseppe; Manno, Mauro; Barresi, Luca Sebastiano; Anderloni, Andrea; Dulbecco, P.; Rogai, Francesca; Amato, Arnaldo; Senore, Carlo; Hassan, Cesare.

In: Gut, 19.04.2016.

Research output: Contribution to journalArticle

Radaelli, F, Paggi, S, Repici, A, Gullotti, G, Cesaro, P, Rotondano, G, Cugia, L, Trovato, CM, Spada, C, Fuccio, L, Occhipinti, P, Pace, F, Fabbri, C, Buda, A, Manes, G, Feliciangeli, G, Manno, M, Barresi, LS, Anderloni, A, Dulbecco, P, Rogai, F, Amato, A, Senore, C & Hassan, C 2016, 'Barriers against split-dose bowel preparation for colonoscopy', Gut. https://doi.org/10.1136/gutjnl-2015-311049
Radaelli F, Paggi S, Repici A, Gullotti G, Cesaro P, Rotondano G et al. Barriers against split-dose bowel preparation for colonoscopy. Gut. 2016 Apr 19. https://doi.org/10.1136/gutjnl-2015-311049
Radaelli, F. ; Paggi, S. ; Repici, Alessandro ; Gullotti, G. ; Cesaro, Paola ; Rotondano, G. ; Cugia, L. ; Trovato, Cristina Maria ; Spada, Cristiano ; Fuccio, Lorenzo ; Occhipinti, P. ; Pace, Fabio ; Fabbri, C. ; Buda, Andrea ; Manes, Gianpiero ; Feliciangeli, Giuseppe ; Manno, Mauro ; Barresi, Luca Sebastiano ; Anderloni, Andrea ; Dulbecco, P. ; Rogai, Francesca ; Amato, Arnaldo ; Senore, Carlo ; Hassan, Cesare. / Barriers against split-dose bowel preparation for colonoscopy. In: Gut. 2016.
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abstract = "Objective Although split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim was to assess patients' attitude towards split regimen and patient-related factors associated with its uptake. Design In a multicentre, prospective study, outpatients undergoing colonoscopy from 8:00 to 14:00 were given written instructions for 4 L polyethylene glycol bowel preparation, offering the choice between split-dose and day-before regimens and emphasising the superiority of split regimen on colonoscopy outcomes. Uptake of split regimen and association with patient-related factors were explored by a 20-item questionnaire. Results Of the 1447 patients (mean age 59.2 ±13.5 years, men 54.3{\%}), 61.7{\%} and 38.3{\%} chose a split-dose and day-before regimens, respectively. A linear correlation was observed between time of colonoscopy appointments and split-dose uptake, from 27.3{\%} in 8:00 patients to 96{\%} in 14:00 patients (p1 h (OR 0.55, 95{\%} CI 0.38 to 0.79), low education level (OR 0.72, 95{\%} CI 0.54 to 0.96) and female gender (OR 0.74, 95{\%} CI 0.58 to 0.95) were inversely correlated with the uptake of split-dose. Overall, the risk of travel interruption and faecal incontinence was slightly increased in split regimen patients (3.0{\%} vs 1.4{\%} and 1.5{\%} vs 0.9{\%}, respectively; p=NS). Split regimen was an independent predictor of adequate colon cleansing (OR 3.34, 95{\%} CI 2.40 to 4.63) and polyp detection (OR 1.46, 95{\%} CI 1.11 to 1.92). Conclusion Patient attitude towards split regimen is suboptimal, especially for early morning examinations. Interventions to improve patient compliance (ie, policies to reorganise colonoscopy timetable, educational initiatives for patient and healthcare providers) should be considered. Trial registration number NCT02287051; pre-result.",
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T1 - Barriers against split-dose bowel preparation for colonoscopy

AU - Radaelli, F.

AU - Paggi, S.

AU - Repici, Alessandro

AU - Gullotti, G.

AU - Cesaro, Paola

AU - Rotondano, G.

AU - Cugia, L.

AU - Trovato, Cristina Maria

AU - Spada, Cristiano

AU - Fuccio, Lorenzo

AU - Occhipinti, P.

AU - Pace, Fabio

AU - Fabbri, C.

AU - Buda, Andrea

AU - Manes, Gianpiero

AU - Feliciangeli, Giuseppe

AU - Manno, Mauro

AU - Barresi, Luca Sebastiano

AU - Anderloni, Andrea

AU - Dulbecco, P.

AU - Rogai, Francesca

AU - Amato, Arnaldo

AU - Senore, Carlo

AU - Hassan, Cesare

PY - 2016/4/19

Y1 - 2016/4/19

N2 - Objective Although split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim was to assess patients' attitude towards split regimen and patient-related factors associated with its uptake. Design In a multicentre, prospective study, outpatients undergoing colonoscopy from 8:00 to 14:00 were given written instructions for 4 L polyethylene glycol bowel preparation, offering the choice between split-dose and day-before regimens and emphasising the superiority of split regimen on colonoscopy outcomes. Uptake of split regimen and association with patient-related factors were explored by a 20-item questionnaire. Results Of the 1447 patients (mean age 59.2 ±13.5 years, men 54.3%), 61.7% and 38.3% chose a split-dose and day-before regimens, respectively. A linear correlation was observed between time of colonoscopy appointments and split-dose uptake, from 27.3% in 8:00 patients to 96% in 14:00 patients (p1 h (OR 0.55, 95% CI 0.38 to 0.79), low education level (OR 0.72, 95% CI 0.54 to 0.96) and female gender (OR 0.74, 95% CI 0.58 to 0.95) were inversely correlated with the uptake of split-dose. Overall, the risk of travel interruption and faecal incontinence was slightly increased in split regimen patients (3.0% vs 1.4% and 1.5% vs 0.9%, respectively; p=NS). Split regimen was an independent predictor of adequate colon cleansing (OR 3.34, 95% CI 2.40 to 4.63) and polyp detection (OR 1.46, 95% CI 1.11 to 1.92). Conclusion Patient attitude towards split regimen is suboptimal, especially for early morning examinations. Interventions to improve patient compliance (ie, policies to reorganise colonoscopy timetable, educational initiatives for patient and healthcare providers) should be considered. Trial registration number NCT02287051; pre-result.

AB - Objective Although split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may improve its implementation. Our aim was to assess patients' attitude towards split regimen and patient-related factors associated with its uptake. Design In a multicentre, prospective study, outpatients undergoing colonoscopy from 8:00 to 14:00 were given written instructions for 4 L polyethylene glycol bowel preparation, offering the choice between split-dose and day-before regimens and emphasising the superiority of split regimen on colonoscopy outcomes. Uptake of split regimen and association with patient-related factors were explored by a 20-item questionnaire. Results Of the 1447 patients (mean age 59.2 ±13.5 years, men 54.3%), 61.7% and 38.3% chose a split-dose and day-before regimens, respectively. A linear correlation was observed between time of colonoscopy appointments and split-dose uptake, from 27.3% in 8:00 patients to 96% in 14:00 patients (p1 h (OR 0.55, 95% CI 0.38 to 0.79), low education level (OR 0.72, 95% CI 0.54 to 0.96) and female gender (OR 0.74, 95% CI 0.58 to 0.95) were inversely correlated with the uptake of split-dose. Overall, the risk of travel interruption and faecal incontinence was slightly increased in split regimen patients (3.0% vs 1.4% and 1.5% vs 0.9%, respectively; p=NS). Split regimen was an independent predictor of adequate colon cleansing (OR 3.34, 95% CI 2.40 to 4.63) and polyp detection (OR 1.46, 95% CI 1.11 to 1.92). Conclusion Patient attitude towards split regimen is suboptimal, especially for early morning examinations. Interventions to improve patient compliance (ie, policies to reorganise colonoscopy timetable, educational initiatives for patient and healthcare providers) should be considered. Trial registration number NCT02287051; pre-result.

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