Increased adenoma detection rate with system-wide implementation of a split-dose preparation for colonoscopy

Background: Recent studies using split-dose preparations (SDPs) suggest a significant improvement in the quality of preparation and patient compliance. However, the effects of SDP on other quality indicators of colonoscopy, such as cecal intubation and adenoma detection rates, have not been previously reported, to our knowledge.

Objective: The primary objective of this study was to compare polyp detection rates (PDRs) and adenoma detection rates (ADRs) before and after the implementation of an SDP as the preferred bowel preparation. The secondary objectives were to compare the quality of the preparation and colonoscopy completion rates before and after implementation of the SDP.

Design: Retrospective study.

Setting: Tertiary care medical center.

Patients: Patients undergoing colonoscopy for screening and surveillance of colon polyps and cancer.

Interventions: System-wide implementation of SDP.

Results: A total of 3560 patients in the pre-SDP group and 1615 patients in the post-SDP group were included in the study. SDP use increased significantly from 9% to 74% after implementation. In comparison with the pre-SDP group, both PDRs (44.1%-49.5%; P < .001) and ADRs (26.7%-31.8%; P < .001) significantly improved in the post-SDP group. The colonoscopy completion rate significantly increased from 93.6% to 95.5% in the post-SDP group (P = .008). Bowel preparation quality also improved significantly (P < .001) in the post-SDP group.

Limitations: Retrospective design; not all endoscopists were the same in both periods.

Conclusions: System-wide implementation of an SDP as the primary choice for colonoscopy significantly improved both PDRs and ADRs, overall quality of the preparation, and colonoscopy completion rates.