Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in average-risk screening colonoscopy

• Published in: Gastrointestinal endoscopy Vol. 79; no. 5; pp. 811 - 820.e3
• Main Authors: Menees, Stacy B., Kim, H. Myra, Wren, Patricia, Zikmund-Fisher, Brian J., Elta, Grace H., Foster, Stephanie, Korsnes, Sheryl, Graustein, Brittany, Schoenfeld, Philip
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2014
• Subjects: Cathartics - administration & dosage; Colonoscopy; Early Detection of Cancer; European Continental Ancestry Group - statistics & numerical data; Female; Gastroenterology and Hepatology; Hispanic Americans - statistics & numerical data; Humans; Income; Laxatives - administration & dosage; Male; Marital Status; Middle Aged; Patient Compliance - statistics & numerical data; Polyethylene Glycols - administration & dosage; Prospective Studies; Self Report; Time Factors; ASC; PEG-EL; OR; BBPS; CRC; Boston Bowel Preparation Scale; polyethylene glycol electrolyte; colorectal cancer; ambulatory surgical center; odds ratio
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2014.01.024

Although split-dose bowel regimen is recommended in colon cancer screening and surveillance guidelines, implementation in clinical practice has seemingly lagged because of concerns of patient compliance. To assess patient compliance with the split-dose bowel regimen and assess patient- and preparation process–related factors associated with compliance and bowel preparation adequacy. Prospective survey cohort. Tertiary care setting. Average-risk patients undergoing colonoscopy for colorectal cancer screening between August 2011 and January 2013. Split-dose bowel regimen patient-reported compliance and bowel preparation adequacy with the Boston Bowel Preparation Scale score. Surveys and Boston Bowel Preparation Scale score data were completed in 462 participants; 15.4% were noncompliant with the split-dose bowel regimen, and suboptimal bowel preparation (score <5) was reported in 16% of all procedures. White (P = .009) and married (P = .01) subjects were least likely to be noncompliant, whereas Hispanic subjects and those who reported incomes of US$75,000 or less were most likely to be noncompliant (P = .004). Participants who were noncompliant with split-dosing were less likely to follow the other laxative instructions and more likely to have their colonoscopy appointment before 10:30 am. Compliance differed by bowel preparation type (P = .003, χ2 test), with those who used MiraLAX showing the highest compliance, followed by polyethylene glycol electrolyte solution and other bowel preparations. Noncompliance with split-dose bowel preparation (odds ratio 6.7; 95% confidence interval, 3.2-14.2) was the strongest predictor of suboptimal bowel preparation. Patient self-report, performed at tertiary care center. Overall, 1 in 7 patients do not comply with a split-dose bowel regimen. Ensuring compliance with the split-dose bowel regimen will reduce the risk of a suboptimal bowel preparation.