To sleep perchance to dream?

▶ Matro R, Shnitser A, Spodik M, et al. Efficacy of morning-only compared with split-dose polyethylene glycol electrolyte solution for afternoon colonoscopy: a randomised controlled single-blind study. Am J Gastroenterol 2010 [Epub ahead of print]. doi:10.1038/ajg. 2010.160.

High quality colonoscopy is predicated on good bowel cleansing, measures to improve the quality of bowel prep include ingesting part of the purgative on the day of the procedure. The standard regime for afternoon colonoscopy is to administer bowel prep in a split dose; one the night before and the other the morning of the procedure. This however necessitates patient disruption over 2 days and the potential of disrupted sleep the night before the procedure. A potentially attractive regime is that in which the entire prep is taken on the day of the procedure. In this prospective randomised investigator blinded non-inferiority study, a 2L polyethylene glycol-electrolyte solution (Movicol) bowel preparation was compared in a PM/AM split dose regime and AM only. In the PM/AM regime the first litre was taken at 6pm the night before colonoscopy and the second litre 4 h before. In the AM only group the first litre was taken 7 h before and the second 4 h before. One hundred and twenty five patients were randomised and 116 analysed. Whole colon prep was adequate in 92% in the AM group vs. 94% in the PM/AM group (non inferiority p=0.013) right colon prep was adequate in 93 and 92% (non-inferiority p=0.003). Polyp detection was greater and not inferior in the AM group, although there was no difference in the duration of sleep, the AM only group had better sleep quality (p=0.007) and less interference with the previous workday (p=0.019). This study documents that PM/AM and AM only regimes for low volume PEG …