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Barriers against split-dose bowel preparation for colonoscopy
  1. F Radaelli1,
  2. S Paggi1,
  3. A Repici2,
  4. G Gullotti3,
  5. P Cesaro4,
  6. G Rotondano5,
  7. L Cugia6,
  8. C Trovato7,
  9. C Spada8,
  10. L Fuccio9,
  11. P Occhipinti10,
  12. F Pace11,
  13. C Fabbri12,
  14. A Buda13,
  15. G Manes14,
  16. G Feliciangeli15,
  17. M Manno16,
  18. L Barresi17,
  19. A Anderloni2,
  20. P Dulbecco18,
  21. F Rogai19,
  22. A Amato1,
  23. C Senore20,
  24. C Hassan21
    1. 1 Department of Gastroenterology, Valduce Hospital, Como, Italy
    2. 2 Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
    3. 3 G. Martino Hospital, Messina, Italy
    4. 4 Poliambulanza Foundation Hospital, Brescia, Italy
    5. 5 Maresca Hospital, ASLNA3sud, Torre del Greco, Naples, Italy
    6. 6 SS Annunziata Hospital, Sassari, Italy
    7. 7 European Institute of Oncology, Milan, Italy
    8. 8 Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
    9. 9 S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
    10. 10 Maggiore Carità Hospital, Novara, Italy
    11. 11 Bolognini Hospital, Seriate, Italy
    12. 12 Bellaria-Maggiore Hospital, Bologna, Italy
    13. 13 S. Maria del Prato Hospital, Feltre, Italy
    14. 14 G. Salvini Hospital, Garbagnate Milanese, Milan, Italy
    15. 15 ASUR Marche AV3, Macerata, Italy
    16. 16 Ospedali di Carpi e Mirandola, Modena, Italy
    17. 17 IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
    18. 18 University of Genoa, Genoa, Italy
    19. 19 University Hospital Careggi, Florence, Italy
    20. 20 Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
    21. 21 Nuovo Regina Margherita Hospital, Rome, Italy
    1. Correspondence to Dr F Radaelli, Division of Gastroenterology, Valduce Hospital, Via Dante 11, Como 22100, Italy; francoradaelli01{at}


    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 (p<0.001, χ2 for linear trend). At multivariate analysis, colonoscopy appointment before 10:00 (OR 0.14, 95% CI 0.11 to 0.18), travel time to endoscopy service >1 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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