Split-dose low-volume bowel preparation, a feasible option for preparation for colonoscopy

We read with great interest the article by Mussetto et al. [1] on split-dose low-volume preparation for bowel cleansing (15 mg bisacodyl plus 2 L polyethylene glycol [PEG] solution) being better tolerated yet as effective as split-dose high-volume preparation (4 L PEG solution) in patients with previous colorectal resection. Traditionally, our center used low-volume preparation (10 mg bisacodyl for 2 days plus 2 L PEG solution) for bowel preparation for colonoscopy, which has been shown to be as good as 4 L PEG solution [2]. The PEG solution was taken on the evening before if the colonoscopy was scheduled in the morning. Subsequently, we changed our practice to administer the PEG solution on the same morning, on the basis of the findings from the study by Chiu et al. [3], which clearly demonstrated that this was better.

We were uncertain of the effect of splitting the already low-volume preparation. We proceeded to conduct a randomized, investigator-blinded study on 295 patients attending for a morning outpatient colonoscopy, and found that splitting the low-volume preparation was better tolerated yet as effective when compared with taking the whole dose on the same morning [4].

To the best of our knowledge, we were the first to report on the use of split-dose low-volume preparation and to compare these regimes. With the report from Mussetto et al., there are now at least two studies showing that split-dose low-volume preparation is a feasible option for bowel preparation for colonoscopy, with a better patient tolerability profile.

• References

• 1 Mussetto A, Frazzoni L, Paggi S et al. Split dosing with a low-volume preparation is not inferior to split dosing with a high-volume preparation for bowel cleansing in patients with a history of colorectal resection: a randomized trial. Endoscopy 2015; 47: 917-924
• 2 DiPalma JA, Wolff BG, Meagher A et al. Comparison of reduced volume versus four liters sulfate-free electrolyte lavage solutions for colonoscopy colon cleansing. Am J Gastroenterol 2003; 98: 2187-2191
• 3 Chiu HM, Lin JT, Wang HP et al. The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms–a prospective endoscopist-blinded randomized trial. Am J Gastroenterol 2006; 101: 2719-2725
• 4 Chan WK, Azmi N, Mahadeva S et al. Split-dose vs same-day reduced-volume polyethylene glycol electrolyte lavage solution for morning colonoscopy. World J Gastroenterol 2014; 20: 14488-14494