Clinical Newswire, May 5, 2010 - Colorectal cancer (CRC) is the fourth most common cause of death from cancer worldwide and the second leading cause of cancer-related death in North America. Incident cases of colorectal carcinoma are declining thanks to screening programs, which enable the removal of pre-cancerous polyps from persons identified as being at risk of developing CRC.
The success of elective colonoscopy relies heavily on excellent visualisation of the colon. Although adequate bowel preparation is an essential element of elective colonoscopy, many patients express displeasure with the procedures used to ensure the cleanliness of the bowel prior to colonoscopy. Therefore, patient compliance is often a problem, with the result that the gut is not sufficiently clean for the procedure to be completed successfully. Poor bowel preparation may necessitate a repeat colonoscopy and delay treatment, both of which are deleterious to the patient and increase healthcare costs.
Currently, several different colon cleansing regimens, such as oral sodium phosphate solution and polyethylene glycol (PEG)-based formulations, are used for patients who are undergoing colonoscopy. The standard procedure for colonoscopy patients is to administer the bowel preparation agent in a split dosage schedule, i.e., the night before and the morning of the colonoscopy. The major drawbacks of this regimen are that the patients experience the side-effects both the day before and the day of the procedure and that patient compliance is jeopardized.
A study by the group of David Kastenberg of Thomas Jefferson University (Philadelphia, PA, USA) has looked at an alternative schedule for administering bowel cleansing agents, which involves administration only on the morning of the colonoscopy*. Thus, this group conducted a randomized, single-blind study to compare the outcomes for 116 colonoscopy patients who were administered a split dosage of the colon preparation agent (PEG electrolyte solution) the night before and morning of their colonoscopy (split dosage group; N=54) or given the agent only on the morning of their colonoscopy (same-day dosage; N=62).
In both groups, the images of the colon were deemed to be adequate for >90% of the patients. Polyp detection was significantly better in the same-day dosage group (mean of 1.57 vs. 0.94 polyps/patient, non-inferiority P=0.007). The overall incidence of adverse events was not significantly different between the two groups (P=0.273), Although the frequencies of overall adverse effects were not significantly different between the two groups, the same-day dosage group had a lower incidence of abdominal pain (P=0.024), better sleep quality (P=0.007), and experienced less interference with the previous workday (P=0.019) than the split dosage group.
The major findings of this study are that colonoscopy preparation agents administered the same day as the procedure are as effective as those given the night before plus the morning of the procedure, with the patients who receive the same-day dosage of cleansing agent experiencing fewer of the side-effects that affect quality of life and work performance.
The same-day bowel preparation regimen is advantageous for patients undergoing colonoscopy, as it means that the entire procedure can be completed in a single day. Thus, the patient does not have to worry about having adverse events the night before or lose sleep due to episodes of diarrhea at night. In addition, disruption of the patients working schedule is minimized. All of these factors have a positive impact on patient compliance and reduce healthcare costs, while encouraging those who are at risk of CRC to come forward and be screened.
*Matro, R et al. Efficacy of morning-only compared with split-dose polyethylene glycol electrolyte solution for afternoon colonoscopy: A randomized controlled single-blind study. Am J Gastroenterol Advance online publication 20 April 2010; doi: 10.1038/ajg.2010.160
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