title: Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme.
abstract: Although a split regimen of bowel preparation has been associated with higher levels of bowel cleansing, it is still uncertain whether it has a favourable effect on the adenoma detection rate (ADR). The present study was aimed at evaluating whether a split regimen was superior to the traditional 'full-dose, day-before' regimen in terms of ADR.
  
  
  
  In a multicentre, randomised, endoscopist-blinded study, 50-69-year-old subjects undergoing first colonoscopy after positive-faecal immunochemical test within an organised colorectal cancer organised screening programmes were 1:1 randomised to receive low-volume 2-L polyethylene glycol (PEG)-ascorbate solution in a 'split-dose' (Split-Dose Group, SDG) or 'day-before' regimen (Day-Before Group, DBG). The primary endpoint was the proportion of subjects with at least one adenoma. Secondary endpoints were the detection rates of advanced adenomas and serrated lesions at per-patient analysis and the total number of lesions.
  
  
  
  690 subjects were included in the study. At per-patient analysis, the proportion of subjects with at least one adenoma was significantly higher in the SDG than in the DBG (183/345, 53.0% vs 141/345, 40.9%, relative risk (RR) 1.22, 95% CI 1.03 to 1.46); corresponding figures for advanced adenomas were 26.4% (91/345) versus 20.0% (69/345, RR 1.35, 95% CI 1.06 to 1.73). At per-polyp analysis, the total numbers of both adenomas and advanced adenomas per subject were significantly higher in the SDG (1.15 vs 0.8, p <0.001; 0.36 vs 0.22, p<0.001).
  
  
  
  In an organised screening setting, the adoption of a split regimen resulted into a higher detection rate of clinically relevant neoplastic lesions, thus improving the effectiveness of colonoscopy. Based on such evidence, the adoption of a split regimen for colonoscopy should be strongly recommended.
  
  
  
  NCT02178033.
authors.affiliation: Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Radaelli
authors.affiliation: Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Paggi
authors.affiliation: Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Senore
authors.affiliation: Division of Digestive Endoscopy, Imperia Hospital, Imperia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fasoli
authors.affiliation: Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: Division of Digestive Endoscopy and Gastroenterology, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Buffoli
authors.affiliation: Division of Digestive Endoscopy and Gastroenterology, A.O. Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: M F
authors.initials: MF
authors.lastname: Savarese
authors.affiliation: Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Spinzi
authors.affiliation: Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Rex
authors.affiliation: Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Repici
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D002400:Cathartics / Q000008:administration & dosage*; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D016037:Single-Blind Method; D047368:Tumor Burden
chemical_list: D002400:Cathartics; C520497:MoviPrep; D011092:Polyethylene Glycols
keywords: COLONOSCOPY; COLORECTAL ADENOMAS; COLORECTAL CANCER; COLORECTAL CANCER SCREENING; ENDOSCOPY