title: Barriers against split-dose bowel preparation for colonoscopy.
abstract: 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.
  
  
  
  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.
  
  
  
  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, χ2for 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).
  
  
  
  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.
  
  
  
  NCT02287051; pre-result.
authors.affiliation: Department of Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Radaelli
authors.affiliation: Department of Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Paggi
authors.affiliation: Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Repici
authors.affiliation: G. Martino Hospital, Messina, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Gullotti
authors.affiliation: Poliambulanza Foundation Hospital, Brescia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cesaro
authors.affiliation: Maresca Hospital, ASLNA3sud, Torre del Greco, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rotondano
authors.affiliation: SS Annunziata Hospital, Sassari, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cugia
authors.affiliation: European Institute of Oncology, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Trovato
authors.affiliation: Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Spada
authors.affiliation: S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Fuccio
authors.affiliation: Maggiore Carità Hospital, Novara, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Occhipinti
authors.affiliation: Bolognini Hospital, Seriate, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pace
authors.affiliation: Bellaria-Maggiore Hospital, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Fabbri
authors.affiliation: S. Maria del Prato Hospital, Feltre, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Buda
authors.affiliation: G. Salvini Hospital, Garbagnate Milanese, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Manes
authors.affiliation: ASUR Marche AV3, Macerata, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Feliciangeli
authors.affiliation: Ospedali di Carpi e Mirandola, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Manno
authors.affiliation: IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Barresi
authors.affiliation: Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: University of Genoa, Genoa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Dulbecco
authors.affiliation: University Hospital Careggi, Florence, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Rogai
authors.affiliation: Department of Gastroenterology, Valduce Hospital, Como, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Amato
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: Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Hassan
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D001071:Appointments and Schedules; D002400:Cathartics / Q000008:administration & dosage*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D002400:Cathartics; D011092:Polyethylene Glycols
keywords: COLONIC POLYPS; COLONOSCOPY; ENDOSCOPY