Researchers at Thomas Jefferson University have found that colonoscopy preparation drugs administered the same day as the procedure are equally effective to those given the night before and the morning of the procedure, but result in less complaints of side effects such as abdominal pain, sleep loss and workday interference.
The randomized, single blind study, compared results between 116 colonoscopy patients given a split dosage of colon preparation the night before and morning of their colonoscopy and those given the colonoscopy preparation solely the morning of their colonoscopy. The study shows that both treatments are clinically equal. Primary Investigator David Kastenberg, M.D., department of Gastroenterology and Hepatology at Jefferson Medical College of Thomas Jefferson University and his co-authors present their findings in the current online edition of the American Journal of Gastroenterology.
"The most important thing to consider during a colonoscopy are clear images," said Kastenberg. "During the procedure I want to be able to have the best view to ensure that nothing is missed and all abnormalities are scrutinized. That's why the colon prep is so important. For years patients have been taking the colon prep solution the night before and had successful colonoscopies the following day but had to endure numerous side effects. Recently, the American College of Gastroenterology endorsed split dosing, which means patients need to experience all the side effects of a colon prep both at night and on the morning of the colonoscopy. What we looked at was can we administer the colon prep the same day and get equal results without the side effects? The answer is yes. The images are just as good when giving the colon prep the day of the procedure than they are when giving the colon prep as a split dose on both days, while reducing and in some cases eliminating the side effects."
Of the 116 patients studied 62 received the prep in the morning against 54 receiving it the night before. The colon images were adequate in both groups at well over 90 percent. Polyp detection was actually found to be greater in the morning colon prep group. Overall adverse effects were found not to be significantly different between the two groups.
"The real advantage of the morning prep is it has less interference on the patients quality of life," said Kastenberg. "Many patients complain about trouble sleeping after taking the colon prep the night before. Also this lessens the impact on work-related function the day prior. Perception is also key. Patients may well tolerate the colon prep and procedure better if it's a one day event versus two."
Every year over 14 million Americans have colonoscopies. The procedure is a highly effective way of detecting pre-cancerous polyps. Unchecked these polyps can lead to colon cancer which is one of the top three leading causes of cancer-related deaths among men and women in the United States.
"Colon cancer is a common and preventable disease, but only half of eligible patients undergo screening," said Kastenberg. "Anything we can do that provides additional comfort without affecting results should be considered. If we can make the patient's experience easier and demonstrate to future patients that the procedure from beginning to end will only last one day, then maybe some of the over 42 million Americans who should be screened, but aren't, will come forward and we might be able to save some lives."
- Rebecca Matro, Anastasia Shnitser, Maya Spodik, Constantine Daskalakis, Leo Katz, Alexandra Murtha, David Kastenberg. Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study. The American Journal of Gastroenterology, 2010; DOI: 10.1038/ajg.2010.160
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