Varun Kasula, BA1, Nicole Sangha, MPH2, Manvi Kalra, MBBS3, Monica Arora, DO4, Neeraj Sachdeva, MD2; 1Wake Endoscopy Center, Cary, NC; 2Wake Endoscopy Center, Raleigh, NC; 3Kasturba Medical College, Manipal, Hisar, Haryana, India; 4Wake Endoscopy Center, Macungie, PA
Introduction: Adequate bowel preparation allowing for a good mucosal visualization is the cornerstone of a good screening colonoscopy. Traditionally, the entire preparation was given the evening before the colonoscopy. Split-dose preparation involves taking the first half the evening before the colonoscopy and the second half 4-5 hours before the scheduled procedure. The split-dose regimen is not only associated with better patient acceptability but achieves adequate preparation more often. Split-dose preparation is still not widely used in the community setting, especially by the providers who have been practicing longer and are used to giving all of the bowel-cleansing preparation the evening before the colonoscopy. This study aims to analyze the correlation between the use of split-dose preparation and the physician’s ADR. Methods: We performed a retrospective study to analyze the association between frequency of split-dose preparation utilization and ADR. We included all average-risk individuals undergoing screening colonoscopies from Jan 1, 2019, to Dec 31, 2019, at three affiliated community endoscopy centers. A total of 14 physicians performed procedures at these endoscopy centers. The frequency of a physician’s utilization of split-dose preparation was determined by independently surveying the physician's schedulers and reviewing the patient's charts. A Pearson r test was performed where 0.05 two-tailed probability was used to assess statistical significance. Results: A total of 5478 screening colonoscopies were performed during the study period with at least one adenoma detected during 2173 colonoscopies. A strong, linear correlation was found between the frequency of use of split-dose preparation and the physician’s reported ADR, r(12) = 0.83, p< .01. The mean ADR of the physicians who used the split-dose preparation by default was 1.45 standard deviations higher than the mean ADR of all of the physicians. Discussion: This retrospective analysis showed a positive correlation between adherence to the split-dose regimen and the physician’s ADR. Prior studies have shown increased ADR leads to a decreased risk of interval colorectal cancer and fatal colorectal cancer. A simple shift to increased utilization of split-dose preparation would be a cost-effective way of improving the outcome of colorectal cancer screening. More efforts should be made by practices to use split-dose preparation as much as possible.
Disclosures: Varun Kasula indicated no relevant financial relationships. Nicole Sangha indicated no relevant financial relationships. Manvi Kalra indicated no relevant financial relationships. Monica Arora indicated no relevant financial relationships. Neeraj Sachdeva indicated no relevant financial relationships.