Same-day bowel cleansing regimen is superior to a split-dose Regimen over 2 days for afternoon colonoscopy: results from a large prospective series

Goals and Background: Conventional bowel preparation for afternoon colonoscopy requires an oral agent the day before the procedure. Bowel cleansing given only on the day of the colonoscopy has never been attempted. The aims of this study were to compare the efficacy of bowel cleansing, impact on activities of daily living (ADLs), side effects, and patient preference of a same-day regimen with a 2-day regimen. 
Study:A single-blinded, prospective cohort study. Patients were block recruited into 2 groups with the endoscopist blinded to the regimen. Group A: 3 sachets of sodium picosulphate given at 12:00 noon and at 05:00 PM the day before and at 8:00 AM on the morning of the procedure. Group B: 2 sachets of sodium picosulphate on the morning of the procedure at 07:00 and 10:00 AM. Patients completed a quality-of-life questionnaire investigating the side effects, impact on ADLs, and regimen preference. The main outcome measures were mucosal cleansing, impact on ADLs, side effects, and patient preference of the regimen. Results: A total of 227 patients underwent screening colonoscopy. There were 95 patients in group A and 132 in group B, all of whom were age and sex matched. Same-day preparation produced better mucosal cleansing (P=0.0046) with fewer side effects (P=0.002). Impact on ADLs was less with the same-day regimen (P<0.0001). Significantly more number of patients preferred the same-day preparation compared with the 2-day regimen (P=0.0147). 
Conclusions: Same-day bowel preparation is feasible, safe, and more effective than a split-dose regimen. It has fewer adverse events and is preferred by patients.