Even with all the evidence supporting colorectal screening, less than half of Americans 50 years of age and above elect to have a colonoscopy. This is troubling news because colorectal cancer is the third-leading cause of cancer death and claims the lives of over 50,000 individuals each year. Although all screenings are important, colon screenings are truly in a league of their own. And the most troubling part is that colon cancer is one of the only cancers that is actually preventable with routine screening. Detection of colon cancer at an early stage is associated with a 5-year survival rate of 90 percent.
So why don’t people get colonoscopies like they should? According to a study of patents who had participated in a screening colonoscopy, as well as those who had not, the bowel preparation was the top reason why they did not want to have a colonoscopy. For an accurate screening, the bowel must be completely empty. This has traditionally required the consumption of laxatives dissolved in large volumes of liquid which can leave patients feeling bloated or nauseous. For some patients, the anticipation of the prep is enough to deter them from scheduling a colonoscopy. But for those who are unable or unwilling to completely cleanse the colon, they are at risk for:
Split-dose regimens have been shown to improve bowel preparation and patient comfort compared to conventional bowel cleansing. The split-dose method involves taking half of the prep solution the evening before the colonoscopy and the remainder of the solution on the morning of the procedure. In one study, patients who did the split-dose preparation were much more likely to receive an “excellent” rating by their gastroenterologist than patients taking the entire dose the night before.
The critical aspect of split-dosing is that the second dose must be taken less than 6 hours before the examination. This may mean that some patients must get up at 2:00 a.m. or 3:00 a.m. for an early morning appointment. While this may seem unappealing to many patients, surveys found that patients were willing to wake up early if they knew that the split-dose method would improve their outcome. Fewer patients doing the split-dose method found it difficult to finish their solution than patients who consumed all the solution the night before.
As split-dosing becomes more common and patients see the benefits of better visualization and accurate screening, bowel preparation may not seem so overwhelming or distasteful. Taking away the dread and fear of the prep day will surely increase screening rates in the coming years (Source: GI Digest).