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. 2025 Feb 5:13:a25158539.
doi: 10.1055/a-2515-8539. eCollection 2025.

Day before late regimen vs standard split dose of low-volume PEG-CS for early morning colonoscopy: Multicenter randomized controlled trial

Luigi Pasquale  1 , Giuseppe Grande  2 , Rocco Maurizio Zagari  3 , Paolo Biancheri  4 , Antonio Pisani  5 , Paola Da Massa Carrara  6 , Bastianello Germanà  7 , Enrico Ciliberto  8 , Gianpaolo Cengia  9 , Antonietta Lamazza  10 , Patrizia Lorenzini  11 , Mariavittoria V Carati  12 , Liboria Laterza  13 , Flavia Pigò  14 , Desiree Picascia  15 , Carmelo Stillitano  8 , Matteo Pollastro  16 , Elisabetta Dal Pont  7 , Stefania Maraggi  5 , Rita Conigliaro  17 , Giuseppe Galloro  16
Affiliations

Day before late regimen vs standard split dose of low-volume PEG-CS for early morning colonoscopy: Multicenter randomized controlled trial

Luigi Pasquale et al. Endosc Int Open. .

Abstract

Background and study aims: Despite lower patient adherence, the overnight split-dose (SD) intestinal preparation regimen is currently recommended for early morning colonoscopies. Using low-volume preparation, we compared performance of a "day before late" (DBL) regimen, with the whole preparation taken between 8.30 pm and midnight on the day before the endoscopic procedure vs the overnight SD regimen for colonoscopies scheduled between 8 am and 10 am.

Patients and methods: Patients were randomized to the DBL group (n = 162) or SD group (n = 158). The SD group took the second dose 5 hours before colonoscopy. Successful bowel cleansing, defined as an overall Boston Bowel Preparation Score ≥ 3, safety, compliance and tolerability were assessed in the two groups.

Results: The DBL regimen failed to demonstrate non-inferiority compared with the SD regimen in terms of successful bowel cleansing (DBL, 88.2 % vs SD, 98.1%, P < 0.001). Subgroup analysis on colonoscopies before 9 am showed BBPS ≥ 3 rates of 94.6% and 100% in the DBL and SD groups, respectively P = 0.126). The two regimens showed similar compliance and tolerability. Compared with SD patients (25.5%), a lower proportion of DBL patients (13.9%) reported fear of incontinence during the journey to the hospital ( P = 0.01).

Conclusions: Albeit more tolerable, the DBL regimen was less effective than the SD regimen with regard to successful bowel cleansing for colonoscopies between 8 am and 10 am. Subgroup analysis on colonoscopies scheduled before 9 am showed that the two regimens have similar efficacy, suggesting that the DBL regimen may be a valuable alternative to the SD regimen for very early morning colonoscopies.

Keywords: CRC screening; Endoscopy Lower GI Tract; Polyps / adenomas / ...; Preparation; Quality and logistical aspects.

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Conflict of interest statement

Conflict of Interest Giuseppe Grande, MD (corresponding author) is: - consultant for: Olympus, ERBE, Boston Scientific - conference speaker for: Alfa Sigma spa; Mayoly All other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Consolidated Standard of Reporting Trials (CONSORT) flow diagram showing enrollment and analysis. AE, adverse event
See this image and copyright information in PMC

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