Morning-Only 4 L PEG vs Split Dose Prep for Afternoon Colonoscopies, Endoscopist-Blinded Prospective Study

The aim of colorectal cancer screening is to reduce mortality. This can be effectively
achieved by colonoscopy with direct visualization of the entire colon to detect preneoplastic
lesions such as adenomatous polyps. Bowel preparation quality is critical for the accuracy of
colonoscopy, time required to complete the procedure and its success. On the other hand, poor
quality of bowel preparation was shown to be associated with a lower adenoma detection rate.
Prior studies have shown that time of colonoscopy is one of the major factors influencing
bowel preparation quality with the afternoon colonoscopies being notable for a high failure
rate. This failure rate is related to poor bowel preparation quality. Given that, the number
of afternoon colonoscopies performed is still high due to the increased need for
colonoscopies. Therefore, it is suggested that improving the bowel preparation quality can
reduce failure rate of afternoon colonoscopies. Several studies on split-dose bowel
preparation have shown that it is superior to the conventional day-before regimen, in terms
of preparation quality and patient's tolerability. Another study on split-dose bowel
preparation also showed that it is associated with a better adenoma detection rate, better
polyp detection rate and colonoscopy completion rate. There also have been few studies
comparing same day dose vs. day-before for afternoon colonoscopies and showed that same day
was superior to day before.There is no data comparing quality of preparation of colonoscopy
in patients taking same day 4L preparation vs. 4 L split-dose preparation for an afternoon
colonoscopy.

Using a 4L PEG-ELS solution, the investigators aim to evaluate the efficacy and patient's
tolerability for the same day versus split-dose regimen.

Inclusion Criteria:

1. All patients above 18 years of age undergoing elective outpatient colonoscopy at CCF
Florida who are scheduled for an afternoon colonoscopy procedure. All patients must have
been prescribed a 4 L PEG based bowel preparation.

Exclusion Criteria:

1. Patients who had prior Colectomy or colon resection surgery.

2. Patients with confirmed diagnosis of impaired GI motility.

3. Chronic nausea or vomiting.

4. Severe constipation (=/<1 bowel movement per week).

5. Pregnancy.

6. Breast feeding.

7. Patients taking drugs which are known to influence GI motility.

8. Hospital inpatients.