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Thématique :
- MICI
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2017/02  
 
  2017 Feb;66(2):270-277.  
  doi: 10.1136/gutjnl-2015-310685.  
 
  Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme.  
 
  Radaelli F, Paggi S, Hassan C, Senore C, Fasoli R, Anderloni A, Buffoli F, Savarese MF, Spinzi G, Rex DK, Repici A  
  http://gut.bmj.com/content/early/2015/12/09/gutjnl-2015-310685  
 
 

Abstract

OBJECTIVE:

Although a split regimen of bowel preparation has been associated with higher levels of bowel cleansing, it is still uncertain whether it has a favourable effect on the adenoma detection rate (ADR). The present study was aimed at evaluating whether a split regimen was superior to the traditional 'full-dose, day-before' regimen in terms of ADR.

DESIGN:

In a multicentre, randomised, endoscopist-blinded study, 50-69-year-old subjects undergoing first colonoscopy after positive-faecal immunochemical test within an organised colorectal cancer organised screening programmes were 1:1 randomised to receive low-volume 2-L polyethylene glycol (PEG)-ascorbate solution in a 'split-dose' (Split-Dose Group, SDG) or 'day-before' regimen (Day-Before Group, DBG). The primary endpoint was the proportion of subjects with at least one adenoma. Secondary endpoints were the detection rates of advanced adenomas and serrated lesions at per-patient analysis and the total number of lesions.

RESULTS:

690 subjects were included in the study. At per-patient analysis, the proportion of subjects with at least one adenoma was significantly higher in the SDG than in the DBG (183/345, 53.0% vs 141/345, 40.9%, relative risk (RR) 1.22, 95% CI 1.03 to 1.46); corresponding figures for advanced adenomas were 26.4% (91/345) versus 20.0% (69/345, RR 1.35, 95% CI 1.06 to 1.73). At per-polyp analysis, the total numbers of both adenomas and advanced adenomas per subject were significantly higher in the SDG (1.15 vs 0.8, p <0.001; 0.36 vs 0.22, p<0.001).

CONCLUSIONS:

In an organised screening setting, the adoption of a split regimen resulted into a higher detection rate of clinically relevant neoplastic lesions, thus improving the effectiveness of colonoscopy. Based on such evidence, the adoption of a split regimen for colonoscopy should be strongly recommended.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT02178033.

 

 
Question posée
 
La préparation colique fractionnée est-elle supérieure à la préparation non fractionnée pour les faibles volumes (2L) ?
 
Question posée
 
Cette étude multicentrique randomisée italienne montre une nette supériorité de la préparation fractionnée, permettant une détection accrue des adénomes y compris avancés.
 
Commentaires

Cette étude vient s’ajouter aux données (déjà nombreuses) témoignant de la supériorité des préparations fractionnées, recommandées par la grande majorité des sociétés savantes.

 
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