Effect of an intensive patient educational programme on the quality of bowel preparation for colonoscopy: a single-blind randomised controlled trial

A novel strategy for improving bowel preparation based on social software-enhanced education: A prospective, multicenter, randomized controlled study

BACKGROUND AND AIM

The compliance and timeliness of oral laxatives have always been the key factors restricting bowel preparation (BP). We have constructed a novel enhanced-educational content and process based on social software (SS) for BP to optimize these issues.

METHODS

A multicenter, prospective, randomized controlled study was conducted at 13 hospitals in China from December 2019 to December 2020. A total of 1774 enrollees received standard instructions for BP and were randomly assigned (1:1) to the SS group (SSG) that received a smartphone-based enhanced-education strategy starting 4 h before colonoscopy or the control group (CG).

RESULTS

A total of 3034 consecutive outpatient colonoscopy patients were assessed for eligibility, and 1774 were enrolled and randomly assigned. Ultimately, data from 1747 (SSG vs CG: 875 vs 872) enrollees were collected. The BP adequacy rate was 92.22% (95% CI: 90.46-93.98) in the SSG vs 88.05% (95% CI: 85.91-90.18) in the CG (P = 0.005), and the total Boston Bowel Preparation Scale scores (6.89 ± 1.15 vs 6.67 ± 1.15, P < 0.001) of those in the SSG were significantly higher than those in the CG. The average number of polyps detected in the SSG was considerably higher than that in the CG (0.84 ± 2.00 vs 0.53 ± 1.19, P = 0.037), and the average diameter of the polyps was significantly lower than that of the control group (4.0 ± 2.5 vs 4.9 ± 3.7, P < 0.001).

CONCLUSIONS

This SS-enhanced education strategy can improve the BP adequacy rate and increase the average number of polyps detected, especially those of small diameter.

Effect of Visual Booklets to Improve Bowel Preparation in Colonoscopy: Systematic Review with Meta-Analysis

An optimal bowel preparation for colonoscopy is essential to increasing the quality of the examination. Visual booklets have been proposed with conflicting results to enhance bowel preparation. A literature search was performed in March 2023 in the most important databases. Only RCTs were selected. We calculated odd ratios (OR) for dichotomous outcomes. Mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity with the Chi² and the I² statistics. In cases of high heterogeneity, a random effect model was used. Six studies were selected, enrolling 1755 patients overall. Adequate bowel preparation was observed in 86.7% of the booklet group versus 77.5% of the control group, with an OR = 2.31 in favor of the booklet. In studies using a 4-L PEG-based preparation, no difference compared to controls was observed, while in non-PEG formulations, preparation with booklets was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in an inpatient setting without any differences between booklets and controls, while outpatients receiving booklets had better results (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). The adenoma detection rate was similar between the two groups. In conclusion, booklets are useful to improve bowel preparation. Outpatient settings and preparations not containing PEG could benefit more from booklets.

Effect of nurse-performed enhanced patient education on colonoscopy bowel preparation quality

OBJECTIVE

to evaluate the effect of nurse-performed enhanced patient education sessions on adequate bowel preparation and cecal intubation rates.

METHOD

a prospective, quasi-experimental, comparative study with a quantitative approach. The intervention group (n=150) received education enhanced by a visual presentation and reminder calls. The control group (n=156) received the clinic's standard written instructions. Adequate bowel preparation rates and other colonoscopy quality indicators were compared between the groups.

RESULTS

Boston Bowel Preparation scale scores and adequate bowel preparation rates were higher in the intervention group than in the control group (respectively, 6.76±2.1 vs. 5.56±2.4, p=0.000, and 80% vs. 69.2%, p=0.031). The cecal intubation rates were higher in the intervention group (80% vs. 67.3%, p=0.012). Due to inadequate bowel preparation, unsuccessful cecal intubation rates were 0% in the intervention group and 17.6% in the control group. Biopsy rates were higher in the intervention group (28% vs. 13.3%, p=0.002).

CONCLUSION

the nurse-performed enhanced patient education sessions increase adequate bowel preparation rates and, in parallel, cecal intubation rates. To reach the colonoscopy quality standards recommended in the guidelines, it is suggested that patient education be supported by different training tools and given by health professionals.

High-Quality Colonoscopy: A Review of Quality Indicators and Best Practices

Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care.

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

Background

Colonoscopy is widely used for the screening, diagnosis and treatment of intestinal diseases. Adequate bowel preparation is a prerequisite for high-quality colonoscopy. However, the rate of adequate bowel preparation in outpatients is low. Several studies on supplementary education methods have been conducted to improve the rate of adequate bowel preparation in outpatients. However, the controversial results presented encourage us to perform this meta-analysis.

Method

According to the PRISMA statement (2020), the meta-analysis was registered on PROSPERO. We searched all studies up to August 28, 2021, in the three major electronic databases of PubMed, Web of Science and Cochrane Library. The primary outcome was adequate bowel preparation rate, and the secondary outcomes included bowel preparation quality score, polyp detection rate, adenoma detection rate, cecal intubation time, withdrawal time, nonattendance rate and willingness to repeat rate. If there was obvious heterogeneity, the funnel plot combined with Egger’s test, meta-regression analysis, sensitivity analysis and subgroup analysis were used to detect the source of heterogeneity. RevMan 5.3 and Stata 17.0 software were used for statistical analysis.

Results

A total of 2061 records were retrieved, and 21 full texts were ultimately included in the analysis. Our meta-analysis shows that supplementary education can increase the rate of adequate bowel preparation for outpatients (79.9% vs 72.9%, RR = 1.14, 95% CI: 1.08–1.20, I² = 87%, p<0.00001). Supplementary education shortened the withdrawal time (MD: -0.80, 95% CI: -1.54 to -0.05, p = 0.04) of outpatients, increased the Boston Bowel Preparation Scale (MD: 0.40, 95% CI: 0.36 to 0.44, p<0.00001), reduced the Ottawa Bowel Preparation Scale (MD: -1.26, 95% CI: -1.66 to -0.86, p<0.00001) and increased the willingness to repeat (91.9% vs 81.4%, RR:1.14, 95% CI: 1.04 to 1.25, p = 0.004).

Conclusion

Supplementary education for outpatients based on the standard of care can significantly improve the quality of bowel preparation.

1L NER1006 can improve rates of adequate and high-quality bowel cleansing in the right colon: a post hoc analysis of two randomised clinical trials

BACKGROUND

The right colon is difficult to cleanse compared with other colon segments. This post hoc analysis of two randomised clinical trials (MORA and NOCT) examined whether 1L polyethylene glycol (PEG) NER1006 and two mid-volume alternatives could improve adequate and high-quality cleansing in the right colon among patients with complete cleansing assessments.

METHODS

Patients received NER1006 (N2D), 2L PEG plus ascorbate (2LPEG) or oral sulphate solution (OSS) as a 2-day evening/morning split-dosing regimen or NER1006 as a same-day morning-only dosing regimen (N1D). Patients had full segmental scoring assigned by treatment-blinded central readers using the Harefield Cleansing Scale. The right colon adequate (score ≥ 2) and high-quality (score ≥ 3) cleansing success of NER1006 (N2D and N1D) versus 2LPEG and OSS was analysed individually and as pooled groups (N2D vs. 2LPEG/OSS). We assessed the comparative right colon cleansing rates of the N2D versus 2LPEG/OSS in overweight males. We also performed a multivariable regression analysis to examine factors affecting cleansing in the right colon.

RESULTS

A total of 1307 patients were included. Pooled N2D showed significantly improved rates of adequate-level cleansing in the right colon compared with 2LPEG (97.5% [504/517] vs. 94.6% [246/260]; p = 0.020) and OSS (97.5% [504/517] vs. 93.8% [244/260]; p = 0.006). In MORA, the rate of adequate right colon cleansing did not significantly differ between N1D and 2LPEG (95.2% [257/270] vs. 94.6% [246/260]; p = 0.383). The rate of right colon high-quality cleansing was significantly improved with N2D or N1D vs. 2LPEG (p < 0.001 for both), and was numerically higher with N2D versus OSS (p = 0.11). In overweight males, NER1006 delivered numerically higher adequate (p = 0.398) and superior high-quality (p = 0.024) cleansing rates versus 2LPEG/OSS. Multivariable regression analysis showed NER1006 was associated with adequate and high-quality cleansing (p = 0.031 and p < 0.001), while time between preparation and colonoscopy was negatively associated (p = 0.034 and p = 0.006).

CONCLUSIONS

NER1006 delivered improved rates of adequate and high-quality right colon cleansing compared with 2LPEG and OSS. The increased rate of high-quality cleansing with NER1006 versus its comparators was also seen in overweight males.

Effect of nurse-performed enhanced patient education on colonoscopy bowel preparation quality

Objective:

to evaluate the effect of nurse-performed enhanced patient education sessions on adequate bowel preparation and cecal intubation rates.

Method:

a prospective, quasi-experimental, comparative study with a quantitative approach. The intervention group (n=150) received education enhanced by a visual presentation and reminder calls. The control group (n=156) received the clinic’s standard written instructions. Adequate bowel preparation rates and other colonoscopy quality indicators were compared between the groups.

Results:

Boston Bowel Preparation scale scores and adequate bowel preparation rates were higher in the intervention group than in the control group (respectively, 6.76±2.1 vs. 5.56±2.4, p=0.000, and 80% vs. 69.2%, p=0.031). The cecal intubation rates were higher in the intervention group (80% vs. 67.3%, p=0.012). Due to inadequate bowel preparation, unsuccessful cecal intubation rates were 0% in the intervention group and 17.6% in the control group. Biopsy rates were higher in the intervention group (28% vs. 13.3%, p=0.002).

Conclusion:

the nurse-performed enhanced patient education sessions increase adequate bowel preparation rates and, in parallel, cecal intubation rates. To reach the colonoscopy quality standards recommended in the guidelines, it is suggested that patient education be supported by different training tools and given by health professionals.

Los efectos de la educación perfeccionada, realizada por enfermeros en la calidad de la preparación intestinal para colonoscopia

Resumen Objetivo: evaluar el efecto de la educación perfeccionada realizada por enfermeros en la preparación intestinal adecuada y en las tasas de intubación cecal. Método: estudio prospectivo, casi experimental y comparativo, con abordaje cuantitativo. El grupo de intervención (n=150) recibió la educación perfeccionada y llamadas telefónicas recordatorias. El grupo de control (n=156) recibió las instrucciones estándar de la clínica por escrito. Las tasas de preparación intestinal adecuadas y otros indicadores de la calidad de la colonoscopia fueron comparadas entre los grupos. Resultados: las puntuaciones obtenidas en la Boston Bowel Preparation Scale y las tasas de preparación intestinal adecuadas fueron en el grupo de intervención mayores que en el grupo de control (6,76±2,1 vs. 5,56±2,4, p=0,000, y 80% vs. 69,2%, p=0,031, respectivamente). Las tasas de intubación cecal fueron mayores en el grupo de intervención (80% vs. 67,3%, p=0,012). La tasa de intubación cecal fracasada debido a la preparación intestinal inadecuada fue de 0% en el GI, en cuanto que el GC obtuvo una tasa de 17,6%. Además de eso, las tasas de biopsia fueron mayores en el grupo de intervención (28% vs. 13,3%, p=0,002). Conclusión: la educación del paciente perfeccionada y realizada por enfermeros aumenta las tasas de preparación intestinal adecuadas y, consecuentemente, las tasas de intubación cecal. Para alcanzar los estándares de calidad de colonoscopia recomendados en las directrices, recomendamos que la educación del paciente sea apoyada por diferentes herramientas de entrenamiento y realizada por profesionales de la salud.

Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy: A Meta-analysis

This meta-analysis aimed to evaluate the impact of prepackaged low-residue diet (PLRD) on bowel preparation for colonoscopy. We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases from inception to August 2020. Randomized controlled trials (RCTs) comparing PLRD with clear liquid diet (CLD) or self-prepared LRD were considered for inclusion. The analysis calculated the odds ratio (OR) for the rate of adequate bowel preparation, patient tolerance, willingness to repeat bowel preparation, tolerability of bowel preparation, and overall adverse effects. Five RCTs published between 2006 and 2019 (N = 561) were included in our meta-analysis. Compared with the traditional CLD or self-prepared LRD, PLRD showed significantly higher rates of adequate bowel preparation (OR, 2.16; 95% confidence interval [CI], 1.18-3.98; p = .01), patient tolerance (OR, 1.99; 95% CI, 1.30-3.07; p = .002), and willingness to repeat the bowel preparation (OR, 1.68; 95% CI, 1.05-2.70; p = .03), with no differences in adverse events (OR, 0.93; 95% CI, 0.59-1.46; p = .75). Prepackaged low-residue diet improved bowel preparation quality, patient tolerance, and willingness to repeat bowel preparations. Importantly, PLRD does not increase the incidence of adverse events. This suggests that it is effective and safe to use PLRD for bowel preparation before colonoscopy.