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Yang X, Xiao Y, Zhao Z, Yu S, Liu E, Xiao X, Ning S, Zheng S, Gong Y, Zhou L, Liu W, Lin H, Ji R, Zhang H, Bai J, Yang S. A novel strategy for improving bowel preparation based on social software-enhanced education: A prospective, multicenter, randomized controlled study. J Gastroenterol Hepatol 2024. [PMID: 39004797 DOI: 10.1111/jgh.16659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
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.
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Affiliation(s)
- Xin Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yufeng Xiao
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhifeng Zhao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shen Yang, China
| | - Shuang Yu
- Department of Gastroenterology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - En Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiao Xiao
- Department of Gastroenterology, Chongqing University Central Hospital, Chongqing, China
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
| | - Suyun Zheng
- Department of Gastroenterology, Qujing City First People's Hospital, Qujing, China
| | - Yanan Gong
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Lei Zhou
- Department of Gastroenterology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hui Lin
- Department of Epidemiology, Army Medical University, Chongqing, China
| | - Rui Ji
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Heng Zhang
- Department of Gastroenterology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianying Bai
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shiming Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
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Farid N, Sharifian S, Ghafouri R. Evaluation of the effect of reinforced education on the satisfaction of patients undergoing colonoscopy: A randomized controlled trial. PLoS One 2024; 19:e0296126. [PMID: 38180990 PMCID: PMC10769074 DOI: 10.1371/journal.pone.0296126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/02/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Fourteen million colonoscopies are performed annually in the United States, with the results dependent on bowel preparation before the procedure. However, suitable preparation is neglected in 20-25% of cases, resulting in increased loss of time, failure to diagnose, procedure repetition, and decreased patient satisfaction. Consequently, the current study was performed to evaluate the effect of reinforced education (RE) on the satisfaction of patients undergoing colonoscopy. METHODS This study employed an experimental research method. Participants included 83 patients referred to Ayatollah Taleghani Medical Educational Center for colonoscopy, who were divided into control and intervention groups. The control group received standard education, whereas the intervention group received instruction via media and virtually, and preparation was followed up on the day before the colonoscopy. The research tool was a demographic and satisfaction questionnaire developed by the researcher. Analyses were conducted using IBM SPSS software (v. 20). RESULTS Eighty-three patients, including 47 men and 36 women with an average age of 49.19 years, participated in the study. Mean (standard deviation) patient satisfaction was 11.78 (4.65) in the intervention group and 9.04 (2.95) in the control group; the independent t-test revealed a significant difference between the two groups (P<0.001). CONCLUSIONS The study suggests that reinforced education using media and virtual means is effective in the satisfaction of patients undergoing colonoscopy.
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Affiliation(s)
- Negin Farid
- Student Research Committee, Department of Medical Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shakila Sharifian
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Raziyeh Ghafouri
- Department of Medical and Surgical, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gimeno-García AZ, Benítez-Zafra F, Nicolás-Pérez D, Hernández-Guerra M. Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1834. [PMID: 37893552 PMCID: PMC10608636 DOI: 10.3390/medicina59101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Proper bowel preparation is of paramount importance for enhancing adenoma detection rates and reducing postcolonoscopic colorectal cancer risk. Despite recommendations from gastroenterology societies regarding the optimal rates of successful bowel preparation, these guidelines are frequently unmet. Various approaches have been employed to enhance the rates of successful bowel preparation, yet the quality of cleansing remains suboptimal. Intensive bowel preparation techniques, supplementary administration of bowel solutions, and educational interventions aimed at improving patient adherence to instructions have been commonly utilized, particularly among patients at a high risk of inadequate bowel preparation. Expedited strategies conducted on the same day as the procedure have also been endorsed by scientific organizations. More recently, the utilization of artificial intelligence (AI) has emerged for the preprocedural detection of inadequate bowel preparation, holding the potential to guide the preparation process immediately preceding colonoscopy. This manuscript comprehensively reviews the current strategies employed to optimize bowel cleansing, with a specific focus on patients with elevated risks for inadequate bowel preparation. Additionally, the prospective role of AI in this context is thoroughly examined. CONCLUSIONS While a majority of outpatients may achieve cleanliness with standard cleansing protocols, dealing with hard-to-prepare patients remains a challenge. Rescue strategies based on AI are promising, but such evidence remains limited. To ensure proper bowel cleansing, a combination of strategies should be performed.
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Mohammed RA, Lafi SY. The Effectiveness of a Low-Cost Personalized Educational Program on the Quality of Bowel Cleansing Among Patients Undergoing a Colonoscopy. Gastroenterol Nurs 2022; 45:335-341. [PMID: 35833735 DOI: 10.1097/sga.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
In relation to endoscopic practices, particularly a colonoscopy, patient education is required to maximize the quality of bowel preparation. Thus, the intention of this study is to examine how personalized patient education prior to a colonoscopy influences the quality of bowel preparation. A quasi-experimental post-test design was employed at the Kurdistan Center for Gastroenterology Hepatology and the Ebin Sina Center in Iraq from December 21, 2019, to September 30, 2020. Of 270 participants, 219 were selected for data analysis. The mean age ( SD ) of the participants was 41.18 (15.22), with a median of 41 years and a slightly higher percentage (58.4%) of females in comparison with males (41.6%). The bowel preparation quality of the control and intervention groups in the two centers was based on the Boston Bowel Preparation Scale scores and there was a significant difference ( p < .001) of M ± SD between the control (5.79 ± 1.123) and experimental (7.52 ± 1.225) groups. Findings suggest a personalized educational program is having a significant impact on increasing the quality of bowel preparation.
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Affiliation(s)
- Ribwar A Mohammed
- Ribwar A. Mohammed, PhD, MSc, BSc, is Lecturer and Researcher, College of Nursing, University of Raparin
- Samir Y. Lafi, PhD, MSc, BSc, is Professor, College of Nursing, University of Raparin
| | - Samir Y Lafi
- Ribwar A. Mohammed, PhD, MSc, BSc, is Lecturer and Researcher, College of Nursing, University of Raparin
- Samir Y. Lafi, PhD, MSc, BSc, is Professor, College of Nursing, University of Raparin
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Arslanca G, Aygün M. Effect of nurse-performed enhanced patient education on colonoscopy bowel preparation quality. Rev Lat Am Enfermagem 2022; 30:e3626. [PMID: 35976357 DOI: 10.1590/1518-8345.5597.3626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/05/2022] [Indexed: 12/09/2022] Open
Abstract
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.
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Affiliation(s)
- Gamze Arslanca
- Prof. Dr. Cemil Taşcıoğlu City Hospital, Colonoscopy Department, Istanbul, Turquia
| | - Mahmure Aygün
- Biruni University, Graduate Education Institute Nursing Program, Istanbul, Turquia
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Chiu YT, Kuo CY, Lee FJ, Chang CY. Dedicated staff for patient education improves bowel preparation quality and reduces the cecal intubation time of colonoscopy: A single institution retrospective study. Medicine (Baltimore) 2022; 101:e29437. [PMID: 35866774 PMCID: PMC9302250 DOI: 10.1097/md.0000000000029437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Adequate bowel preparation is an essential part of a high-quality colonoscopy. Recent studies showed that the small-volume bowel cleansing agent Bowklean performs better in terms of tolerability and acceptability. However, its split-dose regimen is sometimes confusing to the patient. To promote Bowklean in Fu Jen Catholic University Hospital, dedicated staff for patient education on bowel preparation were provided by Universal Integrated Corporation (Taiwan), but not in every period because of the clinic room availability and manpower capacity. This provided us an opportunity to compare the quality of colonoscopy between those with and without the dedicated patient education. This study aimed to compare various quality indices between the two groups. We set bowel preparation quality as the primary endpoint, assessed by modified Aronchick scale, and other quality indices including procedure time and adenoma detection rate as the secondary endpoints. We performed a single institution retrospective study. All patients who received colonoscopy from an outpatient setting with Bowklean as the bowel cleansing agent from October 2020 to November 2020 were reviewed. Primary and secondary endpoints were then compared between the conventional group and the dedicated staff group, with StataSE 14 by Wilcoxon rank sum test or logistic regression. Four hundred ten patients were recruited, including 217 patients with dedicated patient education and 193 without. The proportion of bowel preparation quality "Excellent + Good + Fair" was significantly higher in dedicated staff group than conventional group (97.7% vs 93.3%, P = .03; logistic regression coefficient = 1.12). The cecal intubation time was significantly shorter in the dedicated staff group (3.68 ± 2.02 minutes vs 4.52 ± 3.25 minutes, P < .01). After excluding those with polypectomy or biopsy, the total procedure time tended to be shorter in the dedicated staff group (10.2 ± 3.35 minutes vs 9.40 ± 2.43 minutes, P = .06). There was no significant difference regarding adenoma detection rate between the two groups. Our study shows that patient education by dedicated staff can improve bowel preparation quality and has the potential to decrease procedure time. Further large-scale prospective trials are still needed to evaluate if it can also achieve a better adenoma detection rate.
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Affiliation(s)
- Yu-tse Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University, Hospital, New Taipei City, Taiwan
- *Correspondence: Yu-tse Chiu, No. 69, Guizi Road, Taishan District, New Taipei City 243089, Taiwan (R.O.C.) (e-mail: )
| | - Chen-Ya Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University, Hospital, New Taipei City, Taiwan
| | - Fu-Jen Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University, Hospital, New Taipei City, Taiwan
| | - Chi-Yang Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University, Hospital, New Taipei City, Taiwan
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Lam TY, Wu PI, Tang RS, Tse Y, Lau JY, Wu JC, Sung JJ. Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial. Int J Nurs Stud 2022; 133:104301. [DOI: 10.1016/j.ijnurstu.2022.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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Peng S, Liu S, Lei J, Ren W, Xiao L, Liu X, Lü M, Zhou K. Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials. PLoS One 2022; 17:e0266780. [PMID: 35446863 PMCID: PMC9023061 DOI: 10.1371/journal.pone.0266780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Shicheng Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sixu Liu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiaming Lei
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wensen Ren
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lijun Xiao
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaolan Liu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Muhan Lü
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- * E-mail: (KZ); (ML)
| | - Kai Zhou
- Department of Emergency, Affiliated Hospital of Southwest Medical University, Luzhou, China
- * E-mail: (KZ); (ML)
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Arslanca G, Aygün M. Effect of nurse-performed enhanced patient education on colonoscopy bowel preparation quality. Rev Lat Am Enfermagem 2022. [PMID: 35976357 PMCID: PMC9364776 DOI: 10.1590/1518-8345.5597.3627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
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.
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Arslanca G, Aygün M. Los efectos de la educación perfeccionada, realizada por enfermeros en la calidad de la preparación intestinal para colonoscopia. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5597.3628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
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.
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Tian X, Yi LJ, Han Y, Chen H, Liu XL, Chen WQ, Jiménez-Herrera MF. Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials. J Med Internet Res 2021; 23:e19915. [PMID: 34694227 PMCID: PMC8576559 DOI: 10.2196/19915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/13/2020] [Accepted: 03/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed. Objective We performed a network meta-analysis to determine the optimal instructions. Methods We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence. Results We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR). Conclusions Newly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. Trial Registration INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/
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Affiliation(s)
- Xu Tian
- Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Yang Han
- Chongqing University Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing University Cancer Hospital, Chongqing, China
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Efficacy of macrogol 4000 plus electrolytes in bowel preparation for colonoscopy in patients with chronic constipation. BMC Gastroenterol 2021; 21:387. [PMID: 34666685 PMCID: PMC8527605 DOI: 10.1186/s12876-021-01976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022] Open
Abstract
Background Chronic constipation is a significant factor in poor bowel preparation for colonoscopy. Macrogol 4000 plus electrolytes (Movicol, EA Pharma, Tokyo, Japan), containing polyethylene glycol (PEG) and electrolytes, have been used recently to treat patients with constipation. However, prospective studies on the use of macrogol 4000 for bowel cleansing for colonoscopy are lacking. This study aimed to investigate the efficacy and safety of macrogol 4000 in addition to PEG administered in patients with chronic constipation. Methods This single-center, single-arm prospective study enrolled patients with chronic constipation who were scheduled to undergo colonoscopy. The primary endpoint was the proportion of good bowel preparation assessed using the Boston bowel preparation scale (BBPS) (6 or more points). The secondary endpoints were the time from when pPEG (MoviPrep, EA Pharma, Tokyo, Japan) was taken until colonoscopy could be started, amount of PEG taken, number of defecations, whether additional PEG doses were taken, and adverse events. Endoscopy-related endpoints included cecal intubation rate, insertion time, observation time, adenoma detection rate (ADR), and polyp detection rate (PDR). The tolerability of PEG and macrogol 4000 was assessed using a questionnaire. Results Forty patients were included in the analysis. The median BBPS was 7 (range 3–9) and ≥ 6 points in 37 cases (92.5%). The median time until colonoscopy can be started was 210 min (90–360 min), the median volume of PEG taken was 1500 mL (1000–2000 mL), and the median number of defecations was 7 (3–20). No adverse events were observed. Fourteen patients required an additional dose of PEG. Cecal intubation was achieved in all cases, the median insertion time was 6.0 min (range 2.3–22 min), and the median observation time was 8.8 min (range 4.0–16.0 min). The ADR and PDR were 60.0% and 75.0%, respectively. A proportion of patients rated the tolerability of macrogol 4000 and PEG as 95.0% and 50.0%, respectively. Conclusions Intake of macrogol 4000 in addition to PEG is effective and safe for colonoscopy in patients with chronic constipation. Clinical trial registration statement This study was registered in the UMIN-CTR database (UMIN-ID000038315).
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Determination of the Effectiveness of Informing With the Guidance of an Education Booklet in Patients Undergoing Colonoscopy-A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:502-507. [PMID: 32451203 DOI: 10.1016/j.jopan.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/09/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of precolonoscopy information with the guidance of an education booklet on anxiety and bowel preparation adequacy in patients undergoing colonoscopy. DESIGN A randomized controlled study. METHODS The education group was informed face to face by the researcher with the guidance of the colonoscopy education booklet and provided the education booklet. The control group received usual care. FINDINGS The mean state and trait anxiety scores of the patients in the education group were found to be significantly lower than the control group. In the education group, the bowel preparation adequacy was determined to be higher compared with the control group. CONCLUSIONS Informing patients with the guidance of the education booklet before the colonoscopy decreased patients' state and trait anxiety levels and increased their bowel preparation adequacy.
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Guo X, Li X, Wang Z, Zhai J, Liu Q, Ding K, Pan Y. Reinforced education improves the quality of bowel preparation for colonoscopy: An updated meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0231888. [PMID: 32343708 PMCID: PMC7188205 DOI: 10.1371/journal.pone.0231888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background and aims Inadequate bowel preparation (BP) is an unfavorable factor that influence the success of colonoscopy. Although standard education (SE) given to patients are proved useful to avoid inadequate BP. Studies concerning the effects of reinforced education (RE) on the quality of BP were inconsistent. The aim of this updated meta-analysis of randomized controlled trial was to compare the quality of BP between patients receiving RE in addition to SE and those receiving SE alone. Methods MEDLINE, EMBASE, Web of Science and the Cochrane Library were systemically searched to identify the relevant studies published through April 2019. The primary outcome was the rate of adequate BP. Subgroup analyses were conducted. Secondary outcomes included BP score, adenoma detection rate (ADR), polyp detection rate (PDR), insertion time, withdrawal time, adverse events, >80% purgative intake and diet compliance. Dichotomous variables were reported as odds ratio (OR) with 95% confidence interval (CI). Continuous data were reported as mean difference (MD) with 95%CI. Pooled estimates of OR or MD were calculated using a random-effects model. Statistical heterogeneity was accessed by calculating the I2 value. A P value less than 0.05 was considered significant. Results A total of 18 randomized controlled trails (N = 6536) were included in this meta-analysis. Patients who received RE had a better BP quality than those only receiving SE (OR 2.59, 95%CI: 2.09–3.19; P<0.001). A higher ADR (OR 1.35; 95%CI: 1.06–1.72; P = 0.020) and PDR (OR 1.24, 95%CI: 1.02–1.50; P = 0.030), shorter insertion (MD -0.76; 95%CI: -1.48-(-0.04); P = 0.040) and withdrawal time (MD -0.83; 95%CI: -1.83-(-0.28); P = 0.003), less nausea/vomiting (OR 0.78; 95%CI: 0.64–0.97; P = 0.020) and abdominal distension (OR 0.72; 95%CI: 0.68–0.92; P = 0.020) were achieved in the RE group. More patients had >80% purgative intake (OR 2.17; 95%CI, 1.09–4.32; P = 0.030) and were compliant with diet restriction (OR 2.38; 95%CI: 1.79–3.17; P<0.001) in the RE group. Conclusion RE significantly improved BP quality, increased ADR and PDR, decreased insertion and withdrawal time and adverse events.
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Affiliation(s)
- Xiaoyang Guo
- Department of Ultrasound, The 305 Hospital of PLA, Bejing, China
- Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | - Xin Li
- Department of Pneumology, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Zhiyan Wang
- Department of Pneumology, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Junli Zhai
- Department of Pneumology, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Qiang Liu
- Department of Ultrasound, The 305 Hospital of PLA, Bejing, China
| | - Kang Ding
- Department of Ultrasound, The 305 Hospital of PLA, Bejing, China
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
- * E-mail:
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Taveira F, Areia M, Elvas L, Alves S, Brito D, Saraiva S, Cadime AT. A 3-day low-fibre diet does not improve colonoscopy preparation results compared to a 1-day diet: A randomized, single-blind, controlled trial. United European Gastroenterol J 2019; 7:1321-1329. [PMID: 31839957 DOI: 10.1177/2050640619883176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023] Open
Abstract
Background Although a 1-day low-fibre diet before colonoscopy is currently recommended, some endoscopists prescribe a 3-day diet. Objective The objective of this study was to compare the influence of a 3-day versus a 1-day low-fibre diet on bowel preparation quality, patient tolerability and adherence. Methods Outpatients scheduled for total colonoscopy were randomized in two groups, 3-day versus 1-day low-fibre diet, performing a 4-litre polyethylene glycol split-dose. The primary outcome was a reduction of inappropriate preparations in the 3-day low-fibre diet arm from 15% to 5% (bowel preparation was assessed by the Boston Bowel Preparation Scale). Secondary outcomes were adherence to, difficulty to perform, difficulty to obtain and willingness to repeat the diet. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. Results A total of 412 patients were randomized (206 per group). Bowel preparation quality was similar between groups. On ITT analysis (n = 412), adequate bowel preparation was 91.7% (3-day diet) versus 94.7% (1-day diet), p = 0.24 and on PP analysis (n = 400) 93.5% versus 96.5%, respectively, p = 0.16. Difficulty to perform the diet was significantly higher on the 3-day diet, p = 0.04. No differences were found on difficulty to obtain the diet, willingness to repeat the diet, adverse events and intra-colonoscopy findings. Conclusion A 3-day low-fibre diet does not bring benefit to the bowel preparation quality and is harder to perform than a 1-day diet.
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Affiliation(s)
- Filipe Taveira
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Elvas
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Susana Alves
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Daniel Brito
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sandra Saraiva
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Ana T Cadime
- Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
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Hernández G, Gimeno-García AZ, Quintero E. Strategies to Improve Inadequate Bowel Preparation for Colonoscopy. Front Med (Lausanne) 2019; 6:245. [PMID: 31781565 PMCID: PMC6857107 DOI: 10.3389/fmed.2019.00245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
Bowel cleansing is one of the most important parameters included in the evaluation of colonoscopy quality. The available evidence suggests that inadequate bowel preparation reduces the diagnostic yield of colorectal neoplasia and increases post-colonoscopy colorectal cancer risk. Nowadays, up to 30% of patients referred for colonoscopy have a poor bowel cleansing. Recently, several studies have analyzed the risk factors for inadequate bowel cleansing as well as the strategies to optimize bowel preparation. In this review, we have focused on summarizing the available evidence in this field.
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Affiliation(s)
- Goretti Hernández
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Antonio Z Gimeno-García
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Enrique Quintero
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.,Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Strategies to optimise the quality of bowel cleansing. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:326-338. [PMID: 31027972 DOI: 10.1016/j.gastrohep.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022]
Abstract
Colonoscopy is the gold standard procedure for detecting neoplastic lesions of the colon and its efficiency is closely linked to the quality of the procedure. Adequate bowel preparation is a crucial factor in achieving the recommended quality indicators, but poor preparation has been reported in up to 30% of outpatients referred for colonoscopy. Consequently, over recent years, a number of studies have developed strategies to optimise bowel cleansing by improving adherence and tolerance to and the efficacy of the bowel preparation. Moreover, the identification of risk factors for inadequate bowel cleansing has led to tailored bowel preparation strategies being designed, with promising results. We aimed to review studies that assessed risk factors for inadequate bowel preparation and strategies to optimise bowel cleansing in patients at high risk of having poor preparation.
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Taveira F, Areia M, Elvas L, Alves S, Brito D, Saraiva S, Cadime AT. Quality in Colonoscopy: Beyond the Adenoma Detection Rate Fever. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 24:211-218. [PMID: 29255755 DOI: 10.1159/000478940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/20/2017] [Indexed: 01/04/2023]
Abstract
Background Colonoscopy quality is a hot topic in gastroenterological communities, with several actual guidelines focusing on this aspect. Although the adenoma detection rate (ADR) is the single most important indicator, several other metrics are described and need reporting. Electronic medical reports are essential for the audit of quality indicators; nevertheless, they have proved not to be faultless. Aim The aim of this study was to analyse and audit quality indicators (apart from ADR) using only our internal electronic endoscopy records as a starting point for improvement. Methods An analysis of electronically recorded information of 8,851 total colonoscopies from a single tertiary centre from 2010 to 2015 was performed. Results The mean patient age was 63.4 ± 8.5 years; 45.5% of them were female, and in 14.6% sedation was used. Photographic documentation was done in 98.4% with 10.7 photographs on average, and 37.4% reports had <8 pictures per exam. Bowel preparation was rated as adequate in 67%, fair in 27% and inadequate in 4.9% of cases. The adjusted caecal intubation rate (CIR) was 92%, while negative predictors were inadequate preparation (OR 119, 95% CI 84-170), no sedation (OR 2.39, 95% CI 1.81-3.15), female gender (OR 1.61, 95% CI 1.38-1.88) and age ≥65 years (OR 1.56, 95% CI 1.34-1.82). In 28% of patients, a snare polypectomy was performed, correlating with adequate preparation (OR 5.75, 95% CI 3.90-8.48), male gender (OR 1.82, 95% CI 1.64-2.01) and age ≥65 years (OR 1.25, 95% CI 1.13-1.37; p < 0.01) as positive predictors. An annual evolution was observed with improvements in photographic documentation (10.7 vs. 12.9; p < 0.001), CIR (91 vs. 94%; p = 0.002) and "adequate" bowel preparation (p = 0.004). Conclusions: There is much more to report than the ADR to ensure quality in colonoscopy practice. Better registry systematization and integrated software should be goals to achieve in the short term.
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Affiliation(s)
- Filipe Taveira
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal
| | - Miguel Areia
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Elvas
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal
| | - Susana Alves
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal
| | - Daniel Brito
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal
| | - Sandra Saraiva
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal
| | - Ana Teresa Cadime
- Department of Gastroenterology, Portuguese Oncology Institute, Coimbra, Portugal
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