Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis

Effect of the nursing process with standardized taxonomy on bowel cleansing prior to colonoscopy in outpatients

OBJECTIVE

The aim of this study was to examine the effect of the nursing process applied by using standard nursing terminologies on colonoscopy preparation of outpatients on bowel cleansing.

METHODS

The sample of the prospective, single-blind, randomized controlled study consisted of 116 patients (intervention n = 57, control n = 59). Both groups were interviewed face to face one week before the procedure day, nursing diagnoses were determined individually, and nursing outcome scales were employed as a baseline assessment. In the intervention group, the nursing process was applied to the patients with standard nursing terminology, training was given with an information booklet, and then the preparation instructions were reminded through telephone calls, text messages and instant messages. The adequacy of bowel cleansing was evaluated by the endoscopist using Boston Bowel Preparation Score (BBPS) who blindly performed the procedure for both groups.

RESULTS

The mean BBPS score of the intervention group was 7.00 ± 1.43, and the control group was 4.16 ± 2.15. A significant difference found between the rates of adequate preparation in the intervention group (82.5%) and in the control group (16.9%) (P < .05). A significant difference was found after the intervention in terms of nursing outcome scales (P < .05).

CONCLUSIONS

According to the study adequate preparation for the colonoscopy procedure can be achieved by applying the nursing process based on NANDA-I, NOC and NIC.

A randomized pilot study to evaluate the stability, taste, and palatability of a novel liquid formulation of tenapanor

OBJECTIVE

This pilot study aimed to develop a liquid formulation of tenapanor and evaluate taste and palatability with different sweetener and flavor combinations.

SIGNIFICANCE

Tenapanor is a first-in-class, minimally absorbed, small molecule inhibitor of intestinal sodium/hydrogen exchanger 3, indicated (as tablets) to treat adults with constipation-predominant irritable bowel syndrome. It is also approved as add-on therapy to reduce serum phosphorus in adults with chronic kidney disease on dialysis who are intolerant of, or unacceptably responsive to, any dose of phosphate binder therapy. Since many patients have difficulty swallowing pills and pediatric studies are underway, a liquid formulation was developed, and taste profiles were evaluated for overall acceptability.

METHODS

Formulation of liquid tenapanor targeted a concentration of 5 mg/mL, for a dosing range of 1-50 mg twice daily. Improvements in solubility and stability of tenapanor in water were investigated with the use of buffers, cosolvents, and preservatives. Seven liquid formulations with different sweetener/flavor combinations were assessed for taste and palatability by healthy adult participants using the sip-and-spit method in a randomized design.

RESULTS

An aqueous solution of tenapanor (5 mg/mL), pH 3.4, with 0.05 % (w/v) benzoic acid, was stable at 2-8 °C for 12 months. The formulation with sucralose and raspberry flavor had the greatest improvement in overall acceptability and taste when compared to the reference solution without sweeteners or flavors.

CONCLUSIONS

A suitable liquid formulation was identified for progression to patient studies.

Interventions to improve bowel cleansing in colonoscopy

INTRODUCTION

Suboptimal bowel preparation adversely affects colonoscopy quality, increases healthcare costs, and prolongs waiting time. The primary contributing factors include poor tolerance to the preparation solutions, noncompliance with prescribed instructions, and suboptimal efficacy of the bowel cleansing solution itself.

AREAS COVERED

This review examined the predictive factors associated with suboptimal bowel preparation and discussed interventions aimed at improving bowel cleansing. It also provides evidence-based practical algorithms supplemented by insights from our own clinical experience. Relevant topics were reviewed using resources from the PubMed database.

EXPERT OPINION

Although current bowel preparation protocols are effective for the majority of patients, a significant proportion still present challenges for optimal preparation. These patients may benefit from personalized strategies tailored to the specific causes of preparation failure. Conducting a thorough interview is crucial for identifying the reasons for failure, particularly in patients who have previously experienced suboptimal preparation during colonoscopy. In colonoscopy-naïve patients, it is essential to assess the risk of suboptimal preparation. In both cases, interventions should be customized to either address the identified causes in the former group or employ preventive strategies to reduce the likelihood of failure in the latter.

Dried lemon slices improve bowel cleansing quality of polyethylene glycol for colonoscopy preparation: randomized controlled trial

BACKGROUND

adequate bowel preparation is related to the quality of colonoscopy. Dried lemon slices can increase gastrointestinal peristalsis, which has shown potential as an adjuvant of bowel preparation. We hypothesized that the combination of dried lemon slices and polyethylene glycol (PEG) could improve the efficacy of bowel preparation and be more acceptable to participants.

AIM

to investigate the effectiveness of lemon slices combined with PEG for colonoscopy preparation.

METHODS

a prospective, single-center, randomized, controlled trial was performed of 521 patients randomly assigned to two groups. A total of 254 patients were given lemon slices based on conventional 4-L PEG treatment for the bowel, while 267 patients received only 4-L PEG treatment. Patients' basic information, procedure-related parameters, adverse effects, and subjective feelings were collected by questionnaires. Intestinal tract cleanliness was scored according to the Boston Bowel Preparation Scale (BBPS) by experienced endoscopists. Data were analyzed by the two-sample t-test or the Chi-squared test.

RESULTS

the BBPS scores were significantly higher in the PEG + lemon slice group (p < 0.05). The taste acceptability, satisfaction, and willingness to repeat bowel preparation were significantly higher in the PEG+ lemon slice group (p < 0.05). However, a larger proportion of patients from the PEG+ lemon slice group (30.7 %) suffered abdominal distension compared with the PEG group (20.6 %), while the incidence of other adverse effects was comparable between the two groups.

CONCLUSION

the addition of dried lemon slices to conventional PEG showed its superiority for bowel preparation.

Analysis of the Current Status and Factors Influencing Compliance with Colonoscopic Monitoring After Endoscopic Surgery for Advanced Colorectal Adenoma

Background

Advanced colorectal adenomas are at a risk of malignant transformation following endoscopic resection, and colonoscopic monitoring interval after polypectomy have been widely used. This study aims to investigate the prevailing state of compliance with postoperative colonoscopic surveillance among patients with advanced colorectal adenomas and its' influencing factors at Affiliated Hospital of Jiangnan University between November 2020 and April 2021.

Methods

A retrospective analysis was conducted on patients who underwent endoscopic treatment for ACA at Affiliated Hospital of Jiangnan University from November 2020 to April 2021. Compliance with postoperative colonoscopic surveillance was assessed based on established guidelines. Factors such as sociodemographic features, medical histories, and health beliefs were analyzed to determine their influence on compliance. Univariate analysis, survival analysis, and multi-factor Cox regression analysis were used for statistical evaluation.

Results

A total of 511 patients were included in the study. The compliance rate was found to be 43.2%. The univariate analysis indicated that factors such as gender, education level, work status, type of health insurance, place of residence, marital status, type of consultation, presence of gastrointestinal symptoms, number of polyps, and the maximum diameter of polyps significantly affected compliance. Multi-factor Cox regression analysis revealed that female gender, absence of gastrointestinal symptoms, outpatient endoscopic treatment, and solitary polyps were independent factors influencing compliance. Reasons for poor compliance included underestimating the severity of the disease, fear of colonoscopy, and procedural complexities.

Conclusion

Patients with advanced colorectal adenomas had poor compliance with postoperative colonoscopy monitoring. Tailored health education programs should be designed, targeting women, outpatients undergoing endoscopic procedures, and patients with solitary polyps to enhance their compliance with colonoscopy monitoring.

Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing?

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.

Novel frontiers of agents for bowel cleansing for colonoscopy

The incidence of colorectal cancer (CRC) is characterized by rapid declines in the wake of widespread screening. Colonoscopy is the gold standard for CRC screening, but its accuracy is related to high quality of bowel preparation (BP). In this review, we aimed to summarized the current strategy to increase bowel cleansing before colonoscopy. Newly bowel cleansing agents were developed with the same efficacy of previous agent but requiring less amount of liquid to improve patients’ acceptability. The role of the diet before colonoscopy was also changed, as well the contribution of educational intervention and the use of adjunctive drugs to improve patients’ tolerance and/or quality of BP. The review also described BP in special situations, as lower gastrointestinal bleeding, elderly people, patients with chronic kidney disease, patients with inflammatory bowel disease, patients with congestive heart failure, inpatient, patient with previous bowel resection, pregnant/lactating patients. The review underlined the quality of BP should be described using a validate scale in colonoscopy report and it explored the available scales. Finally, the review explored the possible contribution of bowel cleansing in post-colonoscopy syndrome that can be related by a transient alteration of gut microbiota. Moreover, the study underlined several points needed to further investigations.

The unmet needs for identifying the ideal bowel preparation

Colonoscopy, since it was first employed over 60 years ago, is now the gold standard method for visualizing the mucosa of the colon, but should be of good quality. Many factors affect quality, including the type of health service organization, type of facility, staff, equipment, patient characteristics, and bowel preparation (BP). The adequacy of bowel cleansing is critical, but, unfortunately, may be inadequate in up to one‐third of procedures. The current article will present and discuss the main BPs and their drawbacks, which include patient‐dependent and procedure‐dependent factors. Cleansing quality depends on the ease/complexity of solution preparation, volume, taste, and timing of consumption. Consequently, important positive factors include simple instructions, easy preparation of the solution, low volume, pleasant taste, short drinking time (e.g. <30 min), and splitting the dose between the evening before and the morning of the colonoscopy (or even better, only one dose in the early morning to avoid night‐time problems), and short onset of action. The BP solution must also be safe with negligible side effects. Furthermore, a positive experience supports patient willingness to repeat the procedure.

The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR

Introduction

In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation.

Aim

To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report).

Methods

Retrospective, single center, cohort study. Patients' demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed.

Results

We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001).

Conclusion

A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.