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Zhang YY, Vimala R, Chui PL, Hilmi IN. A Systematic Review of Exercise Therapy for Bowel Preparation: Evidence to Guide Practice. Gastroenterol Nurs 2023; 46:393-403. [PMID: 37347807 DOI: 10.1097/sga.0000000000000759] [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: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000-10,000 steps or 0.5-1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.
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Affiliation(s)
- Yuan-Yuan Zhang
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ramoo Vimala
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ping Lei Chui
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ida Normiha Hilmi
- Yuan-Yuan Zhang, MSN, RN, PhD candidate, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; and Lecturer, School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu, China
- Ramoo Vimala, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ping Lei Chui, PhD, RN, is Senior Lecturer, Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Ida Normiha Hilmi, PhD, RPH, is Professor, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Wang K, Xu WT, Kou WJ, Qi XS. Factors affecting cecal intubation time during colonoscopy. Shijie Huaren Xiaohua Zazhi 2023; 31:105-112. [DOI: 10.11569/wcjd.v31.i3.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In recent years, the morbidity and mortality of colorectal cancer (CRC) have increased significantly in China, and it has become one of the major malignancies that threaten the health of residents. Colonoscopy is the gold standard for the diagnosis of CRC. High-quality colonoscopy can effectively reduce the mortality of CRC. Cecal intubation time (CIT) is one of the indicators to reflect the quality of colonoscopy. Studies have found that many factors can affect CIT. This paper reviews the literature to identify the factors that affect CIT, such as those related to doctors, patients, assistive technologies, and equipment, in order to improve the quality of colonoscopy performed by endoscopists.
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Affiliation(s)
- Ke Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Wen-Tao Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
| | - Wen-Jing Kou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Archer T, Shirazi-Nejad AR, Al-Rifaie A, Corfe BM, Riley S, Thoufeeq M. Is it time we split bowel preparation for all colonoscopies? Outcomes from a national survey of bowel preparation practice in the UK. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000736. [PMID: 34610925 PMCID: PMC8493910 DOI: 10.1136/bmjgast-2021-000736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/08/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Adequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes. Methods Trusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ2 test was used to assess for differences in bowel preparation adequacy. Results Moviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate. Conclusion Most trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.
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Affiliation(s)
- Thomas Archer
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK .,Molecular Gastroenterology Research Group, Department of Oncology & Metabolism, The University of Sheffield, Sheffield, UK
| | - Ahmad Reza Shirazi-Nejad
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ammar Al-Rifaie
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bernard M Corfe
- Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Riley
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Goksoy B, Kiyak M, Karadag M, Yilmaz G, Azamat IF. Factors Affecting Cecal Intubation Time in Colonoscopy: Impact of Obesity. Cureus 2021; 13:e15356. [PMID: 34094787 PMCID: PMC8169101 DOI: 10.7759/cureus.15356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aims to determine the factors that prolong cecal intubation time (CIT) and determine the effect of obesity on CIT measured using multiple indexes. Methods Patients who underwent elective colonoscopy between July 10, 2020, and January 20, 2021, were evaluated in this prospective observational study. Age, gender, constipation, bowel preparation, presence of diverticulosis, previous surgery history, auxiliary maneuver and additional analgesic requirement, cecum intubation length (CL) and obesity indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR)] were analyzed. Factors affecting CIT were assessed by both univariate and multivariate logistic regression (LR) analyses. Results A total of 512 patients were analyzed. Mean CIT was 5.6 ± 1.6 min, and median CIT was 5.17 min. The CIT median was ≤5.17 min in 264 (51.5%) of the patients, and the CIT median was >5.17 min in 248 (48.5%). In the univariate LR results, young age, constipation, poor bowel preparation, increased CL, additional analgesic requirement, low WHtR, and low BMI (<25 kg/m2) were the factors that prolonged CIT (p <0.05). In the multivariate LR analysis results, WHtR >0.5 and BMI >30 kg/m2 were found to be independent factors that decrease CIT [OR: 0.01 (0.01 0.03) p <0.001; OR: 0.28 (0.13 0.57) p <0.001]. Conclusion Younger age, low WHtR, low BMI, increased CL, constipation, inadequate bowel preparation, and the use of extra analgesics were found to be associated with longer CIT. When all factors were evaluated together, obesity measured by only WHtR (>0.5) and BMI (>30 kg/m2) were the best predictors of decreased CIT.
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Affiliation(s)
- Beslen Goksoy
- General Surgery, Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences, İstanbul, TUR
| | - Mevlut Kiyak
- Gastroenterology, Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Mehmet Karadag
- Biostatistics, School of Medicine, University of Hatay Mustafa Kemal, Hatay, TUR
| | - Gokhan Yilmaz
- General Surgery, Istanbul Medipol University, Istanbul, TUR
| | - Ibrahim F Azamat
- General Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, TUR
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Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy: A Meta-analysis. Gastroenterol Nurs 2021; 44:E29-E37. [PMID: 33795626 DOI: 10.1097/sga.0000000000000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
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.
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