291 Effect of Digital Patient Reinforcement With an Smartphone App on High Quality Colonoscopy Preparation in CRC Screening; Results From the Multicenter Coloprapp Study

Abstract

Background: The use of anti-foaming agent and mucolytics before esophagogastroduodenoscopy (EGD) as premedication may show a better mucosal visibility and improve the quality of endoscopy. Aim: To detect whether the combination of Simethicone with N-Acetyl Cysteine (NAC) as premedication before EGD improves mucosal visualization. Methods: The study population included 768 participants. They were randomized into four arms (Group A: Simethicone + N-Acetyl cysteine, Group B: Simethicone alone, Group C: N-Acetyl cysteine (NAC) alone and Group D: Placebo) using sealed envelopes. The participants were given 90 ml of solution (15ml emulsion + 75 ml of water). The participants and the endoscopist were blinded. After 20 minutes of consuming the solution, EGD done and multiple images from oesophagus, stomach and duodenum were obtained. The Total mucosal visibility score (TMVS), total duration of procedure and total number of lesions detected were calculated. Results: The study population included 57% males and the mean age was 44.18 years. Each group was randomized with 192 participants. TMVS was lowest in group-A with a score of 8.31 (P<0.05) than the other groups (B, C & D-9.93, 11.46 & 12.06 respectively). The score of mucous/bubbles obscuring the vision was significantly lower in group A with 78.16% of its participants compared to the other groups (B, C & D-67.7%, 50.52% and 38.85% respectively). The time duration to complete the procedure was also significantly less in group A compared to other groups. Eighty one percent of the participants in group A did not require flushing to clear the mucous/bubbles, which was the highest compared to other groups. Conclusion: Simethicone with NAC premedication had a better TMVS, reduced mucous/bubbles obscuring the vision, reduced total duration of procedure during the procedure. Hence, the usage of premedication with anti-foaming agents and mucolytics may improve the quality of EGD.

Colonoscopia de calidad, limpieza y preparación colónica

“…Educación: Múltiples estudios 15,16 demostraron la utilidad de estrategias educativas para el paciente como el envío de recordatorios mediante mensajes de texto automatizados mejoran la calidad de la limpieza intestinal, reduce la tasa de cancelaciones e incrementa la satisfacción de los pacientes, aunque otros estudios no encontraron diferencias significativas. El estudio prospectivo multicéntrico COLOPRAPP demostró que reforzar la educación del paciente mediante una aplicación para celular los 3 días previos al procedimiento mejoró la calidad de la preparación (BBPS 7.6 vs. 6.7; p < 0.0001), ADR (35 vs. 28%) y la detección de adenomas planos en colon derecho (p = 0.004) comparado con el grupo sin reforzamiento 17 .…”