Educational strategies for colonoscopy bowel prep overcome barriers against split‐dosing: A randomized controlled trial

Abstract

Background: A split-dose (SD) regimen is crucial for colonoscopy quality. Compliance with SD for early morning colonoscopy is generally poor. The present study evaluated whether pre-colonoscopy counselling, in addition to a dedicated leaflet, might increase SD uptake. Methods: Consecutive 50-69-year-old patients undergoing screening colonoscopy before 10 a.m. were randomized to either receive written information only on bowel preparation (Written Group, WG) or written and oral instructions (Written and Oral Group, WaOG). The leaflet strongly encouraged SD adoption. The primary endpoint was the number of patients adopting SD in each group. The secondary endpoints were predictors of SD uptake, compliance with preparation schemes and cleansing adequacy. Results: A total of 286 patients (143 WG, 143 WaOG) were enrolled (mean age 59.6 AE 6.1 years, men 49.3%). SD was adopted by 114 and 125 patients in the WG and WaOG, respectively (79.7% versus 87.4%, p ¼ 0.079). No significant differences were observed for the proportion of patients with full compliance with preparation scheme (97.9% versus 97.2%, p ¼ 0.99) and of procedures with adequate bowel cleansing (95.6% versus 95.1%, p ¼ 0.77). At multivariate analysis, a > 1 h travel time to the endoscopy service was inversely correlated with SD uptake (odds ratio (OR) 0.30, 95% confidence interval (CI) 0.09-0.98). Conclusions: Our leaflet guaranteed satisfactory uptake of SD and excellent adherence to the preparation scheme for early morning colonoscopy. Its use might marginalize the need for additional oral instructions, particularly in open-access settings.

Impact of simple, specific, verbal instructions on the quality of bowel preparation in hospitalized patients undergoing colonoscopy: a multicenter randomized controlled trial

“…In this sense, the rationale of education seems extremely valuable for mobilized patients, who perhaps should be the principal target for healthcare practices. A recent RCT showed that mobilized outpatients receiving written or written and oral instructions achieved high rates of compliance with the preparation schema (split-dose) and consequently adequate bowel cleansing 20 .…”

The Impact of Patient Education Level on Split-Dose Colonoscopy Bowel Preparation for CRC Prevention

“…It has been found that 10-min conversations surrounding preparation details given along with written instructions significantly improve the quality of BP when compared to the absence of counseling sessions [ 10 , 20 ]. Further studies found that written instruction leaflets were better than verbal BP instructions [ 21 ]. Additional research and intervention are needed to define the best approaches to closing this gap in understanding.…”

Endoscopy and central reading in inflammatory bowel disease clinical trials: achievements, challenges and future developments

“…6 The practical consequence is that they may have a suboptimal prep, but better education may help. 7 Head-to-head studies of bowel preps have only recently become available. Gu et al found in a large non-commercial 'real-world' prospective multicenter trial with 4339 colonoscopies and 75 endoscopists that MiraLAX with Gatorade, Movi-Prep and Suprep were associated with superior tolerability and bowel cleansing.…”

“… 6 The practical consequence is that they may have a suboptimal prep, but better education may help. 7 …”