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

Abstract

Background and study aims Bowel preparation for colonoscopy is frequently inadequate in hospitalized patients. We explored the impact of specific verbal instructions on the quality of inpatients bowel preparation and factors associated with preparation failure. Patients and methods Randomized (1:1), two strata (mobilized vs. bedridden; 3:2) trial of consecutive inpatients from four tertiary centers, who received either specific, verbal instructions or the standard of care (SOC) ward instructions about bowel preparation. The rate of adequate bowel preparation (Boston Bowel Preparation Score [BBPS] ≥ 6, no segment < 2) comprised the primary endpoint. Mean BBPS score, good (BBPS score ≥ 7, no segment score < 2) and excellent (BBPS = 9) were among secondary endpoints. Results We randomized 300 inpatients (180 mobile) aged 71.7 ± 15.1 years in the intervention (49.7 %) and SOC (50.3 %) groups, respectively. Overall, more patients in the intervention group achieved adequate bowel preparation, but this difference did not reach statistical significance neither in the intention-to-treat [90/149 (60.4 %) vs. 82/151 (54.3 %); P = 0.29] nor in the per-protocol analysis [90/129 (69.8 %) vs. 82/132 (62.1 %); P = 0.19]. Overall BBPS score did not differ statistical significantly in the two groups, but the provision of specific verbal instructions was associated with significant higher rates of good (58.1 % vs. 43.2 %; P = 0.02) and excellent (31.8 % vs. 16.7 %; P = 0.004) bowel preparation compared to the SOC group. Administration of same-day bowel preparation and patient American Society of Anesthesiologists score > 2 were identified as risk factors for inadequate bowel preparation. Conclusions Provision of specific verbal instructions did not increase the rate of adequate bowel preparation in a population of mobilized and bedridden hospitalized patients.

Optimizing bowel preparation for colonoscopy: A cross-sectional study of the Chinese population

“…First, it was conducted at a single center and was a single-arm, retrospective study, which may cause bias of the results. Second, it has demonstrated that patient-related factors like drugs intake, previous abdominal surgery, and chronic constipation may be associated with an increased risk of inadequate preparation; nevertheless, we did not enroll these factors, which may influence the accuracy of the results (26)(27)(28)(29). Third, past research showed that poor patient compliance may also cause inadequate bowel preparation (30).…”

Comparative Performance and External Validation of Three Different Scores in Predicting Inadequate Bowel Preparation Among Inpatients Undergoing Colonoscopy

“…For 2 of them (models A and C [6,8]), the cutoff value that most accurately predicts the inadequate bowel preparation is provided, while for the third one (model B [7]) an online calculator predicting the probability of inadequate bowel preparation for each patient is available. For the purposes of this study, the raw data of a previous prospective randomized (1:1), 2 strata (mobilized vs. bedridden; 3:2) trial of consecutive inpatients from 4 tertiary centers in Greece, evaluating the role of simple and specific verbal instructions in improving the bowel preparation of inpatients (mobilized and bedridden, defined as in previous iterations [9,10]) undergoing colonoscopy were assessed to calculate the respective values for each score/model [10]. The protocol of the study was approved by the Attikon University General Hospital Ethics Committee (EBΔ 1677/6-7-16) and is available in the ClinicalTrials.gov registry (NCT02887014).…”

“…Patients enrolled in the original validation cohort received bowel cleansing with 4 L of polyethylene glycol solution along with a 2-day low-fiber diet, followed by a clear liquid diet the day before the colonoscopy. Bowel preparation was administered either as split doses or as same day (day before) dosing, according to the time of the colonoscopy (morning or afternoon examinations), while all examinations were performed 4-6 h after the intake of cathartics was completed [10]. Each model's comportments and cutoff values, as well as the main characteristics of their derivation/ validation cohort and their efficacy in predicting the quality of bowel preparation are depicted in Table 1.…”

“…This approach is supported by simulation studies [15], assuming equal outcome prevalence in the development and validation datasets. Based on the suggestion that at least 100 events and 100 non-events for statistical tests have "reasonable power" in an external sample [16], a sample size of 261 patients would be deemed adequate [10] test. In addition, the following parameters were calculated as measures of the scores' performance: 1.…”

Koloskopievorbereitung bei Patienten mit Diabetes mellitus: Entwicklung einer Handlungsempfehlung

“…Neben der Wahl des Abführmittels und der Frage welcher Zeitpunkt der Einnahme günstig ist, ist die Art der Aufklärung zur Darmvorbereitung wichtig [26]. In einer kürzlich veröffentlichten Studie erhielten die Patienten 4 Liter einer PEG-Lösung, gemeinsam mit einer zweitägigen ballaststoffarmen Kost und einer flüssigen Kost am Tag vor der Koloskopie.…”