Effects of a Personalized Smartphone App on Bowel Preparation Quality: Randomized Controlled Trial

Abstract

Background Adequate bowel preparation is essential for the visualization of the colonic mucosa during colonoscopy. However, the rate of inadequate bowel preparation is still high, ranging from 18% to 35%; this may lead to a higher risk of missing clinically relevant lesions, procedural difficulties, prolonged procedural time, an increased number of interval colorectal carcinomas, and additional health care costs. Objective The aims of this study are to compare bowel preparation instructions provided via a personalized smartphone app (Prepit, Ferring B V) with regular written instructions for bowel preparation to improve bowel preparation quality and to evaluate patient satisfaction with the bowel preparation procedure. Methods Eligible patients scheduled for an outpatient colonoscopy were randomized to a smartphone app group or a control group. Both the groups received identical face-to-face education from a research physician, including instructions about the colonoscopy procedure, diet restrictions, and laxative intake. In addition, the control group received written information, whereas the smartphone app group was instructed to use the smartphone app instead of the written information for the actual steps of the bowel preparation schedule. All patients used bisacodyl and sodium picosulfate with magnesium citrate as laxatives. The quality of bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) by blinded endoscopists. Patient satisfaction was measured using the Patient Satisfaction Questionnaire-18. Results A total of 87 patients were included in the smartphone app group and 86 in the control group. The mean total BBPS score was significantly higher in the smartphone app group (mean 8.3, SD 0.9) than in the control group (mean 7.9, SD 1.2; P=.03). The right colon showed a significantly higher bowel preparation score in the smartphone app group (mean 2.7, SD 0.5 vs mean 2.5, SD 0.6; P=.04). No significant differences were observed in segment scores for the mean transverse colon (mean 2.8, SD 0.4 vs mean 2.8, SD 0.4; P=.34) and left colon (mean 2.8, SD 0.4 vs mean 2.6, SD 0.5; P=.07). General patient satisfaction was high for the smartphone app group (mean 4.4, SD 0.7) but showed no significant difference when compared with the control group (mean 4.3, SD 0.8; P=.32). Conclusions Our personalized smartphone app significantly improved bowel preparation quality compared with regular written instructions for bowel preparation. In particular, in the right colon, the BBPS score improved, which is of clinical relevance because the right colon is considered more difficult to clean and the polyp detection rate in the right colon improves with improvement of bowel cleansing of the right colon. No further improvement in patient satisfaction was observed compared with patients receiving regular written instructions. Trial Registration ClinicalTrials.gov NCT03677050; https://clinicaltrials.gov/ct2/show/NCT03677050

Research Progress of Bowel Preparation for Colonoscopy

“…With the development of science and technology, social media apps and public websites have also become a way to educate patients about bowel preparation. zander Team independently developed a smartphone application, patients can run the application on android or ios equipment, the application provides information and conventional hospital education content is very similar, but the way of information is more intuitive, namely according to the patient appointment colonoscopy time customization, provide patients need to achieve intestinal cleaning degree of low residue food image, laxative intake method and image, provide personalized intestinal preparation steps, the results showed that the quality of gut preparation was significantly better in the smartphone app population compared to the control group [5]. Guan Y Team uses WeChat, a smart Chinese instant messaging and social media application, let colonoscopy or their families in booking time scan or codes WeChat group, the medical staff WeChat group with text, pictures, videos telling the importance of intestinal preparation, dietary requirements, and diarrhea drug medication instructions, etc., the results show that using WeChat group, can improve the quality of intestinal preparation and increase the adenoma detection rate, shorten the total time of colonoscopy, and reduce the discomfort in intestinal preparation [6].…”

Advancements in AI Research for Digestive System Diseases

“…Further research has been conducted by scholars in this field. van der Zander [9] and others developed a smartphone application called Prepit (Ferring B V), which consists of six parts: colonoscopy examination date, educational tools, bowel preparation schedule, low-fiber diet examples, visually assisted preparation instructions, and examples of transparent liquid intake. They provided oral and written education to 86 patients while the remaining 87 patients followed the steps outlined in the smartphone application for bowel cleansing preparation.…”

Exploring the Use of Pictograms in Privacy Agreements to Facilitate Communication Between Users and Data Collecting Entities: Randomized Controlled Trial

“…Chief among these advantages is that pictograms can be more easily understood than their written counterparts [ 8 , 9 , 18 , 20 , 26 , 28 , 30 , 31 ]. When it comes to health care, pictograms have been shown to be better at informing patients about examination preparation [ 34 ].…”