Reinforced education improves the quality of bowel preparation for colonoscopy: An updated meta-analysis of randomized controlled trials

Guo, Xiaotong; Li, Xin; Wang, Zhiyan; Zhai, J; Liu, Qiang; Ding, Kang; Pan, Yanglin

doi:10.1371/journal.pone.0231888

Cited by 17 publications

(29 citation statements)

References 49 publications

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“…Patient education is key to attaining good quality bowel preparation. 26 Our meta-analysis shows that adjuncts can be used with bowel preparation in a safe manner without compromising mucosal visualisation but, conversely, increase bowel cleanliness by enhancing palatability and tolerability. This may have implications for the patient perception of colonoscopy and may improve compliance with colonoscopy attendance.…”

Section: Discussionmentioning

confidence: 80%

“…Many patients and healthcare professionals hold the misconception that bowel preparation should only be used with water. Patient education is key to attaining good quality bowel preparation 26 . Our meta‐analysis shows that adjuncts can be used with bowel preparation in a safe manner without compromising mucosal visualisation but, conversely, increase bowel cleanliness by enhancing palatability and tolerability.…”

Section: Discussionmentioning

confidence: 91%

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Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta‐analysis

et al. 2020

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Background Bowel preparation for colonoscopy is often poorly tolerated due to poor palatability and adverse effects. This can negatively impact on the patient experience and on the quality of bowel preparation. This systematic review and meta-analysis was carried out to assess whether adjuncts to bowel preparation affected palatability, tolerability and quality of bowel preparation (bowel cleanliness). Methods A systematic search strategy was conducted on PubMed, MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to identify studies evaluating adjunct use for colonoscopic bowel preparation. Studies comparing different regimens and volumes were excluded. Specific outcomes studied included palatability (taste), willingness to repeat bowel preparation, gastrointestinal adverse events and the quality of bowel preparation. Data across studies were pooled using a random-effects model and heterogeneity assessed using I2-statistics. Results Of 467 studies screened, six were included for analysis (all single-blind randomised trials; n = 1187 patients). Adjuncts comprised citrus reticulata peel, orange juice, menthol candy drops, simethicone, Coke Zero and sugar-free chewing gum. Overall, adjunct use was associated with improved palatability (mean difference 0.62, 95% confidence interval 0.29–0.96, p < 0.001) on a scale of 0–5, acceptability of taste (odds ratio 2.75, 95% confidence interval: 1.52–4.95, p < 0.001) and willingness to repeat bowel preparation (odds ratio 2.92, 95% confidence interval: 1.97–4.35, p < 0.001). Patients in the adjunct group reported lower rates of bloating (odds ratio 0.48, 95% confidence interval: 0.29–0.77, p = 0.003) and vomiting (odds ratio 0.47, 95% confidence interval 0.27–0.81, p = 0.007), but no difference in nausea ( p = 0.10) or abdominal pain ( p = 0.62). Adjunct use resulted in superior bowel cleanliness (odds ratio 2.52, 95% confidence interval: 1.31–4.85, p = 0.006). Heterogeneity varied across outcomes, ranging from 0% (vomiting) to 81% (palatability), without evidence of publication bias. The overall quality of evidence was rated moderate. Conclusion In this meta-analysis, the use of adjuncts was associated with better palatability, less vomiting and bloating, willingness to repeat bowel preparation and superior quality of bowel preparation. The addition of adjuncts to bowel preparation may improve outcomes of colonoscopy and the overall patient experience.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 91%

Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta‐analysis

et al. 2020

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“…Our pooled analysis shows that supplementary education based on traditional nursing education can significantly improve the rate of adequate bowel preparation (79.9% vs 72.9, p <0.00001) for outpatients. A recent meta-analysis showed that reinforced education based on standard education improves the quality of bowel preparation for colonoscopy [ 40 ]. Unlike this study, we only explored the effect of supplemental education on the quality of bowel preparation in outpatients.…”

Section: Discussionmentioning

confidence: 99%

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

et al. 2022

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Background Colonoscopy is widely used for the screening, diagnosis and treatment of intestinal diseases. Adequate bowel preparation is a prerequisite for high-quality colonoscopy. However, the rate of adequate bowel preparation in outpatients is low. Several studies on supplementary education methods have been conducted to improve the rate of adequate bowel preparation in outpatients. However, the controversial results presented encourage us to perform this meta-analysis. Method According to the PRISMA statement (2020), the meta-analysis was registered on PROSPERO. We searched all studies up to August 28, 2021, in the three major electronic databases of PubMed, Web of Science and Cochrane Library. The primary outcome was adequate bowel preparation rate, and the secondary outcomes included bowel preparation quality score, polyp detection rate, adenoma detection rate, cecal intubation time, withdrawal time, nonattendance rate and willingness to repeat rate. If there was obvious heterogeneity, the funnel plot combined with Egger’s test, meta-regression analysis, sensitivity analysis and subgroup analysis were used to detect the source of heterogeneity. RevMan 5.3 and Stata 17.0 software were used for statistical analysis. Results A total of 2061 records were retrieved, and 21 full texts were ultimately included in the analysis. Our meta-analysis shows that supplementary education can increase the rate of adequate bowel preparation for outpatients (79.9% vs 72.9%, RR = 1.14, 95% CI: 1.08–1.20, I2 = 87%, p<0.00001). Supplementary education shortened the withdrawal time (MD: -0.80, 95% CI: -1.54 to -0.05, p = 0.04) of outpatients, increased the Boston Bowel Preparation Scale (MD: 0.40, 95% CI: 0.36 to 0.44, p<0.00001), reduced the Ottawa Bowel Preparation Scale (MD: -1.26, 95% CI: -1.66 to -0.86, p<0.00001) and increased the willingness to repeat (91.9% vs 81.4%, RR:1.14, 95% CI: 1.04 to 1.25, p = 0.004). Conclusion Supplementary education for outpatients based on the standard of care can significantly improve the quality of bowel preparation.

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“…La incidencia de inadecuada preparación fue del 10 % en los pacientes evaluados, a diferencia de lo estimado en otros estudios, alrededor del 20 %-40 % (21,22) . Esta diferencia puede deberse a la educación individualizada que se ofrece a los pacientes durante la asignación de la cita y dos días previos al procedimiento (23,24) . Los pacientes con mala preparación fueron principalmente mujeres (59 %) y personas menores de 60 años (68 %), lo cual controvierte algunos factores predictores de mala preparación reportados recientemente (21,25,26) .…”

Section: Discussionunclassified

Efectividad y tolerabilidad de tres tipos de productos de preparación para colonoscopia

Roldán-Molina¹,

Roldán-Delfino²,

León-Ramírez³

et al. 2021

Rev. colomb. Gastroenterol.

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Objetivo: establecer las diferencias entre tres tipos de productos de preparación para colonoscopia, en cuanto a efectividad y tolerabilidad. Materiales y métodos: estudio de corte transversal, analítico, prospectivo, ciego para el evaluador de la escala de Boston. Se incluyeron pacientes adultos, mayores de 18 años con requerimiento de colonoscopia y diligenciamiento de la encuesta sobre el tipo de preparación realizada para la limpieza del colon. Resultados: se evaluaron 3 grupos de productos (polietilenglicol, picosulfatos, sales de sulfato) en 907 pacientes, se aplicó la escala de Boston total y por segmentos, sin encontrar diferencias estadísticamente significativas entre ellos (Odds ratio [OR]: 1,10; intervalo de confianza [IC] 95 %: 0,6-1,8; p = 0,728). El 60 % de la población fueron mujeres y la edad promedio 52 años. Se observó el cumplimiento de la dieta en el 99 % de los participantes. La preparación dividida tuvo mejores resultados en la escala de Boston (OR: 5,06; IC 95 %: 3,2-8,01; p = 0,001). Los picosulfatos tuvieron mayor aceptabilidad (OR: 15,8; IC 95 %: 8,83-28,3; p = 0,001) y menores efectos secundarios como distensión abdominal (OR: 0,59; IC 95 %: 0,3-0,9; p = 0,033) y vómito (OR: 0,25; IC 95 %: 0,07-0,82; p = 0,015). Se observó mejor resultado cuando se realizó el examen antes de 6 horas de finalizada la preparación (OR: 6,38; IC 95 %: 3,84-10,6; p = 0,001). Conclusiones: los productos evaluados no presentaron diferencias entre sí con respecto a su efectividad. Los picosulfatos tuvieron menores efectos secundarios y mejor aceptabilidad. Se obtuvo una mejor preparación del colon con preparación dividida y si el examen es hasta 6 horas de finalizada la preparación.

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Reinforced education improves the quality of bowel preparation for colonoscopy: An updated meta-analysis of randomized controlled trials

Cited by 17 publications

References 49 publications

Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta‐analysis

Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta‐analysis

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

Efectividad y tolerabilidad de tres tipos de productos de preparación para colonoscopia

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