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

ABSTRACT: BACKGROUND AND AIMS:Inadequate bowel preparation (BP) is an unfavorable factor that influence the success of colonoscopy. Although standard education (SE) given to patients are proved useful to avoid inadequate BP. Studies concerning the effects of reinforced education (RE) on the quality of BP were inconsistent. The aim of this updated meta-analysis of randomized controlled trial was to compare the quality of BP between patients receiving RE in addition to SE and those receiving SE alone. METHODS:MEDLINE, EMBASE, Web of Science and the Cochrane Library were systemically searched to identify the relevant studies published through April 2019. The primary outcome was the rate of adequate BP. Subgroup analyses were conducted. Secondary outcomes included BP score, adenoma detection rate (ADR), polyp detection rate (PDR), insertion time, withdrawal time, adverse events, >80% purgative intake and diet compliance. Dichotomous variables were reported as odds ratio (OR) with 95% confidence interval (CI). Continuous data were reported as mean difference (MD) with 95%CI. Pooled estimates of OR or MD were calculated using a random-effects model. Statistical heterogeneity was accessed by calculating the I2 value. A P value less than 0.05 was considered significant. RESULTS:A total of 18 randomized controlled trails (N = 6536) were included in this meta-analysis. Patients who received RE had a better BP quality than those only receiving SE (OR 2.59, 95%CI: 2.09-3.19; P<0.001). A higher ADR (OR 1.35; 95%CI: 1.06-1.72; P = 0.020) and PDR (OR 1.24, 95%CI: 1.02-1.50; P = 0.030), shorter insertion (MD -0.76; 95%CI: -1.48-(-0.04); P = 0.040) and withdrawal time (MD -0.83; 95%CI: -1.83-(-0.28); P = 0.003), less nausea/vomiting (OR 0.78; 95%CI: 0.64-0.97; P = 0.020) and abdominal distension (OR 0.72; 95%CI: 0.68-0.92; P = 0.020) were achieved in the RE group. More patients had >80% purgative intake (OR 2.17; 95%CI, 1.09-4.32; P = 0.030) and were compliant with diet restriction (OR 2.38; 95%CI: 1.79-3.17; P<0.001) in the RE group. CONCLUSION:RE significantly improved BP quality, increased ADR and PDR, decreased insertion and withdrawal time and adverse events.

SUBMITTER: Guo X

PROVIDER: S-EPMC7188205 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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

Guo Xiaoyang X Li Xin X Wang Zhiyan Z Zhai Junli J Liu Qiang Q Ding Kang K Pan Yanglin Y

PloS one 20200428 4

<h4>Background and aims</h4>Inadequate bowel preparation (BP) is an unfavorable factor that influence the success of colonoscopy. Although standard education (SE) given to patients are proved useful to avoid inadequate BP. Studies concerning the effects of reinforced education (RE) on the quality of BP were inconsistent. The aim of this updated meta-analysis of randomized controlled trial was to compare the quality of BP between patients receiving RE in addition to SE and those receiving SE alon ...[more]

PMID: 32343708

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Project description:The proportion of outpatients with inadequate bowel preparation before colonoscopy is high owing to patient unawareness of its importance and poor adherence to instructions. This meta-analysis aimed to determine the effect of educational intervention on the quality of bowel preparation before colonoscopy.A comprehensive literature review identified randomized controlled trials measuring the effect of educational intervention on the quality of bowel preparation. Two reviewers independently screened relevant articles, extracted data, and assessed the risk of bias. The primary outcome was the quality of each bowel preparation before colonoscopy, using a particular assessment scale. The secondary outcomes were polyp detection rates during the procedure and the need for a repeat colonoscopy due to incomplete examination.Nine randomized controlled trials were included in this meta-analysis. In all, 2885 patients were enrolled, with 1458 receiving education and 1427 assigned to the control group. An educational intervention before colonoscopy significantly improved bowel preparation (relative risk [RR] = 1.22; 95 % confidence interval [CI], 1.10 - 1.36), however, no significant differences were identified in polyp detection rates (RR = 1.14; 95 %CI 0.87 - 1.51) or the need for repeat colonoscopy (RR = 0.52; 95 %CI 0.25 - 1.04) between the groups. Asymmetry in the appearance of the funnel plot and the result of Egger test (P < 0.001) suggested that publication bias existed.Evidence from these randomized controlled trials shows that a brief counseling session with patients before colonoscopy ensures better bowel preparation. However, evidence is insufficient to assess improvements in polyp detection rate and avoidance of a repeat colonoscopy. Despite these encouraging observations, this meta-analysis had some limitations, including potential publication bias and significant heterogeneity of the types of bowel purgatives. These results should be interpreted with caution.

Project description:BackgroundVarious enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed.ObjectiveWe performed a network meta-analysis to determine the optimal instructions.MethodsWe searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence.ResultsWe included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR).ConclusionsNewly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR.Trial registrationINPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/.

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

Publications

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

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