Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials

Abstract

Background Various 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. Objective We performed a network meta-analysis to determine the optimal instructions. Methods We 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. Results We 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). Conclusions Newly 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 Registration INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/

Effect of Visual Booklets to Improve Bowel Preparation in Colonoscopy: Systematic Review with Meta-Analysis

“…In our meta-analysis, we considered six studies, which confirmed that booklets may enhance the bowel preparation, with an OR of 2.31. A recent meta-analysis found that newly designed booklets were beneficial to improving preparation, but the authors concluded that the evidence was poor due to the number of included studies, which was lower than that in our study [7]. At the end, in our study, we demonstrated that booklets are useful to enhance bowel preparation.…”

“…Adequate comprehension of the preparation and colonoscopy details is a critical contributor to adequate bowel cleansing. Patients usually receive written or verbal instructions from professionals before colonoscopy for details regarding preparation and dietary restrictions, which are defined as standard patient instructions [ 7 ]. However, research by Ness et al found that such guidance often fails to achieve satisfactory bowel preparation [ 8 ].…”

“…However, research by Ness et al found that such guidance often fails to achieve satisfactory bowel preparation [ 8 ]. To increase the awareness of bowel preparation in outpatients and improve compliance, researchers have made extensive attempts such as visual aid and cartoon education booklets [ 7 ]. Educational booklets not only show details about the dietary and purgative instructions, but they also give a more comprehensive explanation of bowel preparation.…”

The status quo of short videos as a source of health information regarding bowel preparation before colonoscopy

“…Inadequate bowel preparation can lead to prolonged operating time, increased difficulty of colonoscopy, incomplete examination, risk of lesion leakage, and increased risk of complications ( 2 – 4 ). Therefore, scholars have proposed many solutions to improve bowel preparation quality, including newly designed booklets and telephone re-education ( 5 ). These methods improve bowel preparation quality to a certain extent, but their implementation requires abundant human and material resources.…”

Effectiveness of bowel preparation innovative technology instructions (BPITIs) on clinical outcomes among patients undergoing colonoscopy: a systematic review and meta-analysis

“…Two systematic reviews were conducted to assess the effects of innovative technology education platforms on the quality of bowel preparation 14 , 15 . However, only the effects of mobile health (mHealth) technologies on colonoscopy preparation outcomes were evaluated in one review.…”