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BOOKLETS TO IMPROVE BOWEL PREPARATION QUALITY IN COLONOSCOPY: SYSTEMATIC REVIEW WITH META-ANALYSIS

Giuseppe Losurdo 1, Maria Ludovica Martino 1, MARGHERITA DE BELLIS 1, Andrea Iannone 1, Alfredo Di Leo 1

Affiliations

1 University of Bari, Bari, Italy

Summary

AI Generated

A systematic review and meta-analysis of six randomized controlled trials (1755 patients) found that visual booklets improve bowel preparation quality for colonoscopy, particularly in outpatients and with non-PEG-based preparations, but do not affect adenoma detection rate.

Visual booklets improved adequate bowel preparation rates compared to controls (86.7% versus 77.5%, OR 2.31, 95% CI 1.20-4.45, p = 0.01), with significant benefit in the transverse colon (MD = 0.37, 95% CI 0.01-0.72, p = 0.03).
Outpatients showed greater benefit from booklets than controls (OR = 7.13, 95% CI 5.39-9.45, p < 0.001), while no difference was observed in inpatient settings.
Non-PEG-based preparations (sodium phosphate, magnesium citrate) benefited more from booklets (OR = 5.10, 95% CI 1.82-14.27, p = 0.002), whereas 4-L PEG-based preparations showed no difference.
Adenoma detection rate was similar between booklet and control groups (OR = 0.93, 95% CI 0.75-1.16, p = 0.53), as was the mean number of polyps detected per patient (MD = 0.22, 95% CI -0.14-0.58, p = 0.23).
This evidence may be most relevant for gastroenterologists and endoscopy units seeking strategies to improve bowel preparation quality in outpatient colonoscopy settings.

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Abstract

Introduction

A good bowel preparation for colonoscopy is fundamental to improve the quality of the examination, reduce procedural complications and achieve optimal polyp detection. Among possible strategies to enhance bowel preparation, visual booklets have been proposed with conflicting results. Therefore we aimed to perform a systematic review with meta-analysis of randomized controlled studies (RCT) to ascertain whether booklets may be useful in this setting.

Aims & Methods

Literature search was performed in July 2022, in main databases (PUBMED, SCOPUS, ScienceDirect, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov). only RCTs were selected. The primary outcome was the quality of bowel preparation. Further outcomes were the adenoma detection rate (ADR), number of polyps detected per patient, rate of cecal intubation, time of insertion and withdrawal, adverse events, willingness to repeat preparation and colonoscopy. We estimated odd ratios (OR) for dichotomous outcomes. mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity among studies with the Chi2 (Cochran Q) and the I2 statistics. In case of high heterogeneity, a random effect model was used, otherwise a fixed effects model was preferred. All analyses were performed using RevMan version 5.4.1.

Results

Six studies were selected, enrolling overall 1755 patients (857 in the booklet and 898 in the control group). Adequate bowel preparation was achieved in the 86.7% (743 out of 857) of booklet preparation versus the 77.5% (696 out of 898) in the control group, with an OR of 2.31 in favour of booklet (95% CI 1.20-4.45, p = 0.01). Booklet was more effective than control in the transverse colon (MD = 0.37, 95% CI 0.01-0.72, p = 0.03), while no differences were found in right colon and left colon. In four studies a 4-L PEG-based preparation was used and the pooled analysis did not find any difference compared to controls, while when sodium phosphate and magnesium citrate or sodium phosphate or PEG were used, preparation with booklet was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in inpatient setting, without difference between booklet and controls while in outpatients patients receiving booklets were better prepared than controls (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). ADR was similar between the two groups, with an OR = 0.93 (95% CI 0.75-1.16, p = 0.53). The mean number of polyps per patient did not differ between the two groups (MD = 0.22, 95% CI -0.14-0.58, p = 0.23).

Conclusion

The present meta-analysis demonstrated that booklets are useful to enhance bowel preparation. Outpatients and non PEG-based preparations seem to benefit more from booklets, while no effect on ADR has been observed.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Beyond surgery: The expanding role of bariatric and metabolic endoscopy

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