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Liao F, Huang Y, Lai Y, Xie J. The status quo of short videos as a source of health information regarding bowel preparation before colonoscopy. Front Public Health 2024; 12:1309632. [PMID: 38414898 PMCID: PMC10896954 DOI: 10.3389/fpubh.2024.1309632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024] Open
Abstract
Background For high-quality colonoscopies, adequate bowel preparation is a prerequisite, closely associated with the diagnostic accuracy and therapeutic safety of colonoscopy. Although popular-science short videos can help people quickly access health information, the overall quality of such short videos as a source of health information regarding bowel preparation before colonoscopy is unclear. Therefore, we intend to conduct a cross-sectional study to investigate the quality of bowel preparation information before colonoscopy through short videos taken on TikTok and Bilibili. Methods The Chinese phrases "colonoscopy" and "bowel preparation" were used as keywords to search for and screen the top 100 videos in the comprehensive rankings on TikTok and Bilibili. The Global Quality Score (GQS) and the modified DISCERN score were used to assess the quality of the information provided in these short videos. Results A total of 186 short videos were included in this study; 56.5% of them were posted by health professionals, whereas 43.5% of them were posted by nonhealth professionals. The overall quality of these videos was unsatisfactory, with a median DISCERN score of 3 (2-4) and a median GQS of 3 (3-4). The radar maps showed that videos posted by gastroenterologists had higher completeness scores regarding outcomes, management, and risk factors, while nongastroenterologists had higher completeness scores concerning adverse effects, symptoms, and definitions of bowel preparation. Additionally, the median DISCERN score and GQS of the videos posted by gastroenterologists were 3 (3-4) and 3 (3-4), respectively, whereas the quality of the videos posted by patients was the worst, with a median DISCERN score of 2 (1-2) and a median GQS of 2 (1.25-3). Conclusion In conclusion, the overall quality of health information-related videos on bowel preparation before colonoscopy posted on specified short video platforms was not satisfactory. Gastroenterologists provide more information on the outcomes, management, and risk factors for bowel preparation before colonoscopy, while nongastroenterologists focus on adverse effects, symptoms, and definitions of bowel preparation.
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Affiliation(s)
- Foqiang Liao
- Department of Gastroenterology, Jiangxi Medical College, Affiliated Ganzhou People’s Hospital, Nanchang University, Ganzhou, China
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yunfeng Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yongkang Lai
- Department of Gastroenterology, Jiangxi Medical College, Affiliated Ganzhou People’s Hospital, Nanchang University, Ganzhou, China
| | - Junfeng Xie
- Department of Gastroenterology, Jiangxi Medical College, Affiliated Ganzhou People’s Hospital, Nanchang University, Ganzhou, China
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Bacsur P, Rutka M, Asbóth A, Resál T, Szántó K, Jójárt B, Bálint A, Ari E, Ajibola W, Kintses B, Fehér T, Pigniczki D, Bor R, Fábián A, Maléth J, Szepes Z, Farkas K, Molnár T. Effects of bowel cleansing on the composition of the gut microbiota in inflammatory bowel disease patients and healthy controls. Therap Adv Gastroenterol 2023; 16:17562848231174298. [PMID: 37324319 PMCID: PMC10265323 DOI: 10.1177/17562848231174298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/20/2023] [Indexed: 06/17/2023] Open
Abstract
Background In patients with inflammatory bowel disease (IBD), Crohn's disease (CD), and ulcerative colitis (UC), numerous cases of exacerbations could be observed after colonoscopy, raising the possible pathogenetic effect of colonic microbiota alterations in IBD flare. Objectives We aimed to investigate the changes in the fecal microbiota composition in IBD patients influenced by the bowel preparation with sodium picosulfate. Design We enrolled patients with IBD undergoing bowel preparation for colonoscopy in the prospective cohort study. The control group (Con) comprised non-IBD patients who underwent colonoscopy. Clinical data, blood, and stool samples were collected before colonoscopy (timepoint A), 3 days later (timepoint B), and 4 weeks later (timepoint C). Methods Disease activity and gut microbiota changes were assessed at each timepoint. Fecal microbiota structure - at family level - was determined by sequencing the V4 region of the 16S rRNA gene. Statistical analysis included differential abundance analysis and Mann-Whitney tests. Results Forty-one patients (9 CD, 13 UC, and 19 Con) were included. After bowel preparation, alpha diversity was lower in the CD group than in the UC (p = 0.01) and Con (p = 0.02) groups at timepoint B. Alpha diversity was significantly higher in the UC group than in the CD and Con (p = 0.03) groups at timepoint C. Beta diversity difference differed between the IBD and Con (p = 0.001) groups. Based on the differential abundance analysis, the Clostridiales family was increased, whereas the Bifidobacteriaceae family was decreased in CD patients compared to the Con at timepoint B. Conclusions Bowel preparation may change the fecal microbial composition in IBD patients, which may have a potential role in disease exacerbation after bowel cleansing.
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Affiliation(s)
- Péter Bacsur
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - András Asbóth
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
- Department of Biochemistry and Molecular Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Tamás Resál
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Boldizsár Jójárt
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
- Hungarian Academy of Science – University of Szeged Momentum Epithelial Cell Signaling and Secretion Research Group, Szeged, Hungary
- HCEMM-USZ Molecular Gastroenterology Research Group, Szeged, Hungary
| | - Anita Bálint
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Eszter Ari
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Department of Genetics, ELTE Eötvös Loránd University, Budapest, Hungary
- HCEMM-BRC Metabolic Systems Biology Research Group, Szeged, Hungary
| | - Walliyulahi Ajibola
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Doctoral School in Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Bálint Kintses
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
- Department of Biochemistry and Molecular Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- HCEMM-BRC Translational Microbiology Research Group, Szeged, Hungary
- National Laboratory of Biotechnology, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Tamás Fehér
- Synthetic and System Biology Unit, Institute of Biochemistry, Biological Research Centre, Eötvös Loránd Research Network (ELKH), Szeged, Hungary
| | - Daniella Pigniczki
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - József Maléth
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
- Hungarian Academy of Science – University of Szeged Momentum Epithelial Cell Signaling and Secretion Research Group, Szeged, Hungary
- HCEMM-USZ Molecular Gastroenterology Research Group, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, Szent-Györgyi Albert Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Kálvária Avenue 57, H-6720 Szeged, Hungary
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Dao HV, Dao QV, Lam HN, Hoang LB, Nguyen VT, Nguyen TT, Vu DQ, Pokorny CS, Nguyen HL, Allison J, Goldberg RJ, Dao ATM, Do TTT, Dao LV. Effectiveness of using a patient education mobile application to improve the quality of bowel preparation: a randomised controlled trial. BMJ Open Gastroenterol 2023; 10:bmjgast-2023-001107. [PMID: 37277203 DOI: 10.1136/bmjgast-2023-001107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/16/2023] [Indexed: 06/07/2023] Open
Abstract
AIMS To determine the effectiveness of a mobile application (app) in improving the quality of bowel preparation for colonoscopy. METHOD An endoscopist-blinded randomised controlled trial enrolled patients who were undergoing a colonoscopy on the same day of bowel preparation. The intervention used a Vietnamese mobile app that provides instructions on bowel preparation while patients in the comparison group received conventional instructions. Outcomes included the Boston Bowel Preparation Scale (BBPS) to assess the quality of bowel preparation and the polyp detection rate (PDR) and adenoma detection rate (ADR). RESULTS The study recruited 515 patients (256 in the intervention group). The median age was 42 years, 50.9% were females, 69.1% high school graduates and higher, and 45.2% from urban area. Patients in the intervention group had higher adherence to instructions (60.9% vs 52.4%, p=0.05) and longer length of taking laxatives (mean difference 0.17 hours, 95% CI 0.06 to 0.27). The intervention did not reduce the risk of poor bowel cleansing (total BBPS<6) in both overall (7.4% vs 7.7%; risk ratio 0.96, 95% CI 0.53 to 1.76) and subgroup analysis. PDR and ADR were similar between the two groups. CONCLUSIONS The mobile app providing instructions on proper bowel preparation improved the practice during bowel preparation but did not improve the quality of bowel cleansing or PDR.
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Affiliation(s)
- Hang Viet Dao
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Endoscopy Center, Hanoi Medical University Hospital, Hanoi, Viet Nam
- Research and Training Department, Institute of Gastroenterology and Hepatology, Hanoi, Viet Nam
| | - Quan Viet Dao
- Endoscopy Center, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Hoa Ngoc Lam
- Research and Training Department, Institute of Gastroenterology and Hepatology, Hanoi, Viet Nam
| | - Long Bao Hoang
- Research and Training Department, Institute of Gastroenterology and Hepatology, Hanoi, Viet Nam
| | - Van Thi Nguyen
- Research and Training Department, Institute of Gastroenterology and Hepatology, Hanoi, Viet Nam
| | - Thuy Thi Nguyen
- Department of Artificial intelligence, RMIT International University School of Science Engineering and Technology, Ho Chi Minh City, Viet Nam
| | - Dat Quoc Vu
- Department of Infectious Disease, Hanoi Medical University, Hanoi, Viet Nam
| | | | - Hoa Lan Nguyen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Robert Joel Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - An Thi Minh Dao
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Toan Thanh Thi Do
- Department of Biostatistics and Medical Informatics, Hanoi Medical University, Hanoi, Viet Nam
| | - Long Van Dao
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Viet Nam
- Institute of Gastroenterology and Hepatology, Hanoi, Viet Nam
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Adamek HE, Bergmann L, Müssig K. [Bowel preparation in patients with Diabetes mellitus: Development of a procedure model]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:784-789. [PMID: 35545113 DOI: 10.1055/a-1791-1627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.
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Affiliation(s)
| | - Laura Bergmann
- Med. Klinik 2, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken GmbH, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
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Colonoscopy: Preparation and Potential Complications. Diagnostics (Basel) 2022; 12:diagnostics12030747. [PMID: 35328300 PMCID: PMC8947288 DOI: 10.3390/diagnostics12030747] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Colonoscopy is a fairly common test that serves both diagnostic and therapeutic purposes. It has been considered the gold standard in colorectal cancer screening for several years. Due to the nature of the examination, various types of complications may occur. The purpose of this analysis is to describe the various complications related to the period of preparation for colonoscopy among hospitalized patients, including life-threatening ones, in order to know how to avoid complications while preparing for a colonoscopy. We analyzed the nursing and medical reports of 9962 patients who were prepared for colonoscopy between 2005 and 2016. The frequency of various side effects associated with intensive bowel cleansing prior to colonoscopy was assessed. In justified cases, additional medical data were collected from patients, their families or from other doctors providing advice to patients after complications. Out of 9962 patients prepared for colonoscopy, 180 procedures were discontinued due to complications and side effects, and in these cases no colonoscopy was performed. The most common complications were: vomiting; epistaxis; loss of consciousness with head injury; abdominal pain; acute diarrhea; symptoms of choking; heart rhythm disturbances; dyspnea; fractures of limbs and hands; acute coronary syndrome; hypotension; hypertension; cerebral ischemia; severe blood glucose fluctuations; increased muscle contraction and allergic reactions. In addition to the documentation of our own research, several works of other research groups were also analyzed. Currently, the literature does not provide data on the frequency and type of complications in the preparation period for colonoscopy. The advantage of our work is the awareness of the possibility of serious complications and postulating the necessary identification of threats. Individualization of the recommended procedures and increased supervision of patients undergoing bowel cleansing procedure, we hope, will reduce the occurrence of complications and side effects.
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Jagdeep J, Sawant G, Lal P, Bains L. Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study. Cureus 2021; 13:e14363. [PMID: 33972914 PMCID: PMC8105882 DOI: 10.7759/cureus.14363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background Colonoscopy is the method of choice to evaluate colonic mucosa and the distal ileum, allowing the diagnosis and treatment of many diseases. Appropriate bowel preparation necessitates the use of laxative medications, preferentially by oral administration. These include polyethylene glycol (PEG), sodium picosulfate, and sodium phosphate (NaP). Lactulose, a semi-synthetic derivative of lactose, undergoes fermentation, acidifying the gut environment, stimulates intestinal motility, and increases osmotic pressure within the lumen of the colon. Methods In this prospective randomized controlled study, we analyzed 40 patients who presented with symptomatic bleeding per rectum and underwent bowel preparation either with lactulose or polyethylene glycol for colonoscopy. The quality of bowel preparation and other variables like palatability, discomfort, and electrolyte levels were analyzed. Results The majority of the patients (90%) were comfortable with the taste of lactulose solution, whereas the PEG group patients (55%) were equally divided on its palatability. On lactulose consumption, 40% of patients reported nausea/vomiting and around 10% of patients complained of abdominal discomfort. Serum sodium levels showed insignificant changes from 4.33 ± 0.07 mEq/L to 4.21 ± 0.18 mEq/L while potassium also remained similar from 4.26 ± 0.03 mEq/L to 4.22 ± 0.17 mEq/L. The mean Boston Bowel Preparation Score (BBPS) in patients who received lactulose solution was 6.25 ± 0.786 and in those who received PEG solution, it was 6.35 ± 0.813 (P-value = 0.59). Conclusions Lactulose is a significantly more palatable form of bowel preparation and causes minor discomfort. It has a good bowel cleansing action comparable to PEG without causing any hemodynamic changes. It can be considered a cheaper and safe alternative for bowel preparation in colonoscopy in low-resource settings.
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Affiliation(s)
- Jagdeep Jagdeep
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Gaurish Sawant
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Pawan Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
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Htet H, Segal J. New Ultra Low Volume Bowel Preparation and Overview of Existing Bowel Preparations. Curr Drug Metab 2020; 21:844-849. [PMID: 32778022 DOI: 10.2174/1567201817666200810112136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adequate bowel cleansing is essential in achieving a good quality colonoscopy. However, one of the barriers to achieving high-quality bowel cleansing is the patient's tolerability. Different bowel preparations have been developed to improve tolerability while maintaining adequate bowel cleansing. OBJECTIVES We aim to explore the pros and cons of commonly used bowel preparations, particularly highlighting the new ultra-low volume bowel preparation. METHODS Extensive literature search was carried out on various databases to evaluate the effectiveness and side effects of different bowel cleansing agents, including findings of recent clinical trials on ultra-low bowel preparation. RESULTS Polyethylene glycol (PEG) has been commonly used as a bowel prep. Due to its high volume required to ingest to achieve an adequate effect, it has been combined with various adjuncts to reduce the volume to make it more tolerable. Magnesium and phosphate-based preps can achieve low volume, but they can be associated with multiple side effects, mainly electrolyte disturbances. Ultra low volume prep (NER1006) was achieved by combing PEG with ascorbic acid, and its efficacy and side effects were demonstrated in three noninferiority studies. CONCLUSION It is important to consider patient preferences, co-morbidities and tolerability, and efficacy and side effect profiles when choosing bowel prep for patients undergoing colonoscopy. New ultra-low bowel prep showed promising results in initial clinical trials, but further real-world post-marketing data will inform its value in clinical practice.
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Affiliation(s)
- Hein Htet
- Department of Gastroenterology, St Richard's Hospital, Chichester, United Kingdom
| | - Jonathan Segal
- Department of Gastroenterology, St Mary's Hospital, London, United Kingdom
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Sharma P, Burke CA, Johnson DA, Cash BD. The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention. Endosc Int Open 2020; 8:E673-E683. [PMID: 32355887 PMCID: PMC7165013 DOI: 10.1055/a-1127-3144] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection. This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9-3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.
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Affiliation(s)
- Prateek Sharma
- University of Kansas Medical Center, Kansas City, Kansas, United States
| | | | - David A. Johnson
- Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Brooks D. Cash
- University of Texas Health Science Center, Houston, Texas, United States
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Schooley B, San Nicolas-Rocca T, Burkhard R. Cloud-based multi-media systems for patient education and adherence: a pilot study to explore patient compliance with colonoscopy procedure preparation. Health Syst (Basingstoke) 2019; 10:89-103. [PMID: 34104428 DOI: 10.1080/20476965.2019.1663974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Technology based patient education and adherence approaches are increasingly utilized to instruct and remind patients to prepare correctly for medical procedures. This study examines the interaction between two primary factors: patterns of patient adherence to challenging medical preparation procedures; and the demonstrated, measurable potential for cloud-based multi-media information technology (IT) interventions to improve patient adherence. An IT artifact was developed through prior design science research to serve information, reminders, and online video instruction modules to patients. The application was tested with 297 patients who were assessed clinically by physicians. Results indicate modest potential (43.4% relative improvement) for the IT-based approach for improving patient adherence to endoscopy preparations. Purposively designed cloud-based applications hold promise for aiding patients with complex medical procedure preparation. Health care provider involvement in the design and evaluation of a patient application may be an effective strategy to produce medical evidence and encourage the adoption of adherence apps.
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Affiliation(s)
- Benjamin Schooley
- Health Information Technology, University of South Carolina, College of Engineering and Computing, Columbia, SC, USA
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Richter JM, Ha JB, Marx M, Campbell EJ, Pandolfi MC. A Digital Preprocedure Instruction Program for Outpatient Colonoscopy. Telemed J E Health 2019; 26:468-476. [PMID: 31298628 DOI: 10.1089/tmj.2019.0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction: Many patients struggle with colonoscopy preparation, which is complex and can be an uncomfortable as well as a time-consuming process. The confusion and anxiety from the preprocedure process may lead patients to delay their colonoscopy or skip it altogether. Digital health technology that focuses on patient engagement can play an important role in promoting colorectal cancer screening. Methods: A digital preprocedure instruction program was implemented for outpatient colonoscopy by sending critical reminders and instructions to patients through a series of short message service messages and/or emails. Eligible patients included English speakers on GoLYTELY®/NuLYTELY® or MiraLAX® preparation regimens with a valid cellphone or email address in the electronic health record. We examined the impact of digital instructions on bowel preparation quality, no-show and same-day cancellations over a 3-month period between an intervention group of 756 patients and a control group of 2,103 patients. Patients who enrolled in the digital instructions also received a patient satisfaction survey. Results: Our controlled study demonstrated the effectiveness of digital instructions to reduce no-show and same-day cancellation rates for outpatient colonoscopy from 10.40% to 6.08% (p < 0.001). Bowel preparation quality was not significantly different between the two groups (p = 0.23). However, 90% of patients who enrolled in the program rated their satisfaction with the digital reminders very highly. Discussion: A digital preprocedure instruction program can have a positive impact on operational efficiency, quality of care, and patient satisfaction. This study shows how digital health tools can effectively engage patients scheduled for a colonoscopy, increase appointment adherence, and, therefore, lead to better cancer screening.
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Affiliation(s)
- James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jasmine B Ha
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Madeline Marx
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily J Campbell
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael C Pandolfi
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
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Sharara AI, Bou Daher H. Bowel Cleansing Strategies After Suboptimal Bowel Preparation. Clin Gastroenterol Hepatol 2019; 17:1239-1241. [PMID: 30625406 DOI: 10.1016/j.cgh.2018.12.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Halim Bou Daher
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Kang MK, Jang BI, Park JS, Kim KO. Efficacy of ramosetron in combination with polyethylene glycol of preparing for a colonoscopy. Yeungnam Univ J Med 2019; 36:99-104. [PMID: 31620620 PMCID: PMC6784633 DOI: 10.12701/yujm.2019.00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 01/22/2023] Open
Abstract
Background Because of its efficacy and safety, polyethylene glycol (PEG) is generally used to prepare for colonoscopy. However, the side effects of PEG, including nausea, vomiting, abdominal discomfort, pain, and general weakness, tend to decrease patient compliance and satisfaction. The aim of this study is to investigate the efficacy and safety of PEG with 0.1 mg ramosetron on colonoscopy patients who had difficulty taking PEG due to side effects or large volume. Methods From January to August in 2012, 28 patients who visited Yeungnam University hospital for a colonoscopy were prospectively enrolled. All enrolled patients were previous history underwent colonoscopy using PEG only in our hospital. The efficacy and safety of ramosetron were assessed through the use of a questionnaire, and compared previous bowel preparation. Results Compared to previous examination, the patients using the ramosetron reported less nausea, vomiting, abdominal discomfort, and abdominal pain, as well as a higher degree of compliance and satisfaction of the patient. There were no side effects reported with the use of ramosetron. However, overall bowel preparation quality was not better than the previous examination. Conclusion In case of the use of ramosetron in combination with PEG for bowel preparation, patients experienced a higher rate of compliance and tolerance. Looking forward, ramosetron may become an option of pretreatment for bowel preparation.
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Affiliation(s)
- Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
- Corresponding author: Byung Ik Jang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3831, Fax: +82-53-623-8038, E-mail:
| | - Jun Suk Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Desai M, Nutalapati V, Bansal A, Buckles D, Bonino J, Olyaee M, Rastogi A. Use of smartphone applications to improve quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Endosc Int Open 2019; 7:E216-E224. [PMID: 30705956 PMCID: PMC6338550 DOI: 10.1055/a-0796-6423] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract
Introduction Smartphone-based applications (apps) have been used to improve the quality of bowel preparation (prep) but the success rates have been variable. We have performed a systematic review and meta-analysis to evaluate the impact of smartphone apps on bowel preparation.
Methods Electronic databases (MEDLINE, Embase, CINAHL and Cochrane) were reviewed for eligible studies of smartphone apps versus standard education before colonoscopy. The following outcomes were analyzed: pooled rate of adequacy of bowel prep among both arms and Boston bowel preparation score (BBPS) when reported. Pooled analysis was reported as odds ratio (OR) or mean difference in random effect model with Review Manager 5.3 (P ≤ 0.05 for statistical significance).
Results Six studies were eligible with smartphone app (810 patients) vs. standard education (855 patients, control group) for bowel prep. The smartphone app group had a higher proportion of adequate bowel prep compared to the control group: 87.5 % vs 77.5 % (five studies), pooled OR 2.67; 95 %CI 1.00 – 7.13 with P = 0.05. There was substantial heterogeneity in studies with I
2 = 78 %. When analysis was limited to randomized controlled trials (RCTs), smartphone app users had a numerically higher rate of bowel cleansing: 87.1 % vs 76.9 %; however, pooled OR was not statistically significant (OR 2.66, 95 %CI 0.92 – 7.69, P = 0.07). When studies using BBPS were evaluated (n = 3), smartphone app users had higher mean scores (better bowel prep) with a mean difference of 0.9 (95 %CI 0.5 – 1.3), which was statistically significant (P < 0.01).
Conclusion The smartphone app is a novel educational tool that can assist in achieving adequate and better bowel cleansing before colonoscopy.
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Venkat Nutalapati
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ajay Bansal
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Daniel Buckles
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - John Bonino
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Mojtaba Olyaee
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Amit Rastogi
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, KS, USA
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14
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Shafer LA, Walker JR, Waldman C, Michaud V, Yang C, Bernstein CN, Hathout L, Park J, Sisler J, Wittmeier K, Restall G, Singh H. Predictors of patient reluctance to wake early in the morning for bowel preparation for colonoscopy: a precolonoscopy survey in city-wide practice. Endosc Int Open 2018; 6:E706-E713. [PMID: 29854940 PMCID: PMC5969990 DOI: 10.1055/s-0044-102298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/22/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Many endoscopists do not use split-dose bowel preparation (SDBP) for morning colonoscopies. Despite SDBP being recommended practice, they believe patients will not agree to take early morning bowel preparation (BP). We assessed patients' opinions about waking early for BP. METHODS A self-administered survey was distributed between 08/2015 and 06/2016 to patients in Winnipeg, Canada when they attended an outpatient colonoscopy. Logistic regression was performed to determine predictors of reluctance to use early morning BP. RESULTS Of the 1336 respondents (52 % female, median age 57 years), 33 % had used SDBP for their current colonoscopy. Of the 1336, 49 % were willing, 24 % neutral, and 27 % reluctant to do early morning BP. Predictors of reluctant versus willing were number of prior colonoscopies (OR 1.20; 95 %CI: 1.07 - 1.35), female gender (OR 1.65; 95 %CI: 1.19 - 2.29), unclear BP information (OR 1.86; 95 %CI: 1.21 - 2.85), high BP anxiety (OR 2.02; 95 %CI: 1.35 - 3.02), purpose of current colonoscopy being bowel symptoms (OR 1.40; 95 %CI: 1.00 - 1.97), use of 4 L of polyethylene glycol laxative (OR 1.45; 95 %CI: 1.02 - 2.06), not having SDBP (OR 1.96; 95 %CI: 1.31 - 2.93), and not having finished the laxative for the current colonoscopy (OR 1.66; 95 %CI: 1.01 - 2.73). Most of the same predictors were identified when reluctance was compared to willing or neutral, and in ordinal logistic regression. CONCLUSIONS Almost three-quarters of patients do not express reluctance to get up early for BP. Among those who are reluctant, improving BP information, allaying BP-related anxiety, and use of low volume BP may increase acceptance of SDBP.
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Affiliation(s)
- L. A. Shafer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. R. Walker
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C. Waldman
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - V. Michaud
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C. Yang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C. N. Bernstein
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - L. Hathout
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Park
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada,CancerCare Manitoba, Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba, Canada
| | - J. Sisler
- CancerCare Manitoba, Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba, Canada,Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - K. Wittmeier
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G. Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - H. Singh
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada,CancerCare Manitoba, Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba, Canada,Corresponding author Harminder Singh, MD MPH Section of GastroenterologyUniversity of Manitoba805-715 McDermot AvenueWinnipegManitobaCanada R3E3P4+1-204-789-3972
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15
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Shafer LA, Walker JR, Waldman C, Yang C, Michaud V, Bernstein CN, Hathout L, Park J, Sisler J, Restall G, Wittmeier K, Singh H. Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings. Dig Dis Sci 2018; 63:610-618. [PMID: 29332165 DOI: 10.1007/s10620-018-4912-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous research has assessed anxiety around colonoscopy procedures, but has not considered anxiety related to different aspects related to the colonoscopy process. AIMS Before colonoscopy, we assessed anxiety about: bowel preparation, the procedure, and the anticipated results. We evaluated associations between patient characteristics and anxiety in each area. METHODS An anonymous survey was distributed to patients immediately prior to their outpatient colonoscopy in six hospitals and two ambulatory care centers in Winnipeg, Canada. Anxiety was assessed using a visual analog scale. For each aspect, logistic regression models were used to explore associations between patient characteristics and high anxiety. RESULTS A total of 1316 respondents completed the questions about anxiety (52% female, median age 56 years). Anxiety scores > 70 (high anxiety) were reported by 18% about bowel preparation, 29% about the procedure, and 28% about the procedure results. High anxiety about bowel preparation was associated with female sex, perceived unclear instructions, unfinished laxative, and no previous colonoscopies. High anxiety about the procedure was associated with female sex, no previous colonoscopies, and confusing instructions. High anxiety about the results was associated with symptoms as an indication for colonoscopy and instructions perceived as confusing. CONCLUSIONS Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.
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Affiliation(s)
- L A Shafer
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - J R Walker
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - C Waldman
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - C Yang
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - V Michaud
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - C N Bernstein
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada.,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada
| | - L Hathout
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada
| | - J Park
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - J Sisler
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - G Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - K Wittmeier
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - H Singh
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada. .,Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada.
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16
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Sharara AI, Chalhoub JM, Beydoun M, Shayto RH, Chehab H, Harb AH, Mourad FH, Sarkis FS. A Customized Mobile Application in Colonoscopy Preparation: A Randomized Controlled Trial. Clin Transl Gastroenterol 2017; 8:e211. [PMID: 28055031 PMCID: PMC5288599 DOI: 10.1038/ctg.2016.65] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/23/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Adherence with diet and prescribed purgative is essential for proper cleansing with low-volume bowel preparations. The aim of this work was to assess the effect of a customized mobile application (App) on adherence and quality of bowel preparation. METHODS One hundred and sixty (160) eligible patients scheduled for elective colonoscopy were randomly assigned to paper (control) or App-based instructions. The preparation consisted of low-fiber diet for 2 days, clear fluids for one day and split-dose sodium picosulfate/magnesium citrate (SPS). Before colonoscopy, information was collected regarding adherence with, and utility of the provided instructions. The colonoscopists, blinded to assignment, graded bowel preparation using the Aronchick, Ottawa, and Chicago preparation scales. The primary endpoint was adherence with instructions. Quality of preparation was a secondary endpoint. RESULTS No difference in overall adherence or bowel cleanliness was observed between the study arms. Adherence was reported in 82.4% of App vs. 73.4% of controls (P=0.40). An adequate bowel preparation on the Aronchick scale was noted in 77.2 vs. 82.5%, respectively (P=0.68). Mean scores on the Ottawa and Chicago scales were also similar. Gender, age, time of colonoscopy, and BMI did not influence preparation or adherence. Compliance with the clear fluid diet component was noted in 94% of patients with BMI<30 vs. 77% with BMI≥30 (P<0.01). SPS was well tolerated by 81.9% of patients. The App was user-friendly and received higher overall rating in this respect than paper instructions (P<0.01). CONCLUSIONS SPS is well tolerated and effective for bowel cleansing regardless of instruction method. Customized smartphone applications are effective, well-accepted and could replace standard paper instructions for bowel preparation.ClinicalTrials.gov: NCT02410720.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean M Chalhoub
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Beydoun
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rani H Shayto
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hamed Chehab
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali H Harb
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi H Mourad
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fayez S Sarkis
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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17
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Sharara AI, Daroub H, Georges C, Shayto R, Nader R, Chalhoub J, Olabi A. Sensory characterization of bowel cleansing solutions. World J Gastrointest Endosc 2016; 8:508-516. [PMID: 27606043 PMCID: PMC4980640 DOI: 10.4253/wjge.v8.i15.508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 02/29/2016] [Accepted: 05/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the sensory characteristics of commercial bowel cleansing preparations.
METHODS: Samples of 4 commercially available bowel cleansing preparations, namely polyethylene glycol electrolyte solution (PEG), PEG + ascorbic acid (PEG-Asc), sodium picosulfate (SPS), and oral sodium sulfate (OSS) were prepared according to the manufacturer’s instructions. Descriptive analysis was conducted (n = 14) using a 15-cm line scale with the Compusense at-hand® sensory evaluation software. Acceptability testing (n = 80) was conducted using the 9-point hedonic scale. In addition, a Just-About-Right (JAR) scale was included for the four basic tastes to determine their intensity compatibility with acceptability levels in the products.
RESULTS: Samples were significantly different, in descriptive analysis, for all attributes (P < 0.05) except for sweetness. SPS received the highest ratings for turbidity, viscosity appearance, orange odor and orange flavor; PEG-Asc for citrus odor and citrus flavor; OSS for sweetener taste, sweet aftertaste, bitterness, astringency, mouthcoating, bitter aftertaste and throatburn, and along with PEG-Asc, the highest ratings for saltiness, sourness and adhesiveness. Acceptability results showed significant differences between the various samples (P < 0.05). SPS received significantly higher ratings for overall acceptability, acceptability of taste, odor and mouthfeel (P < 0.05). JAR ratings showed that PEG and PEG-Asc were perceived as slightly too salty; SPS and OSS were slightly too sweet, while SPS, PEG-Asc and OSS were slightly too sour and OSS slightly too bitter. While using small sample volumes was necessary to avoid unwanted purgative effects, acceptability ratings do not reflect the true effect of large volumes intake thus limiting the generalization of the results.
CONCLUSION: Further improvements are needed to enhance the sensory profile and to optimize the acceptability for better compliance with these bowel cleansing solutions.
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18
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Martin D, Walayat S, Ahmed Z, Dhillon S, Asche CV, Puli S, Ren J. Impact of bowel preparation type on the quality of colonoscopy: a multicenter community-based study. J Community Hosp Intern Med Perspect 2016; 6:31074. [PMID: 27124170 PMCID: PMC4848432 DOI: 10.3402/jchimp.v6.31074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/22/2016] [Indexed: 12/27/2022] Open
Abstract
Background High-quality bowel preparation is crucial for achieving the goals of colonoscopy. However, choosing a bowel preparation in clinical practice can be challenging because of the many formulations. This study aims to assess the impact the type of bowel preparation on the quality of colonoscopy in a community hospital setting. Methods A retrospective, observational study was conducted utilizing a colonoscopy screening/surveillance database in central Illinois during the period of January 1, 2010, to March 31, 2014. Patients without bowel preparation assessment were excluded from this study. Controlling for the confounders, generalized linear models were used to estimate the adjusted impact [odds ratio (OR)] of bowel preparation type on the quality of preparation (excellent, good, fair, and poor), and on the detection of advanced adenoma. The association between the time of withdrawal after insertion and the quality of preparation was also examined using a linear model. Results A total of 28,368 colonoscopies; half the patients were male, and the average age was 61±9 years. Polyethylene glycol (PEG) was used in the majority (70.2%) of bowel preparations, followed by sodium sulfate (21.4%), sodium phosphate (2.5%), magnesium sulfate (0.4%), and others. Compared with PEG, magnesium sulfate had a poorer quality of bowel preparations (OR=0.6, 95% CI 0.4–0.9; p<0.05), whereas the quality of bowel preparation was significantly improved by using sodium sulfate (OR=5.7, 95% CI 5.4–6.1; p<0.001) and sodium phosphate (OR=2.1, 95% CI 1.8–2.5; p<0.001). For those who had adequate bowel preparation, the better quality of preparation significantly increased the detection rate of advanced adenoma (5.0, 3.6, and 2.9% for excellent, good, and fair, respectively). Conclusion When possible, sodium sulfate–based preparations should be recommended in the community setting for colonoscopy because of their high quality of bowel preparation.
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Affiliation(s)
- Daniel Martin
- Department of Gastroenterology, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Saqib Walayat
- Department of Gastroenterology, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Zohair Ahmed
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Sonu Dhillon
- Department of Gastroenterology, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Carl V Asche
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.,Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.,Department of Pharmacy Systems, Outcomes And Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Srinivas Puli
- Department of Gastroenterology, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Jinma Ren
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.,Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, IL, USA;
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19
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Sharara AI, El Reda ZD, Harb AH, Abou Fadel CG, Sarkis FS, Chalhoub JM, Abou Mrad R. The burden of bowel preparations in patients undergoing elective colonoscopy. United European Gastroenterol J 2016; 4:314-318. [PMID: 27087962 PMCID: PMC4804361 DOI: 10.1177/2050640615594550] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/10/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND An adequate bowel preparation is an important quality measure for optimal colonoscopy. AIMS The aim of this article is to study the burden of bowel preparations by examining seven specific variables (hunger, taste, volume, sleep, social, work, and adverse events (AEs)). METHODS Ambulatory patients undergoing elective colonoscopy completed a questionnaire regarding their experience with the prescribed preparation. The seven study variables were graded using a numerical scale of 0-10 (best to worst). A score >6 was considered to indicate a significant impact and used as primary outcome. Patients were also asked to grade in descending order what they perceived as the worst aspect of the preparation. RESULTS A total of 216 patients completed the survey. Preparations consisted of split-dose sodium picosulfate (SPS) (n = 49), split-dose 4 l PEG ± menthol (n = 49), full-dose PEG (n = 68), and 2 l split-dose PEG + ascorbic acid (n = 50). Except for work and AEs, all variables were considered to have a negative impact by >20% of patients (range 20.4-34.2). SPS was superior to PEG regimens in taste (4.1% vs. 35.9%) and volume (0% vs. 44.9%) (p < 0.05 for both) but inferior for hunger (30.6% vs. 19.2%; p = 0.09). The addition of menthol to PEG significantly improved taste (22.4% vs. 41.5%; p = 0.02). Sleep disturbances were most common with SPS and least with split-dose PEG (30.6% vs. 17.4%; p < 0.05). Overall, patients ranked volume, taste, and hunger as most burdensome. CONCLUSIONS The burden of bowel preparation is substantial. An informed personalized choice of preparation may improve adherence, tolerability and colon cleansing.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeinab D El Reda
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali H Harb
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Carla G Abou Fadel
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fayez S Sarkis
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean M Chalhoub
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachel Abou Mrad
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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20
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Sharara AI, Harb AH, Sarkis FS, Chalhoub JM, Habib RH. Body mass index and quality of bowel preparation: Real life vs. clinical trials. Arab J Gastroenterol 2016; 17:11-16. [PMID: 26795085 DOI: 10.1016/j.ajg.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/22/2015] [Accepted: 12/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Obesity is a recognised risk factor for poor bowel preparation in retrospective studies whilst corresponding data in prospective trials are marginally reported. Aims are to evaluate the relation between body mass index (BMI) and preparation quality in retrospective and interventional prospective settings and within a single centre. PATIENTS AND METHODS Data from a recent colorectal cancer screening registry were retrospectively analysed for the relation between BMI and adequacy of preparation. Patients were categorised as underweight (BMI<20kg/m(2)), normal (20-25kg/m(2)), overweight (25-30kg/m(2)), and obese (>30kg/m(2)). Data from a recent prospective colon preparation trial were similarly analysed. RESULTS 541 registry patients were included. Multivariate analysis showed BMI to be an independent risk factor for inadequate preparation. Obesity was associated with odds ratio (OR) of 5.3 [95% confidence interval (CI) 1.4-19.8; p=0.01] compared to normal BMI. A significant difference was also noted in underweight but otherwise healthy individuals (OR=11.1, 95% CI 2-60; p=0.005). In the prospective study of 195 patients, obese patients had comparable rates of inadequate preparation to normal-weight individuals (OR=0.7, 95% CI 1.1-3.96; p=0.68). Underweight patients had a significantly worse preparation compared to normal BMI individuals (OR=8, 95% CI 1.1-58; p=0.04). CONCLUSIONS In real life, bowel preparations in obese individuals have a lower quality in comparison to normal individuals. This finding is not replicated in clinical trials. This discrepancy is likely the result of focused patient education suggesting that this is primarily a dietary compliance phenomenon. Underweight individuals appear to have worse quality of preparation independent of study design or setting.
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Affiliation(s)
- Ala I Sharara
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Ali H Harb
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fayez S Sarkis
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean M Chalhoub
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Robert H Habib
- Outcomes Research Unit, American University of Beirut Medical Center, Beirut, Lebanon
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Abou Fadel CG, Shayto RH, Sharara AI. Optimizing Colonoscopy Quality: From Bowel Preparation to Surveillance. ACTA ACUST UNITED AC 2016; 14:115-27. [DOI: 10.1007/s11938-016-0073-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation. World J Gastroenterol 2015. [PMID: 25684963 DOI: 10.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
AIM To compare the efficacy and palatability of 4 L polyethylene glycol electrolyte (PEG) plus sugar-free menthol candy (PEG + M) vs reduced-volume 2 L ascorbic acid-supplemented PEG (AscPEG). METHODS In a randomized controlled trial setting, ambulatory patients scheduled for elective colonoscopy were prospectively enrolled. Patients were randomized to receive either PEG + M or AscPEG, both split-dosed with minimal dietary restriction. Palatability was assessed on a linear scale of 1 to 5 (1 = disgusting; 5 = tasty). Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales. The main outcomes were the palatability and efficacy of the preparation. Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation. RESULTS Overall, 200 patients were enrolled (100 patients per arm). PEG + M was more palatable than AscPEG (76% vs 62%, P = 0.03). Completing the preparation was not different between study groups (91% PEG + M vs 86% AscPEG, P = 0.38) but more patients were willing to retake PEG + M (54% vs 40% respectively, P = 0.047). There was no significant difference between PEG + M vs AscPEG in adequate cleansing on both the modified Aronchick (82% vs 77%, P = 0.31) and the Ottawa scale (85% vs 74%, P = 0.054). However, PEG + M was superior in the left colon on the Ottawa subsegmental score (score 0-2: 94% for PEG + M vs 81% for AscPEG, P = 0.005) and received significantly more excellent ratings than AscPEG on the modified Aronchick scale (61% vs 43%, P = 0.009). Both preparations performed less well in afternoon vs morning examinations (inadequate: 29% vs 15.2%, P = 0.02). CONCLUSION 4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acid- PEG and is associated with a higher rate of excellent preparations; Clinicaltrial.gov identifier: NCT01788709.
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Gottlieb K, Turner JR, Gillespie BS, Hussain F. Bowel Preparations for Colonoscopy: A Regulatory Perspective. Ther Innov Regul Sci 2015; 49:739-744. [DOI: 10.1177/2168479015577868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sharara AI, Harb AH, Sarkis FS, Chalhoub JM, Badreddine R, Mourad FH, Othman M, Masri O. Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation. World J Gastroenterol 2015; 21:1938-1944. [PMID: 25684963 PMCID: PMC4323474 DOI: 10.3748/wjg.v21.i6.1938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/30/2014] [Accepted: 11/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the efficacy and palatability of 4 L polyethylene glycol electrolyte (PEG) plus sugar-free menthol candy (PEG + M) vs reduced-volume 2 L ascorbic acid-supplemented PEG (AscPEG). METHODS In a randomized controlled trial setting, ambulatory patients scheduled for elective colonoscopy were prospectively enrolled. Patients were randomized to receive either PEG + M or AscPEG, both split-dosed with minimal dietary restriction. Palatability was assessed on a linear scale of 1 to 5 (1 = disgusting; 5 = tasty). Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales. The main outcomes were the palatability and efficacy of the preparation. Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation. RESULTS Overall, 200 patients were enrolled (100 patients per arm). PEG + M was more palatable than AscPEG (76% vs 62%, P = 0.03). Completing the preparation was not different between study groups (91% PEG + M vs 86% AscPEG, P = 0.38) but more patients were willing to retake PEG + M (54% vs 40% respectively, P = 0.047). There was no significant difference between PEG + M vs AscPEG in adequate cleansing on both the modified Aronchick (82% vs 77%, P = 0.31) and the Ottawa scale (85% vs 74%, P = 0.054). However, PEG + M was superior in the left colon on the Ottawa subsegmental score (score 0-2: 94% for PEG + M vs 81% for AscPEG, P = 0.005) and received significantly more excellent ratings than AscPEG on the modified Aronchick scale (61% vs 43%, P = 0.009). Both preparations performed less well in afternoon vs morning examinations (inadequate: 29% vs 15.2%, P = 0.02). CONCLUSION 4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acid- PEG and is associated with a higher rate of excellent preparations; Clinicaltrial.gov identifier: NCT01788709.
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Parra-Blanco A, Ruiz A, Alvarez-Lobos M, Amorós A, Gana JC, Ibáñez P, Ono A, Fujii T. Achieving the best bowel preparation for colonoscopy. World J Gastroenterol 2014; 20:17709-17726. [PMID: 25548470 PMCID: PMC4273122 DOI: 10.3748/wjg.v20.i47.17709] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/20/2014] [Accepted: 11/08/2014] [Indexed: 02/06/2023] Open
Abstract
Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here.
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Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study. Gastroenterol Res Pract 2014; 2014:541586. [PMID: 24995014 PMCID: PMC4068103 DOI: 10.1155/2014/541586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 01/15/2023] Open
Abstract
This single center, randomized, and controlled study aimed to compare the effectiveness and safety of polyethylene glycol electrolyte lavage (PEG-EL) solution and colonic hydrotherapy (CHT) for bowel preparation before colonoscopy. A total of 196 eligible outpatients scheduled for diagnostic colonoscopy were randomly assigned to the PEG-EL (n = 102) or CHT (n = 94) groups. Primary outcome measures included colonic cleanliness and adverse effects. Secondary outcome measures were patient satisfaction and preference, colonoscopic findings, ileocecal arrival rate, examiner satisfaction, and cecal intubation time. The results show that PEG-EL group was associated with significantly better colonic cleanliness than CHT group, fewer adverse effects, and increased examiner satisfaction. However, the CHT group had higher patient satisfaction and higher diverticulosis detection rates. Moreover, the results showed the same ileocecal arrival rate and patient preference between the two groups (P > 0.05). These findings indicate that PEG-EL is the preferred option in patients who followed the preparation instructions completely.
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