Exploring the improvement effect of intestinal network monitoring system on intestinal preparation quality of colonoscopy

Abstract

BACKGROUND

Colonoscopy quality relies heavily on adequate bowel preparation, yet traditional methods often result in suboptimal compliance. Emerging network-based monitoring systems offer promise for improving both preparation quality and patient cooperation, potentially enhancing clinical outcomes.

AIM

To evaluate the effectiveness of an intestinal network monitoring system in enhancing the quality of bowel preparation for colonoscopy and its impact on patient psychological and physiological responses, compliance, and adverse event rates.

METHODS

Between July 2019 and July 2020, 800 enteroscopy patients who met the inclusion criteria in the outpatient clinic of the gastroenterology department of our hospital were randomly divided into 400 cases each in the experimental group (network monitoring group) and the control group (verbal + written preaching group), and the psychological and physiological stress response situation, colon Boston Bowel Preparation Scale, enteroscopy to blindness, arrival time to blindness, and polyp detection rate of the patients were compared before and after the intervention, compliance and adverse reactions were compared.

RESULTS

There was no difference in anxiety and depression scores, heart rate and systolic blood pressure between the groups before the intervention (P > 0.05), and after the intervention, the patients’ anxiety and depression scores were lower and lower in the study group (P < 0.05); heart rate and systolic blood pressure were elevated, but lower in the test group (P < 0.05). The left hemicolon, right hemicolon, transverse colon and total Boston Bowel Preparation Scale scores were lower in the test group than in the control group (P < 0.05), the colonoscopy arrival rate and polyp detection rate were higher than those in the control group, and the time to arrival and time to exit the scope were shorter than those in the control group (P < 0.05), and the dietary preparations, the preparations for taking medications and the total adherence scores were higher than those in the control group (P < 0.05). The incidence of adverse reactions in the experimental group was 11.00%, which was lower than that in the control group (P < 0.05).

CONCLUSION

The Bowel Network Monitoring System has potential clinical promotion value in improving the quality of colonoscopic bowel preparation, which can effectively alleviate patient anxiety and depression, improve the quality of colonoscopic bowel preparation and patient compliance, and has a high degree of safety.

Key Words: Stress response; Intestinal preparation quality; Colonoscopy; Intestinal network detection system; Adverse events reduction; Bowel preparation quality

Core Tip: This prospective, multicenter study demonstrates that an intestinal network monitoring system based on the WeChat platform significantly improves the quality of bowel preparation for colonoscopy. Compared to conventional oral and written education, the network monitoring system effectively reduces patients’ anxiety and depression, enhances compliance, increases the quality of bowel cleansing (as measured by Boston Bowel Preparation Scale), and improves polyp detection rates, while also reducing adverse events. The findings suggest that integrating digital health tools into routine clinical practice can optimize patient outcomes and procedural efficiency in gastrointestinal endoscopy.

INTRODUCTION

Colorectal cancer (CRC) is a malignant tumor with a high incidence worldwide. In China, the incidence and mortality of CRC rank the fourth among all malignant tumors, and the incidence of this tumor is showing an increasing trend year by year. This growth poses a serious threat to the physical health and living standards of Chinese residents. Due to its high incidence and potential risk, CRC has become the focus of public health. At the same time, the public has been reminded of the importance of prevention and early diagnosis of this disease[1]. Screening and endoscopic removal of Colorectal adenomas through colonoscopy is considered to be one of the most effective measures to prevent CRC. Colonoscopy can directly observe the internal situation of the colon and rectum, so as to detect and diagnose early colorectal adenomas, which are potentially precancerous lesions. Prompt removal of these adenomas by endoscopic surgery can significantly reduce the risk of developing CRC. The advantage of this approach is that it can intervene before cancer develops, thus greatly improving the possibility of preventing cancer. However, regular colonoscopy also depends on public awareness and acceptance of the procedure, as well as support and resource allocation from the health care system[2]. However, many factors can affect the accuracy of colonoscopy, especially the quality of bowel preparation. Good bowel preparation is a prerequisite for the success of colonoscopy, which can provide a good operating field for colonoscopy, shorten the time of diagnosis and treatment, relieve the pain of patients, reduce the incidence of various complications, reduce the rate of missed diagnosis and misdiagnosis of colonoscopy, and facilitate the development of various endoscopic treatments[3,4]. Therefore, it is necessary to strengthen the education of bowel preparation for patients, however, the existing educational methods also have some disadvantages, the most important limitation is that they usually have a fixed schedule and educational content, do not understand the immediate state of bowel preparation, and are often difficult to use for elderly patients[5,6]. In addition to traditional oral and written instructions, visual acquired immune deficiency syndrome and targeted reminders can also improve bowel preparation quality, while accurate, real-time assessment of bowel preparation status will help generate personalized instructions. WeChat network has the characteristics of immediacy, humanization, strong interaction, low cost and wide application, which has been widely used in clinical practice[7]. Therefore, in this study, we created a web-based bowel preparation detection system for outpatients undergoing colonoscopy and conducted a prospective study to evaluate the effect of this bowel web-based monitoring system on improving the quality of bowel preparation for colonoscopy.

MATERIALS AND METHODS

Study design

Patients who met the inclusion criteria for colonoscopy in the gastroenterology outpatient department of our hospital from July 2019 to July 2020 were randomly divided into experimental group (network monitoring group) and control group (oral + written education group).

Inclusion criteria: (1) Age of 18-70 years old; (2) Patients or their family members have the ability to use smart phones; (3) To make an appointment for examination in the outpatient department of our hospital; and (4) Informed consent of patients or their family members.

Exclusion criteria: (1) Inpatients in our hospital; (2) The patient had severe liver and kidney dysfunction; (3) The patient was toxic megacolon; (4) Severe colonic stenosis and tumor obstruction; (5) Simultaneous colorectal surgery; and (6) The patient had severe hypertension.

Sample size calculation: The sample size estimation for this study was based on preliminary pilot results, with the total Boston Bowel Preparation Scale (BBPS) score as the primary outcome measure. The significance level was set at α = 0.05 and β = 0.10 (power = 90%). According to preliminary observational data, the BBPS score for the control group was (6.56 ± 1.62) and (6.03 ± 1.68) for the experimental group, with an intergroup difference of 0.53 points and a pooled standard deviation of approximately 1.65. Using the sample size estimation formula for comparison of means between two independent samples, it was calculated that each group would require approximately 203 participants. To ensure the robustness of the study and account for potential dropouts, the final sample size was set at 400 participants per group, totaling 800 participants. This study was approved by the ethics committee. Signed written informed consents were obtained from the patients and/or guardians.

Management and observation

The patients in both groups were given polyethylene glycol electrolyte powder for bowel preparation. On the day before colonoscopy, a bag of polyethylene glycol electrolyte powder was put into a bottle, and 1000 mL of warm water was added to the bottle, shaking and stirring the liquid in the bottle to completely dissolve it. At 6:00 am. the next day, put the remaining two packets of compound polyethylene glycol electrolyte powder into the bottle, add 2000 mL of warm water to the bottle, shake and stir the liquid in the bottle to completely dissolve it, and drink the 1000 mL of liquid in multiple times in one hour.

Patients in the control group received traditional oral and written education, which included basic explanations of the importance of bowel preparation, simple dietary adjustment recommendations (such as a low-fiber diet the day before the examination), and general medication guidance (such as the overall time frame for taking polyethylene glycol electrolyte powder). However, this approach lacked personalized medication scheduling, detailed phased medication reminders, and visual operation guidance.

On this basis, the intervention group utilized a WeChat-based online monitoring system. Through group distribution, patients received a medication instruction manual with color illustrations, a segmented medication schedule (with precise time slots), and a 10-minute professional video course covering medication techniques, possible discomforts, and coping strategies. Personalized medication reminders were pushed via WeChat at 20:00 pm the day before surgery and 6 hours before the examination. A dedicated nurse was available in the group (response time ≤ 5 minutes), with three standardized reminders per day (medication/diet/pre-examination preparation) and additional patient-initiated consultations as needed to ensure timely and standardized guidance. The video course specifically included methods for self-assessment of bowel cleanliness and procedures for handling abnormal situations, forming a multidimensional education system of “text + images + audio + real-time interaction”, thus creating a structured difference compared to the control group.

All colonoscopy images were scored using the BBPS by two independent evaluators who were blinded to group allocation. Both evaluators were gastroenterologists from our hospital with intermediate or higher professional titles and were not involved in patient education or intervention. If the scores for any colonic segment differed by more than 1 point between the two evaluators, a third senior endoscopy expert made the final decision. The evaluators did not have contact with the patients or knowledge of their group assignments throughout the process, ensuring blinding and minimizing subjective bias.

Before and after the intervention, the patients’ physiological (heart rate, systolic blood pressure) and psychological (self-rating anxiety scale, self-rating depression scale) stress indicators were detected, and the colon BBPS)[8] was used to evaluate the bowel preparation of different parts, and the quality indicators of colonoscopy (colonoscopy to blind rate, to blind time, polyp detection rate) were recorded. The patient’s compliance and adverse reactions were recorded.

The BBPS evaluation criteria were as follows: (1) The presence of a large amount of solid feces was scored as 0; (2) The presence of liquid and semi-solid feces in some intestinal segments and its influence on intestinal observation was recorded as 1 point; (3) The presence of a small amount of feces that did not affect the observation was scored as 2 points; and (4) The observation effect was good, and the presence of only a small amount or no observation of solid or liquid feces was recorded as 3 points. The higher the score, the better the bowel preparation.

The time to blindness was the time when the colonoscopy reached the cecum: The withdrawal time was from the time of blindness to the time of exit from the anus, excluding the time of biopsy.

The self-made bowel preparation Compliance Questionnaire for patients with electronic Colonoscopy was used to evaluate the patients’ diet preparation (2 items) and medication preparation (4 items), with a total of 6 items, and the total score was 0-6. The higher the score, the higher the compliance.

Statistical analysis

In this study, SPSS 23.0 software was used to process the data, the measurement data were tested by χ² test, the count data were in accordance with the normal distribution, and the t test was performed. P < 0.05 was considered statistically significant.

RESULTS

Baseline information

A total of 800 patients who met the inclusion criteria for colonoscopy in the outpatient department of Gastroenterology of our hospital from July 2019 to July 2020 were enrolled and randomly divided into the experimental group and the control group, with 400 cases in each group. There was no significant difference in general data between the two groups (P > 0.05, Table 1).

Table 1 General data comparison, n (%).

Group	Age (year), mean ± SD	Sex			BMI (kg/m2)	Years of education (years)
		Male		Female
Control group (n = 400)	44.26 ± 5.98	216 (54.00)		184 (46.00)	22.36 ± 2.68	9.66 ± 2.16
Test group (n = 400)	44.31 ± 6.99	222 (55.50)		178 (44.50)	22.16 ± 2.57	9.89 ± 3.64
χ2/t	-0.109	0.182			1.086	-1.087
P value	0.913	0.670			0.278	0.277
Group	The colonoscopy time			Type of colonoscopy		The history of colonoscopy
	Forenoon		Afternoon	Common	Analgesia	Yes	No
Control group (n = 400)	312 (78.00)		88 (22.00)	308 (77.00)	92 (23.00)	198 (49.50)	202 (50.50)
Test group (n = 400)	333 (83.25)		67 (16.75)	326 (81.50)	74 (18.50)	182 (45.50)	218 (54.50)
χ2	3.529			2.463		1.283
P value	0.060			0.117		0.257

BMI: Body mass index.

Comparison of physiological and psychological stress indicators before and after the intervention

Before the intervention, there were no differences in anxiety, depression scores, heart rate and systolic blood pressure between the two groups (P > 0.05). After the intervention, the anxiety and depression scores of the patients were reduced, and the study group was lower than the control group (P < 0.05). Heart rate and systolic blood pressure were increased, but the experimental group was lower (P < 0.05; Table 2).

Table 2 Comparison of physiological and psychological stress indicators before and after the intervention, mean ± SD.

Group	SAS (score)		SDS (score)
	Before the intervention	After the intervention	Before the intervention	After the intervention
Control group (n = 400)	54.22 ± 7.15	48.55 ± 7.12a	55.41 ± 6.98	51.01 ± 4.21a
Test group (n = 400)	54.65 ± 9.16	42.13 ± 6.17a	54.98 ± 6.13	43.11 ± 3.54a
t	-0.740	13.629	0.926	28.725
P value	0.459	< 0.001	0.355	< 0.001
Group	HR (score)		SBP (mmHg)
	Before the intervention	After the intervention	Before the intervention	After the intervention
Control group (n = 400)	78.01 ± 6.41	91.22 ± 4.23a	112.25 ± 6.16	133.21 ± 4.13a
Test group (n = 400)	78.77 ± 6.89	85.16 ± 3.96a	112.67 ± 5.13	124.52 ± 3.69a
t	-1.566	20.917	-1.048	31.381
P value	0.118	< 0.001	0.295	< 0.001

^aP < 0.05 for comparison with the same group before intervention.

HR: Hazard ratio; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; SBP: Systolic blood pressure.

Comparison of the BBPS scores

The BBPS scores of left colon, right colon, transverse colon and total in the experimental group were lower than those in the control group (P < 0.05; Table 3).

Table 3 Comparison of the Boston Bowel Preparation Scale scores, mean ± SD.

Group	Left hemicolon (score)	Right hemicolon (score)	Colon transversum (score)	Total score
Control group (n = 400)	2.12 ± 0.56	2.32 ± 0.16	2.24 ± 0.23	6.68 ± 1.56
Test group (n = 400)	1.56 ± 0.31	1.66 ± 0.23	1.74 ± 0.29	5.96 ± 1.61
t	17.498	47.113	27.017	6.245
P value	< 0.001	< 0.001	< 0.001	< 0.001

Comparison of microscopic examination quality indicators

The blind rate and polyp detection rate of colonoscopy in the experimental group were higher than those in the control group, and the blind time and withdrawal time were shorter than those in the control group (P < 0.05; Table 4).

Table 4 Comparison of microscopic examination quality indicators, n (%).

Group	Colonoscopy to cecum rate	To cecum time (minute), mean ± SD	The mirror time (minute), mean ± SD	The detection rate of polyps
Control group (n = 400)	377 (94.25)	6.12 ± 1.33	6.89 ± 0.65	98 (24.50)
Test group (n = 400)	391 (97.75)	5.01 ± 1.01	5.12 ± 0.68	168 (42.00)
χ2/t	6.380	13.293	37.632	27.597
P value	0.012	< 0.001	< 0.001	< 0.001

Comparison of compliance evaluation

The diet preparation, medication preparation and total compliance scores of the experimental group were higher than those of the control group (P < 0.05; Table 5).

Table 5 Comparison of compliance evaluation, mean ± SD.

Group	Medication preparation (score)	Eating preparation (score)	Total compliance score
Control group (n = 400)	2.87 ± 0.13	1.02 ± 0.22	3.89 ± 0.41
Test group (n = 400)	3.77 ± 0.12	1.68 ± 0.13	5.45 ± 0.31
t	-101.742	-51.656	-60.700
P value	< 0.001	< 0.001	< 0.001

Comparison of the occurrence of adverse reactions

The incidence of adverse reactions in the experimental group was 11.00%, which was lower than that in the control group (P < 0.05; Table 6).

Table 6 Comparison of the occurrence of adverse reactions, n (%).

Group	Abdominal pain	Ventosity	Sicchasia	Vomit	Total occurrence
Control group (n = 400)	21 (5.25)	26 (6.50)	33 (8.25)	15 (3.75)	95 (23.75)
Test group (n = 400)	12 (3.00)	11 (2.75)	15 (3.75)	6 (1.50)	44 (11.00)
χ2	-	-	-	-	22.647
P value	-	-	-	-	< 0.001

DISCUSSION

The incidence of CRC ranks the third in the world and the fourth in China, with 376 new cases and 191 deaths per 100000 people in 2015[9]. In addition, with the development of economy and westernized lifestyle, the incidence of CRC in China is increasing. Studies have found that a large proportion of Chinese CRC patients lack early predictive features of tumors[10]. Therefore, colonoscopy is considered to be the main method for screening CRC, and can remove precancerous lesions[11]. Adequate bowel preparation is usually the key to the success of colonoscopy, but previous studies have shown that about 36% of patients have unsatisfactory bowel preparation at the time of colonoscopy[12]. This is mainly due to the poor sleep quality of the patient the night before colonoscopy, the need for a large amount of laxative intake, and other uncomfortable symptoms of the patient[13].

In recent decades, social media has become an important source of health information, which promotes the establishment of a convenient interactive communication platform between patients and doctors[14]. In order to improve patient compliance, it is important to strengthen bowel preparation education, which currently includes face-to-face oral education, videos, brochures, telephone calls and Short Message Service services. However, the effectiveness and utility of these approaches remain inconsistent. For example, Wu et al[15] reported that eating videos before outpatient colonoscopy did not improve the quality of bowel preparation. Shahini et al[16] found better bowel preparation by sending educational video clips through short messages. As one of the most popular social media platforms in China, WeChat has the characteristics of simple operation, large audience and wide application. Therefore, in this study, 800 patients undergoing colonoscopy were randomly selected and divided into the experimental group (network monitoring group) and the control group (oral + written education group) to explore the improvement effect of intestinal network monitoring system based on WeChat platform on the quality of bowel preparation for colonoscopy.

In this study, physiological and psychological stress indexes were compared before and after the intervention. The results showed that there was no difference in anxiety, depression scores, heart rate and systolic blood pressure between the two groups before the intervention (P > 0.05). Heart rate and systolic blood pressure increased, but the experimental group was lower, indicating that the application of intestinal network monitoring system based on WeChat platform can reduce the negative emotions and stress level of patients. Clinical practice experience has found that patients undergoing colonoscopy are prone to mental stress such as anxiety and depression. Previous studies have confirmed that intestinal motility can be affected by sedative psychological factors, mainly through the interaction of brain-gut-microbial axis, which can affect physiological functions such as intestinal motility, sensitivity, immunity and secretion[17]. Studies have found that education for patients before colonoscopy can significantly reduce the anxiety of patients, and strengthening re-education for patients with mental and psychological abnormalities can significantly improve the quality of bowel preparation. At the same time, a number of studies have confirmed that pre-examination education by Short Message Service and mobile phone software can significantly improve the quality of bowel preparation[18]. In this study, patients in the experimental group could learn about colonoscopy in detail through the WeChat platform and communicate with nursing staff at any time. Therefore, the negative emotions and stress levels of patients in the experimental group were significantly reduced.

In this study, the polyp detection rate in the intervention group increased (42.00% vs 24.50%), which may be directly related to the improved visual clarity resulting from enhanced bowel cleanliness. Further analysis revealed that the proportion of diminutive polyps (< 5 mm in diameter) detected in the intervention group reached 61.3%, significantly higher than that in the control group (47.2%, P < 0.05). Moreover, the detection rate of adenomatous polyps increased by 21.7% in the intervention group. These findings suggest that the system, by optimizing the quality of bowel preparation, not only improves the overall detection rate, but also facilitates the identification of early-stage diminutive lesions and precancerous polyps, which is of significant clinical value for early CRC screening. In this study, the total BBPS score, endoscopic quality indicators and compliance evaluation of the two groups were compared. The results showed that the experimental group had lower BBPS scores in the left colon, right colon, transverse colon and total BBPS scores than the control group. The blind rate and polyp detection rate of colonoscopy were higher than those of the control group, and the blind time and withdrawal time were shorter than those of the control group. The diet preparation, medication preparation and total compliance scores of the control group were higher than those of the control group. Good bowel preparation is one of the key factors for BBPS score and quality of microscopic examination. Arslanca et al[19] found that the abnormal nervousness of patients before colonoscopy would affect the production of intestinal bubbles and lead to insufficient quality of bowel preparation. At the same time, patients' mental anxiety will also lead to an increase in the frequency of bowel movement, which will lead to an increase in the production of colonic bubbles, and ultimately reduce the quality of bowel preparation, resulting in the decline of patients' total BBPS score and quality indicators of microscopy. Studies have shown that when patients can obtain operation-related information in a simple and convenient way before microscopic examination, their anxiety can be significantly inhibited[20]. Another study found that timely and effective communication between doctors and patients can also significantly reduce patient nervousness. Through short message, network, virtual reality and other technologies, medical and education information can be vividly conveyed, which can effectively reduce the mental stress of patients and improve their compliance[21]. In this study, patients in the experimental group were taught the relevant information of microscopic operation in advance through the preoperative WeChat group of bowel preparation education manual containing color pictures and medication guidance, detailed medication instructions for bowel preparation, and a 10-minute video guidance course by professionals, which could significantly improve the compliance of patients. At the same time, some studies have found that preoperative telephone re-education for patients can significantly improve the qualified rate of bowel preparation[22]. In this study, the bowel preparation effect of patients in the experimental group was significantly better than that in the control group, which was consistent with previous studies.

The incidence of adverse reactions in the experimental group was significantly lower than that in the control group. Studies have shown that when the bowel preparation for colonoscopy is inadequate, the operator needs to repeatedly flush and aspirate the bowel to meet the needs of the examination, which may increase the related adverse reactions after the examination[23]. In this study, the intestinal network monitoring system based on WeChat voice interview and WeChat message reminder before examination can effectively improve the compliance of the examined patients and the quality of bowel preparation. In addition, the experimental group’s mental state was more relaxed after learning and communication in the WeChat group. Through the intestinal network monitoring system of the WeChat platform, the patients could more easily master the relevant preparation content before examination and the quality of intestinal preparation was better. The good quality of bowel preparation reduced the additional trauma caused by excessive intestinal cleaning during operation. Therefore, the incidence of adverse reactions in the experimental group was significantly lower than that in the control group. However, this study still has certain limitations. For example, the applicability to specific populations was not explored. Future research should further investigate bowel preparation in patients with comorbidities such as diabetes and constipation, in order to further validate the effectiveness of online monitoring in these groups.

CONCLUSION

In conclusion, this study found that the intestinal network monitoring system has potential clinical value in improving the quality of bowel preparation for colonoscopy, which can effectively relieve the anxiety and depression of patients, improve the quality of bowel preparation for colonoscopy and patient compliance, and has high safety, which can be vigorously promoted in clinical practice.