Analysis And Improvement Of Intestinal Preparation Quality Before Colonoscopy

Objective:The topic aims to understand the current situation of bowel preparation before colonoscopy in a hospital and explore the relevant factors affecting the quality of colonoscopy.The improvement scheme is proposed to observe the improvement effect and provide a more optimized intestinal preparation scheme for clinical practice.Methods:(1)The first part adopts the single center and prospective research method,select the colonoscopy in the endoscopy center of Youjiang Medical College for Nationalities from October 2022 to December 2022,select eligible subjects according to the inclusion and exclusion criteria,sign the informed consent of the colonoscopy,and collect general data,the intestinal preparation process and the results of the survey.The intestinal preparation quality score was scored by Boston score(Boston bowel preparation scale,BBPS).When the score of each intestinal segment was 2,the corresponding bowel preparation was sufficient.The BBPS total score was 6,and the bowel score was 2.Taking P<0.05 as statistical significance,univariate primary screening analysis was conducted on the factors influencing intestinal preparation quality.After primary screening,multivariate analysis was conducted by binary Logistic regression according to the two levels of sufficient and inadequate intestinal preparation to find out the independent factors influencing the quality of intestinal preparation before colonoscopy.(2)In the second part of randomized controlled study,198 subjects who underwent colonoscopy in the Affiliated Hospital of Youjiang Medical College for Nationalities from December 2022 to January 2023 were grouped according to the examination time,100 subjects who underwent colonoscopy in December 2023 were divided into control group;98 subjects who underwent colonoscopy in January 2023 were divided into experimental group.In the experimental group,98 patients used cartoon drawing education,additional water until the last stool and 30 minutes walking exercise during bowel preparation procedure;100 patients continued to use oral and written routine education without limiting the patients’ exercise during bowel preparation.Both groups were cleared with sodium phosphate salt,and the differences in intestinal tract and total score,lesion detection rate,patient satisfaction,and repeated bowel preparation intention between the two groups were calculated according to the BBPS score.Results:(1)The first part finally recovered 470 valid questionnaire data for the analysis of factors affecting the quality of intestinal preparation.Statistically,359 cases(76.40%)of right hemicolectomy were adequately prepared;390 cases(83.00%)of transverse colon were adequately prepared;419 cases(89.10%)of left hemicolectomy were adequately prepared,and a total of 322 cases(68.51%)of overall intestinal bowel preparation were adequately prepared,and 148 cases(31.49%)of examinees had inadequate bowel preparation.Univariate analysis revealed age(P<0.001),literacy level(P<0.001),usual exercise(P<0.001),history of previous abdominal/pelvic surgery(P<0.001),mode of catharsis(P<0.001),clarity of bowel preparation session(P<0.001),diet two days before examination(P<0.001),whether complete medication was taken(P<0.001),number of bowel movements(P<0.001),last stool properties(P<0.001),exercise during medication(P<0.001),whether additional water was consumed(P<0.001),quality of sleep the night before the examination(P<0.001),and whether nervousness before the examination(P<0.001)were statistically significant differences between groups.Binary logistic regression analysis revealed that it was unclear about the bowel preparation session(OR=3.528,95%CI:1.363-9.131,P=0.009),low residue diet two days before the examination(OR=2.310,95%CI:1.262-4.229,P=0.007),literacy level(P=0.012),and last stool with scum(OR=8.068,95%CI:3.506-18.565,P<0.001),<30minutes of exercise during medication administration(OR=2.905,95%CI:1.486-5.678,P=0.002),and no additional drinking during medication administration(OR=2.692,95%CI:1.187-6.104,P=0.018)were influential factors affecting inadequate bowel preparation.(2)In the second part,there was no significant difference between the baseline data,age,gender,BMI,junior high school education or above,previous abdominal / pelvic surgery,and previous colonoscopy(P>0.05).Comparing the two groups,it was found that the experimental group had significantly higher BBPS scores than the control group in the right hemicolectum(1.98±0.69 vs 1.72±0.92,P=0.026),transverse colon(2.26±0.67 vs 1.99±0.83,P=0.014)and overall intestine(6.64±1.61 vs 5.99±2.08,P=0.014),while in the left hemicolectum(2.41 ± 0.67 vs 2.28 ± 0.77,P=0.212)was not significant.There were also significant differences in polyp detection rate(30.61% vs 18.00%,P=0.029),overall lesion detection rate(51.02% vs 35.00%,P=0.023),and willingness to repeat bowel preparation(77.55% vs 62.00%,P=0.017),which were higher in the experimental group than in the control group.The overall bowel preparation satisfaction in the control group reached 96%,while the experimental group reached 100%,with no statistically significant difference(P=0.121).Conclusion:(1)This study found that lack of clarity about the bowel preparation session,low residue diet two days before the examination,literacy level,last stool with residue,<30minutes of exercise during medication administration,and no additional drinking during medication administration were independent influencing factors affecting inadequate bowel preparation.(2)The bowel preparation plan of enhanced education and additional drinking water to the last stool without slag combined with exercise intervention can improve the quality of the right colon,transverse colon and overall bowel,thus increasing the visualization and improving the detection rate of polyps,overall intestinal lesions and the willingness to repeat bowel preparation.