Effecacy Of Enhanced Education By Face-to-face And Telephone On The Quality Of Bowel Preparation:A Prospective,Single-blind,Randomised,Controlled Trial

Background Colonoscopy is a useful and widely available tool for diagnosing and managing colorectal diseases.The adequacy of bowel cleansing insures the success of colonoscopy.Though the bowel preparation methods are continuously developing,the quality of bowel preparation in some patients accepted colonoscopy remains unsatisfactory.One study introduced by Chan WK et al showed that the risk factors for poor bowel preparation include nonadherence to bowel preparation instructions,non-compliance with dietary instructions,lower education,incorrect timing of bowel preparation administration and longer appointment waiting time.Another study performed in China showed that telephone-based re-education with showed that telephone-based re-education improved both the quality of bowel preparation and the polyp detection rate(PDR)and significantly improved the quality of bowel preparation.So,it is reasonable to assume that to a enhanced educational method of face-to-face re-education will improve patient awareness and maximise patient compliance during bowel preparation.The study compares the efficacy of bowel preparation between the face-to-face re-education(FRE group)and telephone re-education(TRE group)in outpatients.Methods This is a prospective colonoscopist-blinded,randomised clinical study.All patients receive regular instructions at the time of their appointment to undergo colonoscopy.Subjects who are randomized into TRE group accept a TRE that is conducted by a investigator at 9:00-11:00 on the day before colonoscopy.Subjects who are randomized into FRE group receive a FRE that is conducted by a investigator on the same-day of procedure at hospital.The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale(BBPS).The secondary outcomes included polyp detection rate(PDR),adenoma detection rate(ADR),non-compliance with instructions,tolerance and acceptability.Results A total of 658 patients were included in this study and randomised,326 to the FRE group and 332 to the TRE group.In an intention-to-treat analysis of the primary outcome,adequate preparation was found in 82.5%vs 81.9%of FRE group and TRE group,respectively(p=0.844).PDR was 32.9%vs 39.8%in the FRE group and TRE group,respectively(p=0.076).Based on the complete procedure,the total BBPS scores were 6.4±1.5 in the FRE group and 6.3±1.4 in the TRE group(p=0.303).Fewer patients who showed non-compliance with instructions were found in the FRE group(15.0%vs 23.0%,p=0.011).The similar tolerance and acceptability showed no significant differences between the two groups.(p=0.609).Conclusions Patients who are received face-to-face bowel preparation on the day of colonoscopy achieved the similar quality of bowel preparation and PDR,but achieved higher compliance rate than telephone group.Face-to-face bowel preparation would be more valuable in the patients under high risk of inadequate BP.