| Objective:To review the existing methods of enhancing bowel preparation education and evaluate the effect of reinforced education on the quality of bowel preparation and other outcomes.The characteristics of all Clinical trials related to colonoscopic bowel preparation registered from the establishment of the Chinese Clinical Trial Registry(Chi CTR)database to December 31,2020were analyzed to analyze the status and characteristics of Clinical trials related to colonoscopic bowel preparation in China.To evaluate the effect of cartoon educational brochure on the quality of intestinal preparation in patients,and to explore its possible clinical significance.Methods:1.Literature analysis of the effect of reinforced education on the quality of bowel preparation:Pub Med,Embase,Cochrane Library and Web of Science databases were searched,and the included research data were extracted by two researchers independently.The effects of Reinforced Education(RE)and Conventional Education(CE)on the quality of intestinal preparation were compared,and the main outcome index was the quality of intestinal preparation.Rev Man 5.3 and Comprehensive Meta-analysis Software(Version 2)were used for the Analysis.2.Characteristics of clinical trials related to bowel preparation registered in Chi CTR:The main search terms were"bowel preparation","colonoscopy","bowel cleaning".The search period was from the database establishment to December 31,2020 on the Chi CTR website.Use Excel to collect the data.3.The effect of cartoon educational brochure on bowel preparation:This study was a single center,prospective,randomized controlled study.Outpatients attending for colonoscopy in the Affiliated Hospital of Southwest Medical University between April 2019 and March 2020 aged between 18 and 85 years who were able to sign written informed consent were randomly assigned into two groups:cartoon educational brochure about preparation for colonoscopy group(experimental group)and without the brochure group.(2)Design of cartoon educational brochure:This cartoon educational brochure is composed of four parts,mainly in the form of cartoons,schematic drawing and hand draw pictures,and the main content includes the importance of bowel preparation,dietary requirements before colonoscopy,methods for intestinal preparation method,simple method to judge the quality for intestinal preparation.(3)Evaluation indexes:The primary outcomes were quality of the bowel preparation based on Ottawa score and polyp detection rate.The secondary outcomes included adherence for bowel preparation,patient tolerance of bowel procedure,caecal intubation rate,insertion time,and withdrawal time.The baseline characteristics of patients were collected before the colonoscopy:age,sex,BMI,education,history of pelvic or abdominal surgery,comorbidities,colonoscopy examination history,examination indications,waiting time before colonoscopy,compliance,number of defecations,and first time and last time of defecations.Colonoscopy outcomes were collected after colonoscopy:whether sedation,proportion of adequate bowel preparation,reasons for unfinished colonoscopy,Ottawa score,polyp detection rate,caecal intubation rate,insertion time,and withdrawal time and change the position or not,self-rating of abdominal pain for insertion and completion of colonoscopy,press the patient’s abdomen or not and colonoscopy complications.Collect data,conduct statistical analysis,and compare the differences between the two groups.The t-test was used for comparison between two groups of continuous variables conforming to normal distribution.The comparison between the two groups that did not conform to the normal distribution was analyzed by rank sum test.Categorical variables were compared byχ2 test or Fisher’s exact test.Risk factors for inadequate bowel preparation(Ottawa score≥6)and factors associated with polyp detection were analyzed by Logistic regression analysis.Results:1.A total of 25 studies were included in the meta analysis,and most of them were of high quality.The qualified rate of bowel preparation was 50.7%-100%in RE Group and 35.0%-96.1%in CE group.The qualified rate of bowel preparation in RE was higher than that in CE(OR=2.17,95%CI:1.72-2.73;P<0.001,I~2=73%).Compared with CE group,the BBPS score of RE Group was higher(7.0 vs.6.5;MD=1.19,95%CI:0.48-1.91,P=0.001,I~2=99%),and the score of OBPS was lower than that of CE group(3.7 vs.4.8;P<0.05);MD=-0.60,95%CI:-0.82--0.38,P<0.001,I~2=87%)。The polyp detection rate in RE Group(825/2406,34.3%vs.672/2163,31.1%);OR=1.16,95%CI:0.93-1.43;18,I~2=60%)and adenoma detection rate(494/1789,27.6%vs.395/1539,25;OR=1.11,95%CI:0.85-1.45;45,I~2=61%)were similar with thses of CE group.The withdrawal time of RE Group was shorter than that of CE group(MD=-0.25,95%CI:-0.39-0.10,P<0.001,I~2=81%)2.By analyzing the 64 clinical trials finally included,it was found that the number of clinical trials registered in Chi CTR showed an increasing trend in general,and the trial leader units were mainly distributed in Sichuan(n=12),Guangdong(n=9)and Beijing(n=7).The project funds were mainly self raised,and exploratory research/pre experiment accounted for the majority(31.3%).Most of the studies were randomized parallel controlled studies(n=49).3.(1)Patient enrollment:A total of 660 patients were included in the study,330 in the experimental group and 330 in the control group.Finally,292patients in the cartoon education educational brochure group and 294 patients in the control group were analyzed.(2)Baseline characteristics of patients:There were no significant differences in baseline characteristics between the two groups,such as age,gender,BMI,education level,previous history of pelvic or abdominal surgery,comorbidities,history of colonoscopy and examination indications(all P>0.05).(3)Colonoscopy outcomes:The median Ottawa score of the cartoon education brochure group and the control group was 5,and there was no statistical difference(P=0.471).The qualified rates of intestinal preparation in two groups were 66.7%and 65.5%,respectively,and the difference was not statistically significant(P=0.603).The polyp detection rates in two groups were 19.2%and 22.4%,respectively,and the difference was not statistically significant(P=0.330).There were no significant differences in intestinal preparation nonadherence(32.9%vs 37.4%,P=0.250),tolerance to colonoscopy(abdominal pain score:insertion 3 vs 3,p=0.700;withdraw 1 vs 1,P=0.327),caecal intubation rate(96.6%vs 96.9%,P=0.820),insertion time(5.17 min vs 5.33 min,P=0.346),and withdrawal time(4.00 min vs 4.00 min,P=0.998)between the two groups.There were 44 cases of single polyp and 12cases of multiple polyps in the experimental group.There were 34 cases of single polyp and 32 cases of multiple polyps in the control group.The difference between the two groups was statistically significant(P<0.001).There was no significant difference in the anatomical distribution and diameter of polyps between the two groups(P=0.129,P=0.894).(4)Logistic regression analysis results:Constipation(OR=2.589,P=0.003)and unqualified dietary restriction(OR=1.788,P=0.045)were found to be independent risk factors for inadequate bowel preparation.Age(OR=1.060,P<0.001)and withdrawal time(OR=1.239,P=0.002)were significantly correlated with polyp detection.Conclusion:1.Strengthening patients’ bowel preparation education can significantly improve the quality of bowel preparation and reduce withdrawl time.For patients undergoing colonoscopy,in addition to routine bowel preparation education,intensive education should be recommended to enhance patients’understanding of bowel preparation before colonoscopy.2.The number of clinical studies related to bowel preparation registered in ChiCTR platform increased as a whole;Research on bowel preparation is uneven in geographical distribution,mainly concentrated in Sichuan,Guangdong,Beijing,Chongqing and Shanghai,and most of them are university affiliated hospitals or domestic well-known hospitals;However,there are still some problems,such as insufficient explanation of random method and sample size calculation.3.Cartoon education brochure cannot effectively improve the quality of bowel preparation and polyp detection rate in the population in the southern Sichuan area of China.Poor dietary restriction before colonoscopy and constipation are independent risk factors for inadequate bowel preparation.Age and withdrawal time are closely related to polyp detection in patients. |
PDF Full Text Request