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02-04-2013 | Surgery | Article

Colonoscopy bowel preparation improved by telephone-based re-education

Abstract

Free abstract

medwireNews: Bowel preparation quality improves in patients who are given telephone-based re-education (TRE) the day before their colonoscopy, research shows.

The prospective, colonoscopist-blinded study of 605 patients due to have colonoscopies at the Endoscopy Center of the Xijing Hospital of Digestive Diseases in China revealed that adequate bowel preparation increased from 70.3% in the control group to 81.6% in those who received TRE.

The polyp detection rate in the TRE group was also significantly improved, at 38.0% versus 24.7% in controls.

"More adequate bowel preparation through TRE might increase the efficacy of the colonoscopy screening programme and decrease overall colonoscopy cost," comment Xuegang Guo (Xijing Hospital of Digestive Diseases, Shannxi, China) and colleagues.

Outpatients aged 18-75 years undergoing colonoscopy were randomly assigned to two groups: standard instructions at the time of their appointment to discuss colonoscopy; and standard instructions plus TRE on the day before their colonoscopy appointment to reiterate the importance of and correct procedure for bowel preparation. After subsequent cancellations, 273 patients in the control group and 276 patients in the TRE group underwent colonoscopy.

Standard instruction consisted of nurse-provided information and a take-home booklet. All patients were prescribed either polyethylene glycol electrolyte powder or sodium phosphate as a purgative.

Adequate bowel preparation was defined as a total Ottawa score of less than 6. An Ottawa score of 6 or greater, cancellation of the colonoscopy, or incomplete colonoscopy all counted as inadequate bowel preparation.

Nearly half of all patients who were identified as having inadequate bowel preparation at colonoscopy had failed to comply with bowel preparation instructions, as determined by an interview before the procedure. Starting to take purgative at the wrong time and incorrect diet restriction were both associated with non-compliance with bowel preparation instructions; by contrast, failure to follow purgative instructions was not.

Writing in Gut, the authors comment: "Through TRE the day before colonoscopy, patient compliance with diet restriction and the time to start drinking purgative was significantly enhanced, which could be the main reason for improved bowel preparation."

They go on to point out that the patient population they studied was somewhat atypical in that there was a high rate of diagnostic rather than screening colonoscopies, which may have increased patient compliance with bowel preparation instructions. The short interval patients had to wait before colonoscopy may also have increased compliance, and consequently "the intervention of TRE may be even more effective in countries with longer than average intervals."

However, the authors caution that multicenter trials with larger groups of patients will be needed to confirm their findings.

By Afsaneh Gray, medwireNews Reporter

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