Background & Aims

Sufficient bowel preparation is crucial for successful screening and surveillance colonoscopy. However, rates of inadequate preparation are still high. We investigated the effects of reinforced patient education using a smartphone application software (APP) for colonoscopy preparation in participants in a CRC screening program.

Methods

We performed a prospective, endoscopist-blinded study of 500 patients undergoing split-dose bowel preparation for CRC screening or surveillance colonoscopies at multiple centers in Germany, from November 2017 through January 2019. Participants (n = 500) were given oral and written instructions during their initial appointment and then randomly assigned (1:1) to groups that received reinforced education starting 3 days before the colonoscopy (APP group) or no further education (controls). The primary outcome was quality of bowel preparation according to the Boston bowel preparation scale. Secondary outcomes included polyp and adenoma detection rates, compliance with low-fiber diet, split-dose laxative intake, perceived discomfort from the preparation procedure.

Results

The mean Boston bowel preparation scale score was significantly higher in the APP-group (7.6 ± 0.1) than in the control group (6.7 ± 0.1) (P < .0001). The percentage of patients with insufficient bowel preparation was significantly lower in the APP group (8%) than in the control group (17%) (P = .0023). The adenoma detection rate was significantly higher in the APP group (35% vs 27% in controls) (P = .0324). Use of the APP was accompanied by a lower level of non-compliance with correct laxative intake (P =.0080) and diet instructions (P = .0089). The APP group reported a lower level of discomfort during preparation (P < .0001).

Conclusions

In a randomized trial, reinforcing patient education with a smartphone application optimized bowel preparation in the 3 days before colonoscopy, increasing bowel cleanliness, adenoma detection, and compliance in patients undergoing CRC screening or surveillance. ClinicalTrials.gov no: NCT03290157

中文翻译：

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加强教育的智能手机应用程序增加了随机试验中结直肠癌筛查结肠镜检查的高质量准备。

背景与目标

充分的肠道准备对于结肠镜检查的成功筛查和监测至关重要。然而，准备不足的比率仍然很高。我们使用智能手机应用软件 (APP) 对 CRC 筛查项目的参与者进行结肠镜检查准备，调查了强化患者教育的效果。

方法

我们于 2017 年 11 月至 2019 年 1 月在德国多个中心对 500 名接受分次剂量肠道准备以进行 CRC 筛查或结肠镜监测的患者进行了一项前瞻性、内镜盲法研究。参与者 (n = 500) 在期间接受了口头和书面指导他们最初的任命，然后随机分配（1:1）到结肠镜检查前 3 天开始接受强化教育的组（APP 组）或不继续教育（对照组）。主要结果是根据波士顿肠道准备量表的肠道准备质量。次要结果包括息肉和腺瘤检出率、对低纤维饮食的依从性、分次服用泻药、准备过程中的不适感。

结果

APP 组的平均波士顿肠道准备量表评分 (7.6 ± 0.1) 显着高于对照组 (6.7 ± 0.1) ( P < .0001)。APP 组肠道准备不足的患者百分比 (8%) 明显低于对照组 (17%) ( P = .0023)。APP 组的腺瘤检出率显着更高（35% vs 对照组 27%）（P  = .0324）。APP 的使用伴随着较低水平的不遵守正确泻药摄入 ( P  = .0080) 和饮食说明 ( P  = .0089)。APP 组在准备期间报告的不适程度较低（P < .0001）。

结论

在一项随机试验中，通过智能手机应用程序加强患者教育，优化了结肠镜检查前 3 天的肠道准备，提高了接受 CRC 筛查或监测的患者的肠道清洁度、腺瘤检测和依从性。ClinicalTrials.gov 编号：NCT03290157