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E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled
Felix W Leung1, Judith O Harker, Guy Jackson
1Research and Medical Services, Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA. felix.leung@va.gov
Background:
An observational study in veterans showed that a novel water method (water infusion in lieu of air insufflation) enhanced cecal intubation and willingness to undergo a repeat scheduled unsedated colonoscopy.
Objective:
To confirm these beneficial effects and significant attenuation of discomfort in a randomized, controlled trial (RCT).
Design:
Prospective RCT, intent-to-treat analysis.
Setting:
Veterans Affairs ambulatory care facility.
Patients:
Veterans undergoing scheduled unsedated colonoscopy.
Interventions:
During insertion, the water and traditional air methods were compared.
Main Outcome Measurements:
Discomfort and procedure-related outcomes.
Results:
Eighty-two veterans were randomized to the air (n = 40) or water (n = 42) method. Cecal intubation (78% vs 98%) and willingness to repeat (78% vs 93%) were significantly better with the water method (P < .05; Fisher exact test). The mean (standard deviation) of maximum discomfort (0 = none, 10 = most severe) during colonoscopy was 5.5 (3.0) versus 3.6 (2.1) P = .002 (Student t test), and the median overall discomfort after colonoscopy was 3 versus 2, P = .052 (Mann-Whitney U test), respectively. The method, but not patient characteristics, was a predictor of discomfort (t = -1.998, P = .049, R(2) = 0.074). The odds ratio for failed cecal intubation was 2.09 (95% CI, 1.49-2.93) for the air group. Fair/poor previous experience increased the risk of failed cecal intubation in the air group only. The water method numerically increased adenoma yield.
Limitations:
Single site, small number of elderly men, unblinded examiner, possibility of unblinded subjects, restricted generalizability.
Conclusions:
The RCT data confirmed that the water method significantly enhanced cecal intubation and willingness to undergo a repeat colonoscopy. The decrease in maximum discomfort was significant; the decrease in overall discomfort approached significance. The method, but not patient characteristics, was a predictor of discomfort. (Clinical trial registration number NCT00747084).
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