Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network...

Area of Science:

• Gastroenterology
• Medical Informatics
• Clinical Trial Analysis

Background:

• Enhanced patient instructions (EPIs) have shown efficacy in improving polyp and adenoma detection rates during colonoscopies.
• Despite previous meta-analyses, an optimal method for adequate bowel preparation (BP) remains undetermined.

Purpose of the Study:

• To determine the optimal enhanced patient instructions for bowel preparation through a network meta-analysis.
• To compare the effectiveness of various EPIs against standard patient instructions (SPIs).

Main Methods:

• A systematic search for randomized controlled trials (RCTs) comparing different EPIs for BP.
• Direct and Bayesian network meta-analyses were conducted, with evidence quality appraised using GRADE criteria.
• Included 23 RCTs involving 7969 patients comparing 10 distinct instructions.

Main Results:

• Most EPIs, excluding visual aids and mobile apps, improved the adequate preparation rate (APR).
• Network meta-analyses indicated that additional explanations, SMS text messaging, telephone calls, educational videos, and social media applications were superior to visual aids and mobile apps.
• SMS text messaging, telephone calls, and social media applications enhanced adherence, satisfaction, and polyp detection rates, while social media applications reduced adverse events.

Conclusions:

• Newly designed booklets, telephone calls, educational videos, and social media applications can enhance BP quality.
• Telephone calls and social media applications demonstrate significant benefits, including improved adherence, satisfaction, reduced adverse events, and increased polyp detection rates.