Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial

Abstract

Background The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy.

Methods We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases.

Results 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001).

Conclusion Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases.

Publikationsverlauf

Eingereicht: 24. Dezember 2019

Angenommen: 22. April 2020

Artikel online veröffentlicht:
17. Juni 2020

• References

• 1 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United Eur Gastroenterol J 2017; 5: 309-334
• 2 Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2018; 30: 819-826
• 3 Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol 2014; 109: 1714-1723
• 4 Rex DK, Imperiale TF, Latinovich DR. et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002; 97: 1696-1700
• 5 Saltzman JR, Cash BD, Pasha SF. et al. Bowel preparation before colonoscopy. Gastrointest Endosc 2015; 81: 781-794
• 6 Ben-Horin S, Bar-Meir S, Avidan B. The outcome of a second preparation for colonoscopy after preparation failure in the first procedure. Gastrointest Endosc 2009; 69: 626-630
• 7 Ness RM, Manam R, Hoen H. et al. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 2001; 96: 1797-1802
• 8 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2019. Endoscopy 2019; 45: 142-155
• 9 Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci 2010; 55: 2014-2020
• 10 Jones RM, Woolf SH, Cunningham TD. et al. The relative importance of patient-reported barriers to colorectal cancer screening. Am J Prev Med 2010; 38: 499-507
• 11 Liu X, Luo H, Zhang L. et al. Telephone-based re-education on the day before colonoscopy improves the quality of bowel preparation and the polyp detection rate: a prospective, colonoscopist-blinded, randomised, controlled study. Gut 2014; 63: 125-130
• 12 Lee YJ, Kim ES, Choi JH. et al. Impact of reinforced education by telephone and short message service on the quality of bowel preparation: a randomized controlled study. Endoscopy 2015; 47: 1018-1027
• 13 Guo X, Yang Z, Zhao L. et al. Enhanced instructions improve the quality of bowel preparation for colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc 2017; 85: 90-97.e6
• 14 Johnson DA, Barkun AN, Cohen LB. et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2014; 109: 1528-1545
• 15 Clark BT, Protiva P, Nagar A. et al. Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men. Gastroenterology 2016; 150: 396-405
• 16 Dumonceau J-M, Riphaus A, Schreiber F. et al. Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates Guideline – updated June 2015. Endoscopy 2015; 47: 1175-1189
• 17 Hassan C, Bretthauer M, Kaminski MF. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45: 142-150
• 18 Alvarez-Gonzalez MA, Pantaleon MA, Flores-Le RouxJA. et al. Randomized clinical trial: a normocaloric low-fiber diet the day before colonoscopy is the most effective approach to bowel preparation in colorectal cancer screening colonoscopy. Dis Colon Rectum 2019; 62: 491-497
• 19 Gimeno-García AZ, Hernandez G, Aldea A. et al. Comparison of two intensive bowel cleansing regimens in patients with previous poor bowel preparation: a randomized controlled study. Am J Gastroenterol 2017; 112: 951-958
• 20 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692
• 21 Gimeno-García AZ, Baute JL, Hernandez G. et al. Risk factors for inadequate bowel preparation: a validated predictive score. Endoscopy 2017; 49: 536-543
• 22 Dik VK, Moons LMG, Hüyük M. et al. Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score. Gastrointest Endosc 2015; 81: 665-672
• 23 Diari Oficial de la Generalitat de Catalunya ORDRE SLT/165/2018. contraprestació de l’atenció hospitalària i especialitzada; 2018 Available from: https://portaldogc.gencat.cat/utilsEADOP/PDF/7723/1697258.pdf 1-10
• 24 Mangas-Sanjuan C, Santana E, Cubiella J. et al. Variation in colonoscopy performance measures according to procedure indication. Clin Gastroenterol Hepatol 2020; 18: 1216-1223.e2
• 25 Rigaux J, Juriens I, Devière J. A novel system for the improvement of colonic cleansing during colonoscopy. Endoscopy 2012; 44: 703-706
• 26 Hernández G, Gimeno-García AZ, Quintero E. Estrategias para optimizar la calidad de la limpieza colónica. Gastroenterol Hepatol 2019; 42: 326-338
• 27 Radaelli F, Paggi S, Hassan C. et al. Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme. Gut 2017; 66: 270-277
• 28 Gimeno-García AZ, de la Barreda Heuser R, Reygosa C. et al. Impact of a 1-day versus 3-day low-residue diet on bowel cleansing quality before colonoscopy: a randomized controlled trial. Endoscopy 2019; 51: 628-636
• 29 Chokshi RV, Hovis CE, Hollander T. et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc 2012; 75: 1197-1203
• 30 Alvarez-Gonzalez MA, Flores-Le Roux AA, Seoane A. et al. Efficacy of a multifactorial strategy for bowel preparation in diabetic patients undergoing colonoscopy: a randomized trial. Endoscopy 2016; 48: 1003-1009
• 31 Seoane Urgorri A, Font Lagarriga X, Pérez Berbegal R. et al. Educational telephone intervention by endoscopy nurse. Impact on the adherence of outpatient colonoscopy. Endoscopy 2019; 51 (Suppl. 04) S125