Educating patients through the use of a smartphone application optimized bowel preparation for colonoscopy in the days prior to procedures. It also increased bowel cleanliness, adenoma detection, and compliance in patients undergoing colorectal cancer (CRC) screening or surveillance, according to study results published in Clinical Gastroenterology and Hepatology.

CRC is the leading cause of cancer morbidity and mortality in the United States and Europe. Colonoscopy is the preferred screening method for CRC. Adequacy of bowel preparation is an important quality indicator of colonoscopy. Inadequate bowel preparation has been associated with longer procedure time, reduced visualization, risk of complications, risk of missing adenomas, and increased costs. Unfortunately, rates of inadequate preparation remain high, partially due to the confusing and burdensome process of preparing the bowel, which patients do themselves.

Researchers investigated the impact of promoting patient education with a smartphone application software (APP) for colonoscopy preparation on individuals enrolled in a CRC screen programing. A multi-center prospective, endoscopist-blinded, randomized study of 500 patients undergoing split-dose bowel preparation for CRC screening was carried out in Germany from November 2017 to January 2019. Study participants were randomly assigned (1:1) to 1 the following 2  groups: the APP group received standard education and reinforced education starting 3 days prior to the colonoscopy while the control group received only the standard education with no further reinforcement reminders. The primary endpoint was quality of bowel preparation determined by the Boston Bowel Preparation Scale scoring system (BBPS). Secondary endpoints included split-dose laxative intake, polyp and adenoma detection rates (ADRs), compliance with low-fiber diet, as well as patient’s subjective perceived discomfort from the preparation procedure and their perception of APP.


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Results showed that the APP group had significantly improved bowel preparation than the control group according to the BBPS (7.6 ±0.1 versus 6.7±0.1; P<.0001). Compared to the control group, the percentage of patients with inadequate bowel preparation was significantly lower in the APP group (17% versus 8%; P=.0023). Secondary outcomes revealed that the total number of adenomas detected in the APP group was significantly higher compared with the controls (35% vs 27%; P =.0324). Additionally, compliance with dietary instructions and correct laxative intake was higher in the APP group than the control group. The APP group also reported a significantly lower level of discomfort during preparation (P <.0001), and importantly, most participants in the APP group stated they would use an APP guidance again for their next colonoscopy (87% vs 13%).

Limitations of the study include limited generalizability because only smartphone users could participate, Secondly, only morning colonoscopies were included. Consequently, the impact of a preparation APP on afternoon colonoscopies remains unknown. Thirdly, the APP used was only available in German leading to exclusion bias and transferability of results. Lastly, the study revealed relatively low ADRs and was not powered for adenoma detection.

These findings demonstrate that digital resources may guide patients through the bowel preparation process and ultimately lead to an increase in CRC screening participation.

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Reference

Walter B, Frank R, Ludwig L, Dikopoulos N, Mayr M, Neu B. Smartphone application to reinforce education increases high-quality preparation for colorectal cancer screening colonoscopies in a randomized trial (published online March 18, 2020). Clin Gastroenterol Hepatol. doi.org/10.1016/j.cgh.2020.03.051