Enhanced Bowel Prep Instruction Effective in Meta-Analysis

To determine whether enhanced instructions improve the adequacy of bowel preparation in patients undergoing colonoscopy, researchers conducted a meta-analysis of eight randomized, controlled trials of regular instructions (verbal plus written or written only) versus enhanced instructions involving 3795 patients. The enhancements used varied between studies and included pamphlets on what to eat and what to avoid, visual aids describing desired stool color, and smart phone apps.

Adequate bowel preparation was achieved collectively in 88.5% of 1812 patients receiving enhanced instructions compared with 78.4% receiving regular instructions. Enhanced instructions were more effective than regular instructions in achieving adequate bowel preparation regardless of dosage (split-dose or single dose) and preprocedure diet (low fiber or clear liquid). Use of enhanced instructions was associated with a higher cecal intubation rate and greater willingness to repeat preparation, but not with improved polyp detection or reduced adverse events.