The impact of patient education on the quality of inpatient bowel preparation for colonoscopy

BACKGROUND:

For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.

OBJECTIVES:

To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.

METHODS:

A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.

RESULTS:

The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).

CONCLUSION:

Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.     

Improvement in caecal intubation rate and pain reduction by using 3-dimensional magnetic imaging for unsedated colonoscopy: A randomized trial of patients referred for colonoscopy

Objective. Use of magnetic endoscope imaging (MEI) during colonoscopy has the potential to ease caecal intubation and patient discomfort and to reduce dependence on sedation and/or analgesics (SAs). However, pain reduction by using MEI has not been demonstrated so far, probably because of the liberal use of SAs. The aim of the present study was to evaluate the effect of MEI on caecal intubation and patient pain during unsedated colonoscopy performed by experienced and inexperienced colonoscopists. Material and methods. A consecutive series of outpatients referred for colonoscopy were randomly allocated to examination with (imager group) or without (standard group) the use of MEI. Patients agreeing to SAs being given only on demand were included in the study. End-points were caecal intubation and pain, the latter to be graded by category on a form to be completed on the day after the examination. Results. The proportion of colonoscopies performed without SAs was similar when comparing imager and standard groups and experienced with inexperienced colonoscopists; altogether 367(88%) out of 419 colonoscopies. The caecal intubation rate was higher in the imager group (190/212 (90%)) than in the standard group (153/207(74%)) (p<0.001), both collectively and separately for experienced and inexperienced colonoscopists. A pain-reducing effect of MEI was shown only when performed by experienced colonoscopists, with severe pain in 10/137 patients (7.3%) in the imager group and 21/132 patients (16%) in the standard group (p=0.03). Conclusions. In colonoscopy without the routine use of SAs, MEI significantly improves the caecum intubation rate and reduces pain during the procedure.     

Listening to Turkish classical music decreases patients＇ anxiety, pain, dissatisfaction and the dose of sedative and analgesic drugs during colonoscopy： A prospective randomized controlled trial

AIM: To determine whether listening to music decreases the requirement for dosages of sedative drugs, patients' anxiety, pain and dissatisfaction feelings during colonoscopy and makes the procedure more comfortable and acceptable. METHODS: Patients undergoing elective colonoscopy between October 2005 and February 2006 were randomized into either listening to music (Group 1, n = 30) or not listening to music (Group 2, n = 30). Anxiolytic and analgesic drugs (intravenous midazolam and meperidine) were given according to the patients' demand. Administered medications were monitored. We determined their levels of anxiety using the State-Trait Anxiety Inventory Test form. Patients' satisfaction, pain, and willingness to undergo a repeated procedure were self-assessed using a visual analog scale. RESULTS: The mean dose of sedative and analgesic drugs used in group 1 (midazolam: 2.1 +/- 1.4, meperidine: 18.1 +/- 11.7) was smaller than group 2 (midazolam: 2.4 +/- 1.0, meperidine: 20.6 +/- 11.5), but without a significant difference (P > 0.05). The mean anxiety level in group 1 was lower than group 2 (36.7 +/- 2.2 vs 251.0 +/- 1.9, P < 0.001). The mean satisfaction score was higher in group 1 compared to group 2 (87.8 +/- 3.1 vs 58.1 +/- 3.4, P < 0.001). The mean pain score in group 1 was lower than group 2 (74.1 +/- 4.7 vs 39.0 +/- 3.9, P < 0.001). CONCLUSION: Listening to music during colonoscopy helps reduce the dose of sedative medications, as well as patients' anxiety, pain, dissatisfaction during the procedure. Therefore, we believe that listening to music can play an adjunctive role to sedation in colonoscopy. It is a simple, inexpensive way to improve patients' comfort during the procedure.     

The Norwegian Gastronet project: Continuous quality improvement of colonoscopy in 14 Norwegian centres

Objective. The burden on colonoscopy capacity is considerable and expected to increase further as colorectal cancer screening programmes gain a foothold in Europe. In this situation, it is particularly important to evaluate the quality of the service given. In this article we present our first year of experience with a quality network of endoscopy centres in Norway (Gastronet). Material and methods. A questionnaire focusing on caecal intubation rate and pain was completed by the endoscopist (on site) and patient (on the day after the examination). Fourteen centres participated with registration of 7370 colonoscopies by 73 endoscopists. Results. There was 100% endoscopist participation, 87% coverage of colonoscopies and an estimated 76% questionnaire coverage of the patient population. Overall caecal intubation rate was 91%, range 83% to 97% between centres (p<0.001). Patients reporting severe pain during colonoscopy differed from 2 to 24% between centres (p<0.001). Variations could only partly be explained by differences in procedure practice (sedation, CO₂ insufflation). For individual endoscopists, improvement after feedback on performance was restricted to the group of endoscopists having contributed with only 50–99 registered colonoscopies. Conclusions. In quality assurance programmes we recommend a limited number of variables for registration in order to secure high compliance by endoscopists and patients. One year of experience with Gastronet disclosed a satisfactory overall caecal intubation rate, but considerable variation between centres in practice and ability to offer painless colonoscopy. This suggests a need for formal, centralized training of colonoscopists or the development of quality standards for colonoscopy training and practice.     

Improving the quality of colonoscopy bowel preparation using an educational video

Colonoscopy is the preferred modality for colon cancer screening. A successful colonoscopy requires proper bowel preparation. Adequate bowel preparation continues to remain a limiting factor. One hundred thirty-three patients scheduled for an outpatient colonoscopy were prospectively randomized in a single-blinded manner to video or nonvideo group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video. Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale, while patient satisfaction with preparation was evaluated using a questionnaire. Statistical analyses were used to evaluate the impact of the instructional colonoscopy video. There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups. Participants who watched the video had better preparation scores in the right colon (P=0.0029), mid-colon (P=0.0027), rectosigmoid (P=0.0008), fluid content (P=0.03) and aggregate score (median score 4 versus 5; P=0.0002). There was no difference between the two groups with regard to patient satisfaction. Income, education level, sex, age and family history of colon cancer had no impact on quality of colonoscopy preparation or patient satisfaction. The addition of an instructional bowel preparation video significantly improved the quality of colon preparation.     

不同剂量西甲硅油行结肠镜检查术前肠道准备的效果分析

目的探讨结肠镜检查术前使用不同剂量西甲硅油的肠道准备效果。方法150例结肠镜检查患者随机分成3组,各组50例,A．组使用复方聚乙二醇电解质散＋西甲硅油5ml进行肠道准备,A：组使用复方聚乙二醇电解质散＋西甲硅油10ml进行肠道准备,B组（对照组）单纯使用复方聚乙二醇电解质散进行肠道准备,比较各组在肠道清洁程度、祛泡效果、结肠镜检查操作时间、操作者对结肠镜检查的满意度以及患者对结肠镜检查的耐受程度方面存在的差异。结果A,组、A：组和B组祛泡满意率分别为98．0％（49／50）、100．0％（50／50）和80．0％（40／50）,各组比较差异有统计学意义（x^2=17．855,P=0．000）。而各组在肠道清洁满意率（x^2=1．500,P=0．472）、结肠镜检查平均操作时间（Z=-0．333,P=0．765）、操作者对结肠镜检查的满意度（x^2=6．303,P=0．178）以及患者对结肠镜检查的耐受程度（x^2=8．238,P=0．083）方面差异无统计学意义。结论结肠镜检查术前肠道准备中常规使用复方聚乙二醇电解质散的同时联合使用西甲硅油,在不明显影响肠道清洁程度和患者术中耐受程度的前提下,可显著提高祛泡效果,5ml西甲硅油的剂量基本可以满足临床祛泡需要,而10ml剂量的祛泡效果更好。     

结肠镜检查前肠道准备清洁效果的临床对比研究

目的：观察不同方法对结肠镜检查前肠道准备的清洁效果及其副作用。方法：312例结肠镜检查者肠道清洁前随机分为口服甘露醇组（A组）、口服番泻叶组（B组）、结肠循环冲洗组（C组）及联合B方法与C方法（D组）。据结肠镜检查中肠道清洁程度（I－Ⅲ级）和清洁范围（0－4度）评价肠道清洁效果。结果：D组肠道清洁程度和清洁范围最理想，其肠道清洁程度满意－比较满意率（I＋Ⅱ：96．2％）显著高于A组（82．1％；P＜0．01）、B组（85．7％；P＜0．05）和C组（69．3％，P＜0．01）。C组降结肠以下清洁率（65．4％）显著高于A组（37．1％，P＜0．01）和B组37．7％，P＜0．01），同时其肠道清洁失败率（30．8％）也显著高于B组（14．3％，P＜0．01）。此外，C组副作用发生率（3．8％）显著低于其他三组（A组43．6％，B组54．5％和D组58．2％，P均＜0．01）。结论：口服水泻剂联合结肠途径治疗机循环冲洗法是比较理想的全结肠清洁方法，单纯结肠循环冲洗法适合于乙状结肠镜检查前肠道准备。     

Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs

ObjectiveThis study aimed to explore neuropsychiatric symptoms’ (NPS) risk factors in a sample of nursing home residents.MethodsA cross-sectional study was conducted. Residents over 65 years were included, unless they had a known major psychiatric diagnosis. The Neuropsychiatric Inventory (NPI) was completed, and other measures included residents’ sociodemographic characteristics, cognition, functional impairment, regular drugs and number of needs. To explore potential risk factors, a logistic regression was conducted with the presence of NPS (NPI-10 ≥ 1) as dependent variable. Additional exploratory analyses were conducted based on a sub-syndrome approach, and three multivariate models were repeated considering the psychotic, affective and behaviour syndromes as dependent variables.ResultsA total of 140 residents were included (age: 83.71 ± 7.29 years). More than half (50.4%) presented at least one NPS. NPI-10 showed significant correlations with cognition (r_s=-0.177, p = 0.042), functional impairment (r_s = 0.174, p = 0.043), unmet needs (r_s = 0.245, p = 0.004) and nervous system-acting drugs (r_s = 0.271, p = 0.002), particularly anxiolytics (r_s = 0.175, p = 0.047), antidepressants (r_s = 0.204, p = 0.019) and hypnotics/sedatives (U = 2434.5, p = 0.028). However, in the multivariate analysis only unmet needs (OR = 1.30; 95% CI: 1.008–1.670) and hypnotic/sedatives (OR = 4.66; 95% CI: 1.132–19.144) showed an independent association with the presence of NPS. Regarding the additional models, unmet needs and literacy, antidepressants and hypnotic/sedatives, and cognitive status, showed to contribute to explain the variability of psychotic, affective and behaviour syndromes, respectively.ConclusionsIdentifiable and modifiable factors, including unmet needs and prescribed psychotropic drugs, could have contributed to NPS in this sample, suggesting a role for targeted non-pharmacological and person-centred approaches directed to residents’ unmet needs.     

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol(PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleans...     

Evidence to suggest adoption of water exchange deserves broader consideration: Its pain alleviating impact occurs in 90% of investigators

AIM: To determine variations in colonoscopy real-time insertion pain among investigators using three different insertion techniques.METHODS: From March 2013 through June 2014, 18-85-year-old diagnostic and 50-70-year-old screening patients were enrolled at each center to on-demand sedation colonoscopy with water exchange(WE), water immersion(WI) and insufflation with air or CO2 for insertion and withdrawal [air or carbon dioxide(AICD)]. Data were aggregated for analysis. Primary outcome: Variations in real-time maximum insertion pain(0 = none, 1-2 = discomfort, 10 = worst).RESULTS: One thousand and ninety-one cases analyzed: WE(n = 371); WI(n = 338); AICD(n = 382). Demographics and indications were comparable. The WE group had the lowest real-time maximum insertion pain score, mean(95%CI): WE 2.8(2.6-3.0), WI 3.8(3.5-4.1) and AICD 4.4(4.1-4.7), P 0.0005. Ninety percent of the colonoscopists were able to use water exchange to significantly decrease maximum insertion pain scores. One investigator had high insertion pain in all groups, nonetheless WE achieved the lowest real-time maximum insertion pain score. WE had the highest proportions of patients with painless unsedated colonoscopy(vs WI, P = 0.013; vs AICD, P 0.0005); unsedated colonoscopy with only minor discomfort(vs AICD, P 0.0005), and completion without sedation(vs AICD, P 0.0005).CONCLUSION: Aggregate data confirm superiority of WE in lowering colonoscopy real-time maximum insertion pain and need for sedation. Ninety percent of investigators were able to use water exchange to significantly decrease maximum insertion pain scores. Our results suggest that the technique deserves consideration in a broader scale.     

The role of routinely given hyoscine-N-butylbromide in colonoscopy: a double-blind,randomized, placebo-controlled,clinical trial

Objective: Hyoscine-N-butylbromide (HBB) has been proposed to ease colonoscopy and improve mucosal visualization, yet the results from previous studies are conflicting. In our prospective, double-blind, placebo-controlled, randomized study we aimed at evaluating whether routine administration of HBB, before and during colonoscopy, ease the procedure or increase the detection rate for polyps. Material and methods: One hundred fifty outpatients scheduled for an elective colonoscopy were randomized to receive intravenous injections of either 10?mg hyoscine-N-butylbromide or saline before insertion and at cecum. Patient tolerance and technical ease of colonoscopy were evaluated by visual analogue scale (VAS). Procedure times were recorded. Number of detected polyps per patient was evaluated as well. Heart rate was monitored with a pulse oximetry. Results: HBB did not improve patient tolerance or technically ease the procedure as evaluated by VAS. However, HBB led to faster ileal intubation (1.5 vs 2.0 min, p?p?=?0.03). Patients who received HBB also needed less often external abdominal pressure (48.6 vs 66.7%, p?=?0.03). HBB did not improve polyp detection rate (0.89 vs 0.91, p?=?0.90). HBB induced a significant rise in heart rate (p?p?Conclusions: Routine administration of HBB before and during colonoscopy yields only limited improvement in the technical performance of the examination compromised by high incidence of tachycardia.     

Post-polypectomy bleeding after colonoscopy on uninterrupted aspirin/non steroideal antiflammatory drugs: Systematic review and meta-analysis

Background and aimThe aim of this systematic review and meta-analysis was to assess the risk of post-polypectomy bleeding (PPB) in patients that underwent colorectal polypectomy and exposed to ASA/NSAIDs.MethodsRelevant publications were identified in MEDLINE/EMBASE for the period 1950–2016. Studies with specified ASA/NSAIDs exposure and bleeding rate were included. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was based on fixed or random effect models in relation to the heterogeneity.Results11 studies (4 prospective and 7 retrospective) including 9307 patients were included in the analyses. Overall, 344 patients (OR 1.8; 95% CI 1.2–2.7; p-value 0.001, I² 52%) experienced rectal bleeding after procedure. While the rate of immediate PPB on aspirin and/or NSAIDs was not increased (OR 1.1; CI 95% 0.6–2.1; d.f. = 1, p = 0.64, I² 0%), the risk of delayed PPB was augmented (OR 1.7; 95% CI 1.2–2.2; d.f. = 8, p = 0.127, I² 36%).ConclusionsASA/NSAIDs are not a risk factor for immediate PPB but the chance of delayed is increased.     

西甲硅油乳剂在结肠镜检查中的应用与研究

目的 研究西甲硅油乳剂在结肠镜检查术前肠道准备中的应用价值.方法 将200例接受结肠镜检查的患者随机分为两组,实验组100例,对照组100例.实验组给予聚乙二醇电解质散+西甲硅油乳剂,对照组给予口服聚乙二醇电解质散.观察二组的效果.结果 实验组肠腔内气泡存在量明显少于对照组,术后腹胀程度明显轻于对照组,内镜医师操作满意度优于对照组(P＜0.05),而两组肠道清洁程度无差异(P＞0.05).结论 在结肠镜检查术前肠道准备中应用西甲硅油乳剂能够消除泡沫,提高视野清晰度,减少术后腹胀等不良反应,提高术者操作舒适度,缩短操作时间.     

Mechanical analysis of insertion problems and pain during colonoscopy: Why highly skill-dependent colonoscopy routines are necessary in the first place... and how they may be avoided

BACKGROUND:

Colonoscopy requires highly skill-dependent manoeuvres that demand a significant amount of training, and can cause considerable discomfort to patients, which increases the use of sedatives. Understanding the underlying fundamental mechanics behind insertion difficulties and pain during colonoscopy may help to simplify colonoscopy and reduce the required extent of training and reliance on sedatives.

METHODS:

A literature search, anatomical studies, models of the colon and colonoscope, and bench tests were used to qualitatively analyze the fundamental mechanical causes of insertion difficulties and pain. A categorized review resulted in an overview of potential alternatives to current colonoscopes.

RESULTS:

To advance a colonoscope through the colon, the colon wall, ligaments and peritoneum must be stretched, thus creating tension in the colon wall, which resists further wall deformation. This resistance forces the colonoscope to bend and follow the curves of the colon. The deformations that cause insertion difficulties and pain (necessitating the use of complex conventional manoeuvres) are the stretching of ligaments, and stretching of colon wall in the transverse and longitudinal directions, and the peritoneum.

CONCLUSIONS:

Four fundamental mechanical solutions to prevent these deformations were extracted from the analysis. The current results may help in the development of new colonoscopy devices that reduce – or eliminate – the necessity of using highly skill-dependent manoeuvres, facilitate training and reduce the use of sedatives.     

The impact of pain frequency,pain localization and perceived cause of pain on quality of life after cholecystectomy

Objective: Further research is needed to understand how pain frequency, localization of pain and the patient’s conviction of the cause of pain effects long-term outcome after gallstone surgery.

Materials and methods: A cohort study was conducted based on patients evaluated with SF-36 along with three single-items focusing on gallstone specific symptoms. The physical component summary (PCS) and bodily pain (BP) of SF-36 were used as main outcome measures. To assess the improvement from the procedure, the differences between the preoperative and postoperative ratings were tested with univariate and multivariate logistic regression analysis. The ratings on the single-items regarding pain frequency, pain localization and patient’s conviction of the cause of pain were used as predictors. In the multivariate analysis, adjustment was made for age, gender and approach. The study was approved by the Swedish Ethics Committee, Dnr 2015/115.

Results: The study group was based on 4021 patients who responded to the questionnaire SF-36 and the three gallstone specific items preoperatively. A total of 2216 (55.1%) patients also responded postoperatively. In multivariate logistic regression analysis the frequency of the pain attacks and the patient’s conviction of the origin of pain significantly predicted postoperative pain as well as PCS of SF-36 (all p?Conclusions: The preoperative frequency of pain attacks and the patient’s conviction of the cause of pain can predict the outcome regarding PCS and the subscale BP of SF-36 with significantly better ratings in patients with a pain frequency exceeding once per month and in patients convinced of having pain related to gallstones.     

利那洛肽联合复方聚乙二醇在结肠镜肠道准备中应用的初步研究

目的　初步探索利那洛肽联合复方聚乙二醇（polyethylene glycol,PEG）在结肠镜肠道准备中的作用。方法　本试验是一项多中心随机对照研究。连续纳入2021年11月—2022年3月在上海长海医院、山西省人民医院和联勤保障部队第九〇〇医院3家消化内镜中心接受结肠镜检查的受试者,采用完全随机法分成3组,A组肠道准备方案为3 d利那洛肽+3 L PEG,B组为仅3 L PEG,C组为3 d利那洛肽+2 L PEG。主要观察指标为肠道准备合格率,次要观察指标包括肠道准备优秀率、肠道准备完成率以及肠道准备愿意重复率。结果　共入组130例受试者,其中A组46例,B组43例,C组41例,3组受试者肠道准备合格率［95.7%（44/46）、93.0%（40/43）和95.1%（39/41）,χ2=0.465,P=0.893］,肠道准备优秀率［43.5%（20/46）、25.6%（11/43）和34.1%（14/41）,χ2=3.151,P=0.207］及肠道准备完成率［95.7%（44/46）、95.3%（41/43）和100.0%（41/41）,χ2=1.909,P=0.544］差异均无统计学意义。3组受试者愿意再次行相应肠道准备方案的愿意重复率差异有统计学意义［89.1%（41/46）、74.4%（32/43）和100.0%（41/41）,χ2=12.862,P=0.002］。C组受试者肠道准备完成率和愿意重复率均为100.0%,较A、B两组有升高趋势。结论　利那洛肽有提高肠道准备质量的趋势,可以减少PEG用量。