Enhanced Instructions for Inpatients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Introduction: Colonoscopy is the gold standard test for detecting colorectal cancer. Its accuracy relies on adequate bowel preparation (BP), but the current literature shows that hospitalized patients have high rates of inadequate BP. Data about strategies to improve BP in the inpatient population are limited and controversial. Thus, we conducted a systematic review and meta-analysis comparing enhanced instructions (EIs) with regular instructions (RIs) for inpatients undergoing colonoscopy. EIs are educational interventions that provide clearer, more comprehensive guidance, often using visual aids, to optimize patient adherence to BP regimens.

Methods: PubMed, Embase, and Cochrane Central were searched for studies comparing EIs to RIs for inpatients undergoing colonoscopy. The outcomes of interest were total inpatients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 with all segments ≥2; total BBPS mean score; and BBPS mean score in the right, transverse, and left colon.

Results: Six randomized controlled trials were selected, with a total of 1070 patients, of whom 526 (49.2%) received EIs. In the pooled analysis, patients in the EI group were more likely to achieve BBPS ≥6 with all segments ≥2 when compared to those in the RI group (76% versus 60.5%; risk ratio 1.26; 95% confidence interval 1.15-1.37; P < 0.00001; I = 6%). Patients receiving EIs, compared to RIs, presented higher mean BBPS scores in the left colon (mean difference 0.24; 95% confidence interval 0.09-0.38; P = 0.001; I = 41%).

Conclusions: EI significantly improves the overall quality of BP and BBPS score in the left colon of inpatients undergoing colonoscopy. Therefore, EI should be applied to increase colonoscopy visibility and accuracy in hospitalized patients.