Strategies to Improve Inpatients’ Quality of Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

Table 1

Summary of included studies.

Author, year	Country	Study design	Patients enrolled,	Age (mean), intervention vs. no intervention	Intervention	Type of preparation regimen used (only for studies evaluating educational interventions)	Scale assessing bowel preparation quality	Patients achieving adequate preparation in the intervention group, /patients enrolled in this arm,	Patients achieving adequate preparation without intervention, /patients enrolled in this arm,
Educational interventions
Chorev, 2006	Israel	Prospective observational, single center	209	68.5	Physician and nurse educational program (lectures and instruction on preparation); oral, written instructions provided to all patients	Pts in both cohorts received >75 years or with moderate to severe heart or kidney failure were given PEG, 3 L, the evening before. All others were given sodium phosphate, 2 bottles of 45 mL each, to be taken with 12 glasses of tap water. Time elapsing between last sip of purgative and colonoscopy is NA	Adapted quality rating scale	72/105	72/104
Rosenfeld, 2010	Canada	Prospective observational, endoscopist blinded, single center (first 8 weeks assigned to intervention, the following 8 weeks to conventional)	38	65.1 vs. 67.9	Patient education (instruction group provided with 5 min verbal and written instructions prior to colonoscopy vs. no instruction)	Pts in both cohorts received 4 L of PEG bowel preparation with a clear liquid diet on the day before colonoscopy. Time elapsing between last sip of purgative and colonoscopy is NA	Adapted quality rating scale	14/16	7/22
Lee, 2015	South Korea	Prospective, double blind nonrandomized controlled, single center	205	64 vs. 63	Education for ward nurses (educational leaflet and lecture vs. no education)	Pts received low-residue diet 2 days before colonoscopy; on the day before colonoscopy, pts were provided a soft diet for dinner before 6 pm and, after that time, only clear water. 2 L of PEG plus ascorbic acid was ingested—250 mL every 10 minutes. For colonoscopies performed in the morning, a split-dose bowel preparation (half-dose of purgative at 8 : 00 pm on the day before the procedure and the remaining 1 L on the morning of the day of the procedure). For afternoon colonoscopies, a full dose (2 l) of PEG plu Asc between 6 : 00 and 8 : 00 am on the day of the procedure. All colonoscopies were performed between 2 and 8 hours after the purgative intake was complete	OBPS	71/103	42/102
Chambers, 2016	USA	Retrospective, single center	38	NA	Patient and nurse education (preprocedure education)	All patients received half of the 6 L preparation and a bisacodyl pill	Adapted quality rating scale	20/26	4/12
Ergen, 2016	USA	Prospective, randomized, single blind, controlled trial, single center	85	57 vs. 58	Patients given an educational booklet before colonoscopy	All pts received a standard preparation: clear liquid diet the day prior to the day of the procedure followed by split-dose PEG. Patients are instructed to consume 2 L between 6 pm and 8 pm the night prior to colonoscopy and 2 L between 5 am and 7 am on the day of colonoscopy	BBPS	28/45	14/40
Shah-Khan, 2017	USA	Prospective nonrandomized, single center	199	NR	Multiphase intervention program involving physicians and nursing staff education, implementation of electronic order set, and patient education	NA	Adapted quality rating scale	99/103	77/96
Bowel preparation regimens
Seinelä, 2003	Finland	Prospective, randomized, endoscopist blinded, single center	72	84	NaP vs. 4 lit PEG standard dosing		Adapted quality rating scale	30/37	27/35
Reilly, 2004	USA	Retrospective, cohort, single center	101	NA	4 lit PEG vs. 6 lit PEG		Adapted quality rating scale	17/38	25/48
Müller, 2007	Brazil	Prospective, randomized, single center	80	62.4 vs. 60.6	Mannitol-based preparation regimen vs. sodium picosulfate-based regimen		Chilton Scale	26/40	31/40
Ell, 2008	Germany	Prospective, randomized, single blinded, multicenter	308	58 vs. 59.6	2 lit PEG plus ascorbic vs. 4 lit PEG solution		Adapted quality rating scale	136/153	147/155
Kotwal, 2014	USA	Prospective, randomized, endoscopist blinded, single center	103	52.8 vs. 57.4	Morning only preparation (4 lit PEG between 5-9 am on the day of colonoscopy vs. split-dose PEG 2 lit - 2 lit (noninferiority study)		OBPS	16/51	15/52
Yang, 2015	USA	Prospective observational, multiphase, single center	100	63.2 vs. 63.7	Nurse education and electronic order set and split-dose preparation vs. standard full-dose 4 lit PEG		BBPS	50/54	31/46
Tae, 2015	Korea	Prospective, randomized, controlled, single center	62	56.8 vs. 52.4	Low-volume 2 lit PEG containing ascorbic vs. 2 lit PEG plus 20 mg bisacodyl		OBPS	30/31	31/31
Song, 2017	USA	Retrospective, case series	53	64.1	Multiday preparation regimen		BBPS or Aronchick Scale	47/53	NA
Yadlapati, 2017	USA	Pragmatic, two-cohort-quasi-experimental study; postintervention cohort prospectively built; prep-intervention cohort: historic data	879	58.2 vs. 57.1	Implementation of split-dose PEG bowel preparation algorithm combined with an electronic dataset vs. single-dose 4 L PEG solution the evening before inpatient colonoscopy		BBPS or Aronchick Scale	381/445	223/534
Pontone, 2018	Italy	Prospective, randomized, controlled single-center, pilot study	44	64 vs. 63	Same-day 1 L PEG bowel preparation on the morning of the colonoscopy vs. split-dose 4 L PEG (3 L the evening before and 1 L in the morning of the day of colonoscopy)		BBPS	14/22	12/22
Miscellaneous methods
Barclay, 2013	USA	Prospective, randomized, controlled, single center	82	73 vs. 73.5	EGD-assisted bowel prep (2 lit PEG administered endoscopically into distal duodenum plus 1 L PEG orally the following day) vs. split-dose PEG preparation (2 lit PEG orally the evening prior and 1 lit PEG orally the following day)		OBPS	30/42	15/40

NA: not applicable; BBPS: Boston Bowel Preparation Scale; OBPS: Ottawa Bowel Preparation Scale; PEG: polyethylene glycol; NaP: sodium phosphate; EGD: esophagogastroduodenoscopy; as evaluated in each study; detailed information regarding quality preparation assessment scale of each study is available in Supplemental Material C Table 1; adequacy of bowel preparation was defined according to each study’s criterion; the value of stuff educational program on the preparation of hospitalized patients was examined as secondary endpoint; inadequate preparation was defined as an overall Ottawa ; lower score indicates better bowel cleansing; study evaluating different bowel preparation regimens in inpatients; study evaluating efficacy of a multiday colonoscopy bowel preparation; studies using two scales to assess bowel preparation.