Background

Colonoscopy is the gold standard for investigation of the bowel. Adequate bowel preparation (BP) is vital to an effective procedure. Poor BP is a factor in 25% of colonoscopies which miss a cancer or precancerous polyp. A well-informed, motivated patient, who understands and adheres to the BP instructions, is more likely to have adequate BP.  The aim of this study is to assess whether an educational video for patients undergoing colonoscopy can lead to an improvement in BP.

Method

Participants referred for their first colonoscopy and receiving Moviprep were eligible for recruitment. Those recruited, were randomised 1:1 to access to the educational video or the control group. All participants were also provided with standard written instructions. The educational video was developed in collaboration with Nottingham Trent University graphics department. Primary end point was adequacy of BP, defined as a Boston Bowel Preparation Score (BBPS) of 2 or greater in each segment.  BBPS was scored at the time of the examination by the endoscopist performing the examination. Endoscopists received training on BBPS via an online video.

Results

509 participants were recruited, from 6 centres. The mean age was 58 (range 18-88).  265 (52%) of whom were female. 53 patients in the control group had inadequate BP, compared with 34 participants in the intervention group ( p value <.05 95% CI 0.377-0.977). The polyp detection rate in the intervention group was 39%, compared with 30% in the control group (p vaue<.05, CI 0.457 to 0.950).  The rate of adequate BP was not significantly different between centres. There was no significant difference between recognised risk factors for poor bowel preparation between the two groups.

Conclusion

This study demonstrates that an educational video leads to a greater proportion of adequate BP compared with standard instructions alone.  The number needed to treat to prevent one excess inadequate bowel preparation was 12.5. Widespread adoption of enhanced patient education, such as this educational video, could lead to improved adequacy of BP and a superior test for colorectal cancer.

Impact statement

A simple, cheap and acceptable intervention which has been demonstrated to improve the quality of colonoscopic investigation.