Effectiveness of bowel preparation innovative technology instructions (BPITIs) on clinical outcomes among patients undergoing colonoscopy: a systematic review and meta-analysis

Abstract

To evaluate the effectiveness of bowel preparation innovative technology instructions (BPITIs) among patients undergoing colonoscopy. We searched PubMed, MEDLINE, CINAHL, CENTRAL, Scopus, Web of Science, LILACS, ClinicalTrials.gov, and Google Scholar for randomised controlled trials (RCTs) and cluster-RCTs from inception to February 28, 2022. The Cochrane risk of bias (RoB) tool and GRADE were used to assess RoB and certainty of evidence, respectively. Meta-analyses with random-effects model were used for analysis. This review included 47 RCTs (84 records). Seven BPITIs were found among included studies: (1) mobile apps, (2) VDO stream from personal devices, (3) VDO stream from a hospital device, (4) SMS re-education, (5) telephone re-education, (6) computer-based education, and (7) web-based education. The findings demonstrate that BPITIs have a slight impact on adherence to overall instructions (RR 1.20, 95% CI 1.13-1.28; moderate-certainty evidence), adequate bowel preparation (RR 1.10, 95% CI 1.07-1.13; low-certainty evidence), and quality of bowel preparation score (SMD 0.42, 95% CI 0.33-0.52; low-certainty evidence) compared to routine care. BPITIs may enhance the clinical outcomes. Due to the low-certainty evidence and heterogeneity of the included studies, the findings should be interpreted cautiously. Well-designed and reported RCTs are required to confirm the findings.PROSPERO registration number: CRD42021217846.

Figure 1

PRISMA diagram.

Figure 2

Summary of findings table for primary outcomes. ■, downgrade one level for each GRADE domain; ⨁, level of certainty of evidence; k, number of studies; n, number of participants; RR, risk ratio; MD, mean difference; SMD, standardized mean difference; CI, confidence interval.

Figure 3

Summary risk of bias of included studies.

Figure 4

Effects of bowel preparation innovative technology interventions (BPITIs) on adherence with instructions for overall preparation, purgative intake, and diets. Telephone, telephone re-education; SMS, short message service; VDO hospital, video stream from an on-site hospital device; VDO personal devices, video stream from personal devices.

Figure 5

Effects of bowel preparation innovative technology interventions (BPITIs) on (A) adequate bowel preparation and (B) bowel cleansing score. Telephone, telephone re-education; SMS, short message service; VDO hospital, video stream from an on-site hospital device; VDO personal devices, video stream from personal devices.

Figure 6

Subgroup analyses of the effects of bowel preparation innovative technology interventions (BPITIs) on (A) adequate bowel preparation and (B) bowel cleansing score by bowel preparation quality scales. Telephone, telephone re-education; SMS, short message service; VDO hospital, video stream from an on-site hospital device; VDO personal devices, video stream from personal devices.