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24/07/2020 - Press release

One call ensures successful colonoscopy

Actions of this type save patients travelling unnecessarily to health centres, which is important during the ongoing epidemic

One simple call to go over colonoscopy preparation instructions 48 hours before an appointment increases test success by 11.5%. This has been demonstrated in a multi-centre study led by doctors and nurses from the Digestive Tract Service at Hospital del Mar and researchers from the Clinical and Translational Research Group on Colorectal Neoplasia at the Hospital del Mar Medical Research Institute (IMIM). The work, published in the journal Endoscopy, analysed data from 657 patients from 11 Spanish hospitals.  This is the first multi-centre study to analyse how an educational approach can improve colon preparation in people at high risk of not achieving this.

Good preparation avoids repeat testing

A colonoscopy is an invasive reference test for diagnosing various diseases and requires a process that prepares and cleanses the colon. This is essential for it to be successful, and it is more demanding than that used in some surgical procedures. According to the European Society of Gastrointestinal Endoscopy (ESGE), 20-30% of patients do not prepare well. This conditions the invalidity of the test and the need for it to be repeated, in addition to impeding the detection of lesions and leading to possible delays in diagnosis.

The study involved selecting patients with a history of poor preparation for colonoscopy, a group at particular risk of repeat poor preparation. Six hundred and fifty-seven were selected and divided into two groups. All of the subjects received the usual preparation instructions, including a preliminary meeting with an endoscopy nurse and written instructions. In addition, it was recommended that they eat a low-fibre diet for seven days prior to the test date and take a laxative in the preceding hours. Subjects in one of the groups also received a call from a nurse 24 to 48 hours before the colonoscopy.

The call was used to reinforce the instructions, in terms of diet and correct laxative use, and to resolve patients' doubts. The nurses were able to contact 83% of the subjects in this group. In more than eight out of ten cases (83%), good preparation was achieved, while in the group with no educational assistance, this percentage dropped to 72%. Dr. Antonio Álvarez, the main author of the study, a consultant in the Hospital del Mar Digestive Tract Service and an IMIM researcher, underlines that "When a patient fails to prepare for a colonoscopy and it has to be repeated, we have to be able to contact them by phone before the next colonoscopy to go over the instructions."

The reality of the COVID-19 era

"This type of remote health education was already important before the COVID-19 epidemic, but now, it is vital  to optimise a patient's preparation for a colonoscopy and avoid them coming to the hospital for an invasive test without being properly prepared", stresses Dr. Alvarez. This intervention was most effective in patients who already had symptoms, compared to those who were tested as part of the screening process.

"At a time, both now and in the pre-COVID-19 era, when endoscopy units have a heavy workload, measures that optimise preparation and avoid repeat examinations are essential", explains Dr. Xavier Bessa, head of the Digestive Tract Service and the IMIM research group.  "If we manage to reduce the number of endoscopies that need to be repeated due to poor preparation and/or incorrect management of anticoagulant treatments, and we adapt the follow-up intervals for polypoid lesions of the colon according to current guidelines, we will be able to increase the capacity of the endoscopy units. This will allow us to allocate more resources to purely diagnostic procedures, where waiting lists can delay the diagnosis of a serious pathology."

The success of this initiative resulted in improved detection of colon lesions in the intervention group as a result of more effective cleansing. At the same time, the researchers note that these lesions, including 11 cancerous ones, were not identified in the previous test because the patients had not prepared themselves properly. Ultimately, this action is cost-effective, with  savings of 224 euros for each successful colonoscopy

The study was carried out in collaboration with researchers from the University Hospital of the Canary Islands, the University Hospital of Burgos, Viladecans Hospital, Santa Bárbara Hospital in Soria, Gregorio Marañón Hospital in Madrid, Río Hortega Hospital in Valladolid, the Althaia Healthcare Network in Manresa, the Terrassa Healthcare Consortium, Germans Trias i Pujol Hospital in Badalona, 12 de Octubre Hospital in Madrid and the Open University of Catalonia.

Reference article

Alvarez-Gonzalez M A, Pantaleón Sánchez M Á, Bernad Cabredo B et al. Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial. Endoscopy 2020 (efirst). doi:10.1055/a-1178-9844

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