Chongqing University Cancer Hospital, Chongqing, China.
JMIR Mhealth Uhealth. 2020 Jun 1;8(6):e17372. doi: 10.2196/17372.
To improve patients' comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas.
This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas.
We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes.
We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95% CI 1.05-1.35; P<.05; I=42%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95% CI 1.22-2.53; P<.05; I=0%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively.
The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data.
为了提高患者对结肠镜检查前肠道准备的理解，增强患者教育（EPE），如使用卡通图片或其他视觉辅助工具、电话、移动应用程序、多媒体教育和社交媒体应用程序等方法已被提出。然而，EPE 是否能提高结肠息肉和腺瘤的检出率尚不确定。
本荟萃分析旨在评估 EPE 对检测结肠息肉和腺瘤的疗效。
我们从 PubMed、EMBASE 和 Cochrane 对照试验中心数据库建库至 2019 年 6 月检索比较 EPE 与标准患者教育用于接受结肠镜检查的门诊患者的试验。我们使用随机效应模型计算息肉检出率（定义为至少检出一个息肉的患者人数除以选择性结肠镜检查的总人数）、腺瘤检出率（定义为至少检出一个腺瘤的患者人数除以选择性结肠镜检查的总人数）、高级腺瘤检出率（定义为至少检出一个高级腺瘤的患者人数除以选择性结肠镜检查的总人数）、锯齿状息肉检出率（定义为至少检出一个锯齿状息肉的患者人数除以选择性结肠镜检查的总人数）、癌症检出率（定义为至少检出一个癌症的患者人数除以选择性结肠镜检查的总人数）或腺瘤检出率加量（定义为每例结肠镜检查检出的额外腺瘤数）的综合估计值。此外，我们进行了试验序贯分析（TSA），以确定所有主要结局综合估计值的稳健性。
我们纳入了 10 项随机对照试验，共 4560 名参与者。荟萃分析表明，EPE 与息肉检出率（9 项试验；3781 名参与者；风险比 [RR] 1.19，95%置信区间 [CI] 1.05-1.35；P<.05；I²=42%）和腺瘤检出率（5 项试验；2133 名参与者；RR 1.37，95% CI 1.15-1.64；P<.001；I²=0%）的增加有关，这些结果均由 TSA 确定。逆方差模型的汇总结果显示，锯齿状息肉的检出率增加（3 项试验；1248 名参与者；比值比 1.76，95% CI 1.22-2.53；P<.05；I²=0%）。一项试验表明，腺瘤检出率加量（RR 4.39，95% CI 2.91-6.61；P<.001）增加。3 项（1649 名参与者）和 2 项试验（1375 名参与者）的汇总估计值均未显示高级腺瘤检出率和癌症检出率有统计学差异。
目前的证据表明，EPE 应该被推荐用于指导接受结肠镜检查的患者进行肠道准备，因为它可以提高息肉检出率、腺瘤检出率和锯齿状息肉检出率。然而，由于数据有限，还需要进一步的试验来确定 EPE 对高级腺瘤检出率、腺瘤检出率加量和癌症检出率的疗效。
