Purpose: Inadequate bowel preparation leads to missed colonic lesions and incomplete colonoscopy. We evaluated whether implementing a new personalized digital platform could improve bowel preparation and related outcomes.
Methods: The personalized digital platform (DP) is a patient-tailored animated video of bowel preparation instructions, individually produced according to age, sex, comorbidities and language. Before scheduled ambulatory colonoscopy, a link to the digital platform system was sent to random patients (DP-link group), while the control group received standard written instructions. We then performed a retrospective analysis of prospectively collected data regarding colonoscopy outcomes.
Results: Out of 2447 colonoscopies, the DP-link was randomly sent to 913 (37.3%) patients and standard written prep instructions to 1534 (62.7%) (control group). Lower rates of inadequate bowel preparation (Boston bowel preparation scale (BBPS) <6) were observed in the DP-link group compared to the control group (21.2% vs. 27.6%, P<0.001). Among DP link receivers, 470/913 (51.5%) watched >75% of the video (“full-users”) while 443/913 (48.5%) did not (“partial-users”). BBPS<6 rate was lowest among full-users, higher in partial-users and highest in the control group (19.1%, 23.5% and 27.6%, respectively, P<0.001). Cecal intubation rates were higher in the DP-link group (96.5% vs. 94.5%, P=0.026) and propofol dose was lower (233.7±97.5 vs. 244.3±105.9 mg, P=0.020). Logistic regression analysis adjusted for age, sex, prep protocol and morning/afternoon colonoscopy, showed that receiving the DP-link and DP full-usage were each independently associated with reduced rates of BBPS<6 [(OR 0.695, P<0.001) and (OR 0.627, P<0.001), respectively]. Significantly reduced BBPS< 6 rates were maintained upon similar logistic regression in selected population subgroups [male sex (OR 0.727, P=0.013), female sex (OR 0.630, P=0.004), 50–70-year-old patients (OR 0.602, P<0.001), and both morning (OR 0.726 P=0.015), and afternoon colonoscopy (OR 0.639, p=0.004)].
Conclusions: A personalized digital platform for pre-colonoscopy preparation guidance leads to lower rates of inadequate preparation and higher procedure completion rates.

Figure 1. The proportions of inadequate preparation documented in the entire colon (Boston bowel preparation scale (BBPS)<6) or in each bowel segment (BBPS<2), comparing (1A) digital platform (DP)-link receivers and controls, or (1B) full DP-users, partial DP-users, and controls.

Moshe Leshno

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