Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 10, 2019
Date Accepted: Feb 29, 2020
Date Submitted to PubMed: Apr 29, 2020
Enhanced patient education for colonic polyp and adenoma detection: a meta-analysis of randomized controlled trials
ABSTRACT
Background:
It is uncertain whether enhanced patient education (EPE) can increase detection of colonic polyps and adenomas.
Objective:
We conducted this meta-analysis to evaluate the efficacy of EPE for detection of polyps and adenomas.
Methods:
We searched PubMed, Embase, and CENTRAL through June 2019 for identification of trials comparing the EPE with standard patient education (SPE) for outpatients undergoing colonoscopy. We used random-effects model to calculate summary estimates of detection of polyps, adenomas, advanced adenomas, sessile serrated polyps (SSPs), or cancer. Moreover, we also conducted trial sequential analysis (TSA) to determine robustness of summary estimates of all primary outcomes.
Results:
We included 10 RCTs enrolling 4560 participants for analysis. Meta-analyses suggested that EPE was associated with increased detection of polyp (9 trials; 3781 participants, risk ratio (RR), 1.19; 95% confidence intervals (CIs), 1.05 to 1.35) and adenomas (5 trials; 2133 participants; RR, 1.37; 95% CI, 1.15 to 1.64), which were established by TSA. Pooled result from inverse-variance model illustrated an increased detection in SSAs (3 trials; 1248 participants; OR, 1.76; 95% CI, 1.22 to 2.53). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for advanced adenoma and cancer detection rates respectively.
Conclusions:
Current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the detection of colonic polyps, adenomas, and SSAs. However, further trials are warranted in order to determine the efficacy of EPE for ADR, ADR-Plus, and CDR due to limited data.
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