Increased quality of bowel preparation via smartphone WeChat application: a multicenter randomized controlled trial

Introduction
High-quality bowel preparation is an essential precondition for colonoscopy. Few studies have evaluated the smartphone WeChat application as a means of improving the quality of bowel preparation.

Aim
To assess the effect of patient education by using smartphone WeChat application aids on the quality of bowel preparation.

Material and methods
A multicenter prospective, endoscopist-blinded, randomized, controlled study was conducted. Patients were randomly assigned to three groups. A total of 478 patents in groups A were accepted for smartphone WeChat application, 477 in groups B were accepted for conventional education plus smartphone WeChat application while group C (473 patients) was a control group. The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes included polyp detection rate (PDR), cecal intubation rate, insertion and withdrawal time, anxiety score, self-rated sleep quality, and willingness to undergo another colonoscopy.

Results
Total BBPS score was significantly higher in groups B and C than in the control group (7.5 ±1.2, 7.5 ±1.3 vs. 6.5 ±1.2, p < 0.001). PDR in group A (40.2%, 192/478) and group B (41.7%, 199/477) was higher than that in the control group (p = 0.003) and mean number of polyps per patient was higher too (p = 0.015). Moreover, a shorter cecal insertion time was recorded in group A and group B than in the control group (8.8 ±3.9, 8.9 ±3.8 vs. 10.5 ±4.2 min, p < 0.001). Intervention groups showed lower anxiety scores and better quality sleep and were more likely to be willing to repeat colonoscopy.

Conclusions
Patient instruction via smartphone WeChat application efficiently improved bowel preparation for colonoscopy.