OPTIMIZING TIMING OF FOLLOW-UP COLONOSCOPY: A PILOT CLUSTER RANDOMIZED TRIAL OF A KNOWLEDGE TRANSLATION TOOL.

BACKGROUND: Endoscopists have low adherence to guideline recommended colonoscopy surveillance intervals. We performed a cluster randomized single-blind pilot trial in Winnipeg, Canada to assess the effectiveness of a newly developed digital application tool which computes guideline recommended follow-up intervals. METHODS: Participant endoscopists were randomized to either receive access to the digital application (intervention group) or not receive access (control group). Pathology reports and final recommendations for colonoscopies performed in the 1-4 months before randomization and 3-7 months post-randomization were extracted. Generalized estimating equation models were used to determine if the access to the digital application predicted guideline congruence. RESULTS: We included 15 endoscopists in the intervention group and 14 in the control group (out of 42 eligible endoscopists in the city), with 343 patients undergoing colonoscopy before randomization, and 311 post-randomization. Endoscopists who received the application made guideline-congruent recommendations 67.6% of the time prior to randomization and 76.1% of the time after randomization. Endoscopists in the control group made guideline- congruent recommendations 72.4% and 72.9% of the time pre- and post-randomization, respectively. Endoscopists in the intervention group trended to have an increase in guideline adherence comparing post to pre-intervention (OR:1.50, 95%CI 0.82-2.74). In contrast, the control group had no change in guideline adherence (OR:1.07, 95%CI 0.50-2.29). Endoscopists in the intervention group with less than median guideline congruence pre-randomization had a significant increase in guideline congruent recommendations post-randomization. CONCLUSION: An application that provides colonoscopy surveillance intervals may help endoscopists with guideline congruence, especially those with a lower pre-intervention congruence with guideline recommendations. (ClincialTrials.gov number, NCT04889352).

Mandatory vs. optional split-dose bowel preparation for morning colonoscopies: a pragmatic noninferiority randomized controlled trial.

BACKGROUND : We compared the effectiveness of optional split-dose bowel preparation (SDBP) with mandatory SDBP for morning colonoscopies in usual clinical practice. METHODS : Adult patients undergoing outpatient early morning (8:00 AM-10:30 PM) and late morning (10:30 AM-12:00 PM) colonoscopies were included. Written bowel preparation instructions were provided based on randomization: one group were instructed to take their bowel preparation (4 L polyethylene glycol solution) as a split dose (mandatory), while the comparator group was allowed the choice of SDBP or single-dose bowel preparation administered entirely on the day before (optional). The primary end point, using noninferiority hypothesis testing with a 5 % margin, was adequate bowel cleanliness measured by the Boston Bowel Preparation Scale (BBPS) and defined by a BBPS score ≥ 6. RESULTS : Among 770 randomized patients with complete data, there were 267 mandatory SDBP and 265 optional SDBP patients for early morning colonoscopies, and 120 mandatory SDBP and 118 optional SDBP patients for late morning colonoscopies. Optional SDBP was inferior to mandatory SDBP, with a lower proportion of adequate BBPS cleanliness for early morning colonoscopies (78.9 % vs. 89.9 %; absolute risk difference [aRD] 11.0 %, 95 %CI 5.9 % to 16.1 %), but was not statistically different for late morning colonoscopies (76.3 % vs. 83.3 %; aRD 7.1 %, 95 %CI -1.5 % to 15.5 %). CONCLUSIONS : Optional SDBP is inferior to mandatory SDBP in providing adequate bowel preparation quality for early morning colonoscopies (8:00 AM-10:30 AM), and probably inferior for late morning colonoscopies (10:30 AM-12:00 PM).