Clinical outcomes of bowel preparation education strategies in colonoscopy: An evidence map of systematic reviews

Abstract

Background: Bowel preparation before colonoscopy is a research focus and challenge in gastroenterology. Inadequate bowel preparation increases the risk of adenoma miss rate, healthcare costs, and morbidity and mortality from colorectal cancer. While health education shows promise in improving preparation quality, existing studies are limited by fragmented evidence, variable methodological quality, and insufficient strategy comparisons, constraining clinical efficacy. This study innovatively employs an evidence map to clarify the current distribution of evidence, core strategies, and practical gaps, providing a reference for optimizing clinical decision-making.

Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, we searched 8 significant databases (CNKI/Wan Fang/VIP/SinoMed/Web of Science/PubMed/CINAHL/Cochrane Library) built up to October 30, 2024, for inclusion of bowel preparation-related systematic evaluations/meta-analyses. Methodological quality was assessed using AMSTAR-2 and AMSTAR, and multidimensional data visualization was achieved by generating bubble plots via Pymeta.com.

Results: We identified 20 systematic reviews and meta-analyses, clarified 6 core strategies: smartphone application, telephone, short message service, visual aids, newly designed brochure, and multi-method combination. Quality assessment revealed that only 10% of studies achieved moderate methodological quality; the remaining studies were of low or critically low quality. Overall, 6 strategies can effectively improve bowel preparation adequacy with smartphone applications and multi-method combination demonstrating superior efficacy. Among outcome measures, bowel preparation quality, adenoma/polyp detection rate ranked among the top three. Notably, patient-reported outcomes (compliance, satisfaction) improved more than clinician-reported outcomes, attributable to 4 explanatory factors.

Conclusion: A multi-method combination has significant practical potential. This study proposes personalized combination strategies based on the characteristics of different populations, and their effectiveness needs to be further verified by more high-quality research in the future. Additionally, this study pioneers the visualization of the evidence landscape through an evidence map, establishing a direct mapping between educational strategies and outcome measures to provide a framework for optimizing clinical decision-making. These findings call for high-quality research to compare the efficacy and generalizability of strategy combinations, while exploring tailored approaches for diverse populations to advance clinical application of personalized, precision-based bowel preparation education programs.

Keywords: bowel preparation; clinical outcomes; colonoscopy; evidence map; health education strategies; systematic reviews/meta-analyses.