Split-dose vs same-day bowel preparation for afternoon colonoscopies:A meta-analysis of randomized controlled trials

BACKGROUND Quality of bowel preparation in afternoon colonoscopies has been a struggle.Currently,a choice of same-day preparation(SaD)or split-dose preparation(SpD)exists;however,randomized controlled trials’results have varied.AIM To examine the outcomes of SaD and SpD for afternoon colonoscopies.METHODS An extensive literature search was conducted using multiple databases.Only randomized controlled trials(RCTs)in adults that compared SaD to SpD with Ottawa bowel preparation score(OBPS)were included.Odds ratio(OR)or mean difference was used to analyze outcomes.RESULTS Eleven RCTs were included(n=1846).No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD(OR 0.77;95%CI:-0.57-1.03;P=0.07;I2=5%).Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula(polyethylene glycol)(OR 0.83;95%CI:0.51-1.35;P=0.46;I2=39%)as well as receiving same formula and volume(4 L polyethylene glycol)(OR 1.14;95%CI:0.65-2.01;P=0.64;I2=0%).CONCLUSION In patients undergoing afternoon colonoscopies,SaD is comparable with SpD in terms of satisfactory bowel preparation.Further studies are needed to validate these results and determine the optimal formula and dosages.

Use of music during colonoscopy:An updated meta-analysis of randomized controlled trials

BACKGROUND Music seems to be beneficial in multiple clinical areas.Colonoscopy is a stressful event for patients,especially with conscious sedation.Music during colonoscopy has been evaluated in multiple randomized controlled trials(RCTs)with varied results.Even meta-analyses on the subject over the years have yielded inconsistent conclusions.Therefore,we conducted an up-to-date meta-analysis regarding music during colonoscopy.AIM To assess the effects of music played during colonoscopy on patients’perspectives and sedation requirements.METHODS Multiple large databases were aggressively searched(November 2018).RCTs comparing music to without music during colonoscopy on adult patients were included.Pooled estimates were calculated for sedative medication doses,total procedure time,and patients’experience,willingness to repeat procedure,and pain scores using odds ratio(OR)and mean difference(MD)with random effects model.RESULTS Eleven studies(n=988)were included.Music during colonoscopy showed a statistically significant reduction in procedure times(MD:-2.3 min;95%CI:-4.13 to-0.47;P=0.01)and patients’pain(MD:-1.26;95%CI:-2.28 to-0.24;P=0.02)while improving patients’experience(MD:-1.11;95%CI:-1.7 to-0.53;P<0.01)as compared to no music.No statistically significant differences were observed between music and no music during colonoscopy for midazolam(MD:-0.4 mg;95%CI:-0.9 to 0.09;P=0.11),meperidine(MD:-3.06 mg;95%CI:-10.79 to 4.67;P=0.44),or patients’willingness to repeat the colonoscopy(OR:3.89;95%CI:0.76 to 19.97;P=0.1).CONCLUSION Music appears to improve overall patient experience while reducing procedure times and patient pain.Therefore,music,being a non-invasive intervention,should be strongly considered during colonoscopy.