Three Minutes of Verbal Instructions Improved Bowel Preparation in Mobile Inpatients

Three Minutes of Verbal Instructions Improved Bowel Preparation in Mobile Inpatients

Douglas K. Rex, MD, MASGE, reviewing Triantafyllou K, et al. Endosc Int Open 2021 Feb 19.

Clinicians everywhere struggle with colonoscopy bowel preparation in inpatients. In a randomized trial performed in 4 cities, 300 patients (180 mobile and 120 bedridden) received either 3 minutes of verbal instructions from an investigator or usual care, which included written instructions on an informed consent leaflet and typical information provided by the hospital nursing staff. The 3-minute verbal instructions covered the value of adequate preparation, the bowel preparation procedure, diet during the preparation period, the cathartics schedule, the necessity of drinking the entire preparation solution and additional clear fluids, and possible side effects. The preparation was 2 days of a low-fiber diet, followed by clear liquids the day before colonoscopy and 4 liters of polyethylene glycol-electrolyte lavage solution. 

Key results:

  • In the intention-to-treat analysis, the rate of adequate bowel preparation (the primary endpoint for the study) was 60.4% in the intervention group versus 54.3% in the standard-of-care group (P=.29). 
  • In the per-protocol (PP) analysis, the difference was also not significant (69.8% vs 62.1%; P=.19).
  • In the PP analysis of mobile patients, the rate of adequate preparation was higher in the intervention group than the standard-of-care group (81.5% vs 66.3%; P=.03).
  • More patients in the intervention group achieved good or excellent preparation (58.1% vs 43.2%; P=.02).
  • An ASA score ≥3 and same-day preparation administration were prognostic factors for inadequate preparation. If both were present, the odds ratio for inadequate preparation was 55.6.

Douglas K. Rex, MD, FASGE


Although the study was negative for the primary endpoint, these data indicate that mobile inpatients benefit from additional instructions and information. This is also the second study to demonstrate that inpatients are more likely to fail when same-day preparations are attempted. Probably sick patients need more time to ingest the preparation volume, so split dosing works better in this population.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Triantafyllou K, Gkolfakis P, Skamnelos A, et al. Impact of simple, specific, verbal instructions on the quality of bowel preparation in hospitalized patients undergoing colonoscopy: a multicenter randomized controlled trial. Endosc Int Open. 2021;09:E378-E387. (

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