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Colonic DiseaseNCT05709145

Written Recommendation to Improve Adherence in Poor Bowel Preparation

A study testing Written recommendation in people with Colonic Disease and Adherence, Patient, run by Parc de Salut Mar at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Our study aims to improve adherence to international clinical guidelines of repeating colonoscopy within 1 year, when bowel cleansing has failed. To this end, we have designed an ambispective study in patients with inadequately prepared colonoscopy. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Colonic Disease, Adherence, Patient
What is being tested?
Written recommendation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
465 participants
Where
1 siteSpain
Study dates
11 May 2023to 13 Jan 2025
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Patients with a colonoscopy with inadequate bowel preparation for any indication except for colorectal cancer screening

Who cannot join

  • Patients with no indication for repeat colonoscopy due to clinical criteria
  • Patients with a recommendation to repeat the colonoscopy with a different interval
  • Hospitalized patients
  • Patients with special reprogramming circuit (colorectal cancer screening, hospitalized patients, complex polypectomies, revision of polypectomies)
  • Incomplete examination for other reasons than intestinal cleansing (stenosis, loops, etc...)
  • Patients under 18 years of age

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Hospital del Mar

    Barcelona, 08003

Other trials in Spain

About this study

Official title: Written Endoscopist Recommendation to Improve Adherence to Early Repeat Colonoscopy Within 1 Year in Patients With Inadequate Bowel Preparation.

Our study aims to improve adherence to international clinical guidelines of repeating colonoscopy within 1 year, when bowel cleansing has failed. To this end, we have designed an ambispective study in patients with inadequately prepared colonoscopy. An intervention group to which a precise written recommendation on the need to repeat the colonoscopy in less than 1 year is attached, compared with a control group to which no written recommendations are provided.

The sample size calculation is 171 patients per arm. In addition, we will quantify the percentage of pre-malignant and malignant lesions detected at repeat colonoscopy. We will also analyze factors that may be related to the recommendation or non-recommendation of repeat colonoscopy, as well as the association of variables related to adherence to repeat colonoscopy at an interval of less than 1 year.

Through our study, we intend to demonstrate that a written recommendation, easily applicable and generalizable, has a positive impact on adherence to clinical follow-up guidelines in patients in whom bowel cleansing has failed.

Read the detailed description

STUDY HYPOTHESIS

In patients with an inadequately prepared colonoscopy, a written recommendation on the need for repeat colonoscopy in less than 1 year improves adherence.

OBJECTIVES

Main objective

  • To evaluate adherence to repeat colonoscopy in less than 1 year, after including an accurate written recommendation, versus not including a written recommendation, in patients with a colonoscopy with inadequate preparation.

Secondary objectives

  • Determine the detection rate of adenomas, advanced adenomas, serrated lesions, and cancer in the different groups
  • To identify risk factors predicting low adherence to repeat colonoscopy.
  • To identify variables that influence the gastroenterologist-endoscopist to write down the need to repeat colonoscopy in less than 1 year.

METHODOLOGY

  • Ambispective study in patients with inadequately prepared colonoscopy with a prospective inclusion intervention group to which a precise written recommendation on when the colonoscopy should be repeated is attached, compared with a retrospective cohort control group to which no written recommendations are given.

Study population

  • Patients with an inadequately prepared colonoscopy for any indication except colorectal cancer screening.

There are 2 population groups according to the recommendations they received:

  1. Control group: No-recommendation group. Patients to be included in the retrospective cohort will receive a colonoscopy report that includes that the bowel cleansing was inadequate. However, the report will not include that the colonoscopy should be repeated in less than 1 year.
  2. Intervention group: When-to-repeat group

Patients in the intervention group will receive a colonoscopy report that includes that the bowel cleansing was inadequate, and in addition the report will include that the colonoscopy should be repeated within 1 year.

Outcome measures

  • Adherence to the recommendation will be considered a repeat colonoscopy at an interval of less than 1 year.
  • Inadequate preparation will be evaluated according to the Boston Bowel Preparation Scale as less than 2 points in any segment.
  • The physician requesting the baseline colonoscopy will be the one who should request the repeat colonoscopy, following the existing written recommendations and in case there are none, based on his clinical judgment.
  • To assess the degree of bowel cleansing, we will use the Boston Bowel Preparation Scale (BBPS), which is the most validated of those available. This scale divides the colon into three segments, assigning each segment a score between 0 and 3 points. The overall score of the colon is between 0 and 9 points, with a higher score being understood as a better prepared colon in terms of cleanliness.
  • Variables that are potentially related to leaving a written recommendation on the need to repeat and when by the physician-endoscopist will be collected: adenoma detection rate, experience of the endoscopist, full-time vs. partial-time.
  • Variables potentially related to low adherence to repeat colonoscopy will be collected such as: patient age, indication for the test, colonoscopy findings (adenomas, advanced adenoma, ADK), physician requesting the examination (gastroenterologist/primary care/other specialists), patient nationality/language barrier, previous non-appearance, previous colonoscopies.
  • To facilitate the written recommendation, in all patients with inadequate bowel preparation, a mandatory tab will be created to be filled in the colonoscopy report related to bowel preparation. In case of selecting inadequate cleansing, the recommendation to repeat the colonoscopy in an interval of less than 1 year will be automatically included in the report.

Sample size

Accepting an alpha risk of 0.05 and a beta risk of 0.2 in a two-sided test, 171 subjects are necessary in first group and 171 in the second to find as statistically significant a proportion difference, expected to be of 0.3 in group 1 and 0.45 in group 2. It has been anticipated a drop-out rate of 5%.

Being tested
Written recommendation
Keywords
Colonoscopy, Bowel preparation, Quality, Written recommendation
Medical subject headings
Colonic Diseases, Patient Compliance

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Written recommendationOther

    Patients in the intervention group will receive a report of the colonoscopy that will include a written recommendation that the colonoscopy should be repeated within1 year.

    The colonoscopy report will included that an adequate intestinal cleansing has not been achieved and therefore it is an invalid exploration. Additionally, a written recommendation indicating that the colonoscopy should be repeated within1 year will be included in the colonoscopy report. This recommendation is addressed both to the clinician who requested the colonoscopy and to the patient himself.

Study groups in NCT05709145
Study groupRoleWhat they receive
Written recommendationExperimentalPatients in the intervention group will receive a report of the colonoscopy that will include a written recommendation that the colonoscopy should be repeated within 1 year.
Receives: Other: Written recommendation
Non Written recommendationNo interventionPatients in the control group will receive a report of the colonoscopy without a written recommendation that the colonoscopy should be repeated within 1 year.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Adherence to repeat colonoscopy

    Adherence to repeat colonoscopy within1 year in patients with inadequate bowel preparation colonoscopy.

    Measured: 1 year after index colonoscopy

Secondary outcomes (6)
  1. Overall adenoma detection rate

    Ratio of patients with at least one adenoma lesion in the overall colon

    Measured: At the moment of colonoscopy

  2. Overall serrated lesion detection rate

    Ratio of patients with at least one serrated lesion in the overall colon

    Measured: At the moment of colonoscopy

  3. Overall cancer detection rate

    Ratio of patients with at least one cancer in the overall colon

    Measured: At the moment of colonoscopy

  4. Complete colonoscopy rate

    Ratio of successful complete colonoscopies (cecal intubation or in case of previous surgery, ileocolic anastomosis)

    Measured: At the moment of colonoscopy

  5. Overall advanced adenoma detection rate

    Ratio of patients with at least one advanced adenoma lesion in the overall colon

    Measured: At the moment of colonoscopy

  6. Boston Bowel Preparation Scale

    Application of the Boston Bowel Preparation Scale to evaluate colonoscopy bowel cleansing

    Measured: At the moment of colonoscopy

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Feb 2023
  2. Study start11 May 2023
  3. Primary completion31 Dec 2024
  4. Study completion13 Jan 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
465 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05709145
Sponsor's protocol ID
Endo-Remind
Status last verified
Jan 2025
First submitted
24 Jan 2023
Last updated
15 Jan 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Schreuders E, Sint Nicolaas J, de Jonge V, van Kooten H, Soo I, Sadowski D, Wong C, van Leerdam ME, Kuipers EJ, Veldhuyzen van Zanten SJ. The appropriateness of surveillance colonoscopy intervals after polypectomy. Can J Gastroenterol. 2013 Jan;27(1):33-8. doi: 10.1155/2013/279897.

    PubMed 23378981
  • Atkin W, Wooldrage K, Brenner A, Martin J, Shah U, Perera S, Lucas F, Brown JP, Kralj-Hans I, Greliak P, Pack K, Wood J, Thomson A, Veitch A, Duffy SW, Cross AJ. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol. 2017 Jun;18(6):823-834. doi: 10.1016/S1470-2045(17)30187-0. Epub 2017 Apr 28.

    PubMed 28457708
  • Hassan C, East J, Radaelli F, Spada C, Benamouzig R, Bisschops R, Bretthauer M, Dekker E, Dinis-Ribeiro M, Ferlitsch M, Fuccio L, Awadie H, Gralnek I, Jover R, Kaminski MF, Pellise M, Triantafyllou K, Vanella G, Mangas-Sanjuan C, Frazzoni L, Van Hooft JE, Dumonceau JM. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy. 2019 Aug;51(8):775-794. doi: 10.1055/a-0959-0505. Epub 2019 Jul 11.

    PubMed 31295746
  • Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012 Sep;143(3):844-857. doi: 10.1053/j.gastro.2012.06.001. Epub 2012 Jul 3. No abstract available.

    PubMed 22763141
  • Butterly LF, Nadel MR, Anderson JC, Robinson CM, Weiss JE, Lieberman D, Shapiro JA. Impact of Colonoscopy Bowel Preparation Quality on Follow-up Interval Recommendations for Average-risk Patients With Normal Screening Colonoscopies: Data From the New Hampshire Colonoscopy Registry. J Clin Gastroenterol. 2020 Apr;54(4):356-364. doi: 10.1097/MCG.0000000000001115.

    PubMed 30106836
  • Hassan C, Antonelli G, Dumonceau JM, Regula J, Bretthauer M, Chaussade S, Dekker E, Ferlitsch M, Gimeno-Garcia A, Jover R, Kalager M, Pellise M, Pox C, Ricciardiello L, Rutter M, Helsingen LM, Bleijenberg A, Senore C, van Hooft JE, Dinis-Ribeiro M, Quintero E. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy. 2020 Aug;52(8):687-700. doi: 10.1055/a-1185-3109. Epub 2020 Jun 22.

    PubMed 32572858
  • Anton Arnal M, Grima Sopesens N, Seoane Urgorri A, Duran Jorda X, Batlle Garcia M, Parrilla Carrasco M, Pont Feijoo E, Mane Bosch A, Munoz Galito J, Riu Pons F, Dedeu Cusco JM, Bessa Caserras X, Barranco Priego L, Pantaleon Sanchez MA. Written Recommendation to Repeat Colonoscopy within 1 Year after Inadequate Bowel Preparation: A Simple and Highly Effective Intervention. Endosc Int Open. 2026 Oct 16;14:a29737245. doi: 10.1055/a-2973-7245. eCollection 2026.

    PubMed 42898906

Questions about this trial

What is this clinical trial studying?

A study testing Written recommendation in people with Colonic Disease and Adherence, Patient, run by Parc de Salut Mar at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Adherence to repeat colonoscopy (time frame: 1 year after index colonoscopy). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05709145, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Jan 2025.

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