Smartphone App Improves Colonoscopy Prep

Caroline Helwick

May 23, 2013

ORLANDO, Florida — A new smartphone app can help ensure that patients have a good bowel prep prior to colonoscopy, according to clinicians from Arizona Digestive Health, who developed the app.

The doctor-designed app, the first of its kind, features instructions and timed alerts to help patients follow their bowel prep protocol.

"We know better bowel preps result in better colonoscopy exams, and the smartphone app is harnessing technology for a better healthcare outcome," Paul Berggreen, MD, president of Arizona Digestive Health in Phoenix, told reporters attending a news conference here at Digestive Disease Week (DDW) 2013.

"Getting ready for a colonoscopy is difficult and involves a lot of steps," added codeveloper Nilay Kavathia, MD, a gastroenterology fellow at the Phoenix Veterans Administration Hospital. "For patients, having an interactive, simplified, and personalized app on their phone is like having a doctor at their side throughout the process."

Patients enter the date and time of their colonoscopy and the bowel preparation medication chosen by their physician. Timed alerts then appear on the phone to remind the patient of the next step in bowel preparation. The app also explains the procedure, gives tips, and provides pictures of preparation quality.

"There is adaptability in terms of the 4 bowel preps we use," Dr. Berggreen explained. "It also says to avoid nuts, popcorn, and the like 3 days in advance. It's the same information as patients would receive in written form."

The use of a smartphone app is an ingenious approach.

Dr. Berggreen and his team evaluated the usefulness of the app in 2 phases. In the first phase, prior to its release, patients were asked if they owned a smartphone and if they were likely to use the app. The endoscopist, who was blinded to their answers, scored the quality of preparation using the Boston Bowel Preparation Scale.

In the first phase, 49% of the 326 patients said they owned a smartphone. There was no significant difference in mean Boston Bowel Preparation score between patients with a smartphone and those without (6.92 vs 6.76; P = .414).

In the second phase of the study, patients were given instructions on how to download the free app. At the time of colonoscopy, they were asked if they used the app and if they were satisfied with it. Again, the endoscopist was blinded to the answers and scored the bowel prep using the Boston Bowel Preparation Scale.

In all, 52 people used the app. These patients had an average bowel prep score of 8.1 on a 9-point scale. A Boston Bowel Preparation score of 7 or higher is considered a good-quality prep that allows for adequate visualization of the colon.

"This score has significantly improved from the score of 6.9 we saw before the app was released," Dr. Berggreen pointed out.

Table. Value of Smartphone App for Bowel Prep

Measure App Used App Not Used P Value
Boston Bowel Preparation score (0–9) 8.1 6.5 <.001
Good bowel prep (BBPS > 7) 84% 62% <.001


"We concluded that the app did make a significant difference in bowel prep quality, and that the difference could not be explained by the fact that some people are technologically comfortable or can follow directions better," Dr. Berggreen said. "This has fairly large implications. We are using the app to improve bowel preps and polyp detection rates. But encouraged by these results, we are working on an upgrade to give the app even more functionality."

DDW council chair Lawrence Friedman, MD, who is chair of medicine at Newton–Wellesley Hospital in Massachusetts, told reporters that one of the barriers to successful colorectal cancer screening is inadequate bowel preparation.

"We have data showing that the better the quality of the prep, the better the quality of the colonoscopy and the more reliable the results in detecting and treating polyps and adenomas," he said. "Everyone knows the worst part of the colonoscopy is taking the prep, so anything that encourages patients to complete it and perhaps enjoy doing it more than they generally would is welcome. The use of a smartphone app is an ingenious approach, and I believe it will improve the quality of screening," Dr. Friedman explained.

Dr. Berggreen, Dr. Kavathia, and Dr. Friedman have disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2013: Abstract 143c. Presented May 18, 2013.


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