Background and Aims
Colonoscopy is extremely important for the identification and removal of precancerous
polyps. Bowel preparation before colonoscopy is essential for adequate visualization.
Traditionally, patients have been instructed to consume only clear liquids the day
before a colonoscopy. However, recent studies have suggested using a low-residue diet,
with varying results. We evaluated the outcomes of patients undergoing colonoscopy
who consumed a clear liquid diet (CLD) versus low-residue diet (LRD) on the day before
colonoscopy by a meta-analysis.
Methods
Scopus, PubMed/MEDLINE, Cochrane databases, and CINAHL were searched (February 2015).
Studies involving adult patients undergoing colonoscopy examination and comparing
LRD with CLD on the day before colonoscopy were included. The analysis was conducted
by using the Mantel-Haenszel or DerSimonian and Laird models with the odds ratio (OR)
to assess adequate bowel preparations, tolerability, willingness to repeat diet and
preparation, and adverse effects.
Results
Nine studies (1686 patients) were included. Patients consuming an LRD compared with
a CLD demonstrated significantly higher odds of tolerability (OR 1.92; 95% CI, 1.36-2.70;
P < .01) and willingness to repeat preparation (OR 1.86; 95% CI, 1.34-2.59; P < .01) with no differences in adequate bowel preparations (OR 1.21; 95% CI, 0.64-2.28;
P = .58) or adverse effects (OR 0.88; 95% CI, 0.58-1.35; P = .57).
Conclusion
An LRD before colonoscopy resulted in improved tolerability by patients and willingness
to repeat preparation with no differences in preparation quality and adverse effects.
Abbreviations:
BBPS (Boston Bowel Preparation Scale), CI (confidence interval), CLD (clear liquid diet), LRD (low-residue diet), OR (odds ratio), RCT (randomized, controlled trial)To read this article in full you will need to make a payment
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References
- Cancer statistics, 2003.CA Cancer J Clin. 2003; 53: 5-26
- Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup.N Engl J Med. 1993; 328: 901-906
- Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.Gastrointest Endosc. 2005; 61: 378-384
- A prospective study of factors that determine cecal intubation time at colonoscopy.Gastrointest Endosc. 2005; 61: 72-75
- Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea.J Clin Gastroenterol. 2009; 43: 448-452
- Predictors of inadequate bowel preparation for colonoscopy.Am J Gastroenterol. 2001; 96: 1797-1802
- Risk factors predictive of poor quality preparation during average risk colonoscopy screening: the importance of health literacy.J Gastrointest Liver Dis. 2010; 19: 369-372
- Bowel preparation prior to colonoscopy: a continual search for excellence.World J Gastroenterol. 2013; 19: 155-157
- Socioeconomic and other predictors of colonoscopy preparation quality.Dig Dis Sci. 2010; 55: 2014-2020
- CT colonography after fecal tagging with a reduced cathartic cleansing and a reduced volume of barium.AJR Am J Roentgenol. 2005; 184: 1836-1842
- A novel approach to extract colon lumen from CT images for virtual colonoscopy.IEEE Trans Med Imaging. 2000; 19: 1220-1226
- Low-fiber diet in limited bowel preparation for CT colonography: influence on image quality and patient acceptance.AJR Am J Roentgenol. 2010; 195: W31-W37
- Limited-preparation CT colonography in frail elderly patients: a feasibility study.AJR Am J Roentgenol. 2010; 194: 1279-1287
- PillCam colon capsule endoscopy: a prospective, randomized trial comparing two regimens of preparation.J Clin Gastroenterol. 2011; 45: 119-124
- Randomized clinical trial comparing reduced-volume oral picosulfate and a prepackaged low-residue diet with 4-liter PEG solution for bowel preparation.Dis Colon Rectum. 2014; 57: 522-528
- Low-volume morning-only polyethylene glycol with specially designed test meals versus standard-volume split-dose polyethylene glycol with standard diet for colonoscopy: a prospective, randomized trial.Digestion. 2013; 88: 110-118
- Impact of low-residue diet on bowel preparation for colonoscopy.Dis Colon Rectum. 2011; 54: 107-112
- Efficacy of bowel preparation with the use of a prepackaged, low fibre diet with a low sodium, magnesium citrate cathartic vs. a clear liquid diet with a standard sodium phosphate cathartic.Aliment Pharmacol Ther. 2005; 21: 1491-1495
- Efficacy of prepackaged, low residual test meals with 4L polyethylene glycol versus a clear liquid diet with 4L polyethylene glycol bowel preparation: a randomized trial.J Gastroenterol Hepatol. 2009; 24: 988-991
- A prospective study to assess the efficacy and patient tolerance of three bowel preparations for colonoscopy.Gastroenterol Nurs. 2006; 29: 305-308
- A randomized single-blind trial of standard diet versus fiber-free diet with polyethylene glycol electrolyte solution for colonoscopy preparation.Endoscopy. 2010; 42: 633-638
- Efficacy and tolerance of sodium phosphates oral solution after diet liberalization.Gastroenterol Nurs. 2005; 28: 133-139
- A randomized controlled trial comparing a low-residue diet versus clear liquids for colonoscopy preparation: impact on tolerance, procedure time, and adenoma detection rate.J Clin Gastroenterol. 2014; 48: 851-855
- A low-residue breakfast improves patient tolerance without impacting quality of low-volume colon cleansing prior to colonoscopy: a randomized trial.Am J Gastroenterol. 2013; 108: 1551-1555
- A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation.Gastrointest Endosc. 2013; 77: 932-936
- The impact of diet liberalization on bowel preparation for colonoscopy.Am J Gastroenterol. 2013; 108: S162
- The white diet is preferred and better tolerated than a clear fluid diet without hindering successful bowel preparation for colonoscopy [abstract].Gastrointest Endosc. 2014; 79: AB587
- The gourmet colon prep.Pract Gastroenterol. 2007; 31: 41-57
- Cochrane handbook for systematic reviews of interventions.The Cochrane Collaboration. 2011; (Accessed August 2015)
- Assessing the quality of reports of randomized clinical trials: is blinding necessary?.Control Clin Trials. 1996; 17: 1-12
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. GRADE Working Group.BMJ. 2008; 336: 924-926
GRADE working group. Criteria for applying or using GRADE. Available at: http://www.gradeworkinggroup.org/intro.htm#criteria. Accessed August 2015.
- Validation of an instrument to assess colon cleansing [abstract].Am J Gastroenterol. 1999; 94: 2667
- The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.Gastrointest Endosc. 2009; 69: 620-625
- Validation of the Harefield Cleansing Scale: a tool for the evaluation of bowel cleansing quality in both research and clinical practice.Gastrointest Endosc. 2013; 78: 121-131
- US Multi-Society Task Force on Colorectal Cancer. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer.Gastroenterology. 2014; 147: 903-924
- European Society of Gastrointestinal Endoscopy. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline.Endoscopy. 2013; 45: 142-150
Article info
Publication history
Published online: October 09, 2015
Accepted:
September 23,
2015
Received:
March 16,
2015
Footnotes
DISCLOSURE: Dr Bechtold is a consultant for the Nestle Nutrition Institute. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Bechtold at [email protected]
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
