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Low-residual diet versus clear-liquid diet for bowel preparation before colonoscopy: meta-analysis and trial sequential analysis of randomized controlled trials

  • Author Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Xubing Zhang
    Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Affiliations
    Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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  • Author Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Qingbin Wu
    Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Affiliations
    Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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  • Author Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Mingtian Wei
    Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Affiliations
    Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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  • Author Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Yanling Ding
    Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.
    Affiliations
    Department of Cardiology, Anqing Municipal Hospital (Anqing Hospital Affiliated to Anhui Medical University), Anqing, China
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  • Chaoyang Gu
    Affiliations
    Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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  • Sheng Liu
    Affiliations
    Department of General Surgery, Jiangyou Fourth People’s Hospital, Jiangyou, China
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  • Ziqiang Wang
    Correspondence
    Reprint requests: Ziqiang Wang, MD, PHD, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University; Guo Xue Xiang No. 37 Chengdu 610041, China.
    Affiliations
    Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Zhang, Wu, Wei, and Ding contributed equally to this article.

      Background and Aims

      The aim of this study was to compare a low-residual diet (LRD) with a clear-liquid diet (CLD) for bowel preparation before colonoscopy.

      Methods

      A systematic literature search was performed in PubMed, Ovid, and Cochrane databases for randomized clinical trials comparing LRD with CLD for bowel preparation before colonoscopy. The last search was performed on September 20, 2019. The primary outcome was adequate bowel preparation. The outcomes were compared using systematic review with meta-analysis and trial sequential analysis (TSA).

      Results

      Twenty randomized controlled trials published between 2005 and 2019 with 4323 participants were included. LRD was comparable with CLD for adequate bowel preparation (P = .79; odds ratio [OR], 0.96; 95% confidence interval [CI], 0.72-1.29). The detection rates for polyps (P = .68; OR, 1.04; 95% CI, 0.86-1.27) or adenomas (P = .78; OR, 1.03; 95% CI, 0.86-1.23) were similar between the groups. There were significantly fewer advents in individuals in the LRD group: nausea (P = .02; OR, 0.72; 95% CI, 0.56-0.94), vomiting (P = .04; OR, 0.61; 95% CI, 0.38-0.98), hunger (P < .001; OR, 0.36; 95% CI, 0.24-0.53), and headache (P = .02; OR ,0.64; 95% CI, 0.44-0.93). In addition, significantly more individuals in the LRD group found it easy to complete the diet (P = .01; OR, 1.86; 95% CI, 1.15-3.00) and showed willingness to repeat it (P = .005; OR, 2.23; 95% CI, 1.28-3.89). TSA demonstrated that the cumulative Z curve crossed both the traditional boundary and the trial sequential monitoring boundary for adequate bowel preparation.

      Conclusion

      The present study demonstrated that LRD was comparable with CLD in the quality of bowel preparation before colonoscopy. More clinical trials are needed to confirm other outcomes.

      Graphical abstract

      Abbreviations:

      CB (conventional boundary), CI (confidence interval), CLD (clear-liquid diet), CRC (colorectal cancer), FB (futility boundary), LRD (low-residual diet), OR (odds ratio), PEG (polyethylene glycol), RCT (randomized controlled trials), RIS (required information size), TSA (trial sequential analysis), TSMB (trial sequential monitoring boundary)
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      Linked Article

      • Evaluation of preparation methods for colonoscopy
        Gastrointestinal EndoscopyVol. 93Issue 3
        • Preview
          The meta-analysis by Zhang et al1 has important implications given the crucial role preparation plays in ensuring a high-quality colonoscopy.2 Scales of cleanliness are at their core subjective, validation studies (which had relatively low adenoma detection rates [ADRs]3) notwithstanding. We suggest that comparison of cleaning methods would be more objective and valid if ADRs (and right-sided serrated polyp detection rates) in routine first-time average-risk screening colonoscopies were used as dependent variables, with the proviso that the ADRs of the performing colonoscopists be high—we would suggest in excess of 50% (the prevalence of adenomas in average-risk persons is probably over 60%4,5).
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