A low-residue diet before colonoscopy tends to improve tolerability by patients with no differences in preparation quality: a randomized trial
The pre-colonoscopy diet traditionally involves 24 h of a clear liquid diet (CLD) in combination with a lavage solution; however, this preparation is poorly tolerated.
To compare the impact on the quality of bowel cleansing and tolerability of a CLD versus a low-residue diet (LRD).
We performed a randomized trial. Subjects were randomized to CLD or LRD the day before of elective colonoscopy. All subjects received a 4-L preparation of single-dose PEG beginning 16 h prior to colonoscopy. The Boston bowel preparation scale was used to evaluate bowel cleansing; an adequate-quality preparation was defined as a score ≥ 2 per segment.
A total of 205 subjects were included with a mean age (SD) of 55.6 (12.6) years; 133 (64.9%) of them were female. A total of 105 subjects were randomized to receive CLD and 100 to LRD. No significant differences in bowel preparation quality were observed between groups according to the section of colon: right colon (70% vs. 73%, p = 0.08), transverse colon (82% vs. 79%, p = 0.062), or left colon (80% vs. 78.7%, p = 0.28). There was a tendency toward less-frequent nausea (p = 0.08) and vomiting (p = 0.07) in patients with LRD. No differences between groups regarding ADR (12% vs. 10%) were noted.
An LRD before colonoscopy resulted in a tendency toward improved tolerability by patients, with no differences in the quality of bowel preparation.
KeywordsColonoscopy Diet Bowel cleansing Polyp Adenoma Colorectal cancer
EG-R, GG-F, FIT-Á conception and design; EG-R, GG-F, FIT-Á, GCM, NJVV, SMB, analysis and interpretation of the data; FIT-Á, GM-D, AT-P: drafting of the article; FIT-Á and EG-R, FV-A: critical revision of the article for important intellectual content; EG-R, GCM, NJVV, SMB, GM-D, AT-P, LGC-G, GG-F, DR-R data collection; EG-R, GCM, NJVV, SMB, GM-D, AT-P, LGC-G, GG-F, DR-R, FV-A, Félix Ignacio T-A: final approval of the article.
Compliance with ethical standards
Elisa Gómez-Reyes, Alejandra Tepox-Padrón, Gregorio Cano Manrique, Natalia J. Vilchis Valadez, Stefany Mora Bulnes, GM-D, Luis Gerardo Chaires-Garza, Guido Grajales-Figueroa, Daniel Ruiz-Romero and Félix I. Téllez-Ávila have no conflicts of interest or financial ties to disclose.
- 13.Lebwohl B, Capiak K, Neugut AI, Kastrinos F (2012) Risk of colorectal adenomas and advanced neoplasia in Hispanic, black and white patients undergoing screening colonoscopy. Aliment Pharmacol Ther 35:1467–1473. https://doi.org/10.1111/j.1365-2036.2012.05119.x CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Marmo R et al (2010) Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. Gastrointest Endosc 72:313–320. https://doi.org/10.1016/j.gie.2010.02.048 CrossRefPubMedGoogle Scholar
- 16.Melicharkova A, Flemming J, Vanner S, Hookey L (2013) A low-residue breakfast improves patient tolerance without impacting quality of low-volume colon cleansing prior to colonoscopy: a randomized trial. Am J Gastroenterol 108:1551–1555. https://doi.org/10.1038/ajg.2013.21 CrossRefPubMedGoogle Scholar
- 17.Murcio-Pérez ET-ÁF (2012) Options for bowel preparation before colonoscopy. Endoscopia 24:23–31Google Scholar
- 19.Park DI et al (2009) 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 24:988–991. https://doi.org/10.1111/j.1440-1746.2009.05860.x CrossRefPubMedGoogle Scholar
- 20.Pontone S, Angelini R, Standoli M, Patrizi G, Culasso F, Pontone P, Redler A (2011) Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy. World J Gastroenterol 17:4689–4695. https://doi.org/10.3748/wjg.v17.i42.4689 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Siddiqui AA, Yang K, Spechler SJ, Cryer B, Davila R, Cipher D, Harford WV (2009) Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. Gastrointest Endosc 69:700–706. https://doi.org/10.1016/j.gie.2008.09.047 CrossRefPubMedGoogle Scholar
- 28.Stolpman DR, Solem CA, Eastlick D, Adlis S, Shaw MJ (2014) 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 48:851–855. https://doi.org/10.1097/mcg.0000000000000167 CrossRefPubMedGoogle Scholar
- 29.Téllez-Ávila FIB-GJ, García-Osogobio S, López-Arce G (2013) Quality of bowel preparation with 4-L PEG solution for colonoscopy in two Latin-American centers. Endoscopia 25:74–77Google Scholar