A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation

Sipe, Brian; Fischer, Monika; Baluyut, Arthur R.; Bishop, Robert H.; Born, Lawrence J.; Daugherty, D.; Lybik, Mark J.; Shatara, Tassier J.; Scheidler, Mark D.; Wilson, Spencer; Rex, Douglas K.

doi:10.1016/j.gie.2013.01.046

Cited by 57 publications

(57 citation statements)

References 10 publications

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“…In that randomized controlled trial of 226 patients, the White Diet in conjunction with a 2‐L PEG with ascorbate bowel preparation was preferred by patients with less hunger and interference to daily activities without detriment to bowel preparation quality or colonoscopy performance compared with a clear fluid diet 15. Other randomized trials of diet liberalization during bowel preparation suggest that either low‐fiber13 or regular diet14 the day before colonoscopy with split‐dose bowel preparation is associated with improved tolerance and comparable or better colon cleansing compared with a clear fluid diet. In our study, patients taking the White Diet for 2 days reported higher overall satisfaction with the diet and higher satisfaction with the diet compared with any previous colonoscopy (>90% had clear fluid diet at previous colonoscopy).…”

Section: Discussionmentioning

confidence: 99%

“…Typically, patients are instructed to take a clear fluid diet the day prior to colonoscopy because high‐fiber foods may impair bowel preparation. Recent randomized trials, however, suggest that a low‐fiber diet13 or even regular diet14 the day before colonoscopy with split‐dose bowel preparation is associated with better tolerance of the preparation and comparable or better colon cleansing compared with a clear fluid‐only diet. The White Diet is a novel, low‐residue diet of white‐colored foods, which is better tolerated without detriment to bowel preparation quality compared to a clear fluid diet in patients undergoing colonoscopy 15…”

Section: Introductionmentioning

confidence: 99%

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White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

et al. 2017

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Background and AimBowel preparations with polyethylene glycol (PEG) and clear fluids are often poorly tolerated. We compared an innovative low‐residue White Diet and low‐volume, split‐dose Picosalax with the standard preparation at our institution of day‐before clear fluids and combination PEG plus sodium picosulfate/magnesium citrate (SPMC).MethodsAdults undergoing morning colonoscopy were randomized to either the White Diet and split‐dose, two sachets of Picosalax (WD/PICO) or day‐before clear fluids and 1‐L PEG plus two sachets of SPMC (CF/PEG + SPMC). The primary endpoint was successful bowel preparation defined by an Ottawa bowel preparation score ≤ 6. An intention‐to‐treat analysis with a predefined non‐inferiority margin of 15% was used to compare efficacy.ResultsA total of 250 patients were randomized (125 WD/PICO and 125 CF/PEG + SPMC). WD/PICO was non‐inferior to CF/PEG + SPMC for successful bowel preparation by intention‐to‐treat analysis (58% WD/PICO vs 62% CF/PEG + SPMC, 95%CI: −14.2 to 6.2%) and per‐protocol analysis (64% WD/PICO vs 65% CF/PEG + SPMC, 95%CI: −11.3 to 9.4%). Patients in the WD/PICO group reported greater satisfaction with the diet (P < 0.001), greater ease of following the diet (P < 0.001), and improved experience compared with prior colonoscopy (P < 0.0001), less bloating (P = 0.02), less weakness (P = 0.046), less hunger (P < 0.0001), and less interference with daily activities (P = 0.001). Procedure/withdrawal times and adenoma detection rates were similar between groups.ConclusionBowel preparation with the White Diet and low‐volume, split‐dose Picosalax was preferred and better tolerated without detriment to bowel preparation success compared with clear fluids and combination PEG plus SPMC for morning colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

et al. 2017

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“…14 They were all compared with clear-fluid diets. Purgatives varied from low-volume sodium phosphate 9 or sodium sulfate based, 14 medium-volume picosulfate, 13 or large volume PEG-based.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14] While some of these confound the assessment of diet with differing purgatives or preparation regimens in each arm, [5][6][7][8] other studies specifically assessing a low-fiber or low-residue diet have shown improved patient tolerability without impaired bowel cleanliness. [9][10][11][12][13][14] As yet however, no study has examined a fully flexible low residue diet that may be consumed for the whole day prior to the colonoscopy. This prospective, single-blinded, randomized, non-inferiority controlled trial was designed to address two hypotheses: first, that a flexible low-residue diet of white-colored foods (the "White Diet") would be better tolerated than a clear-fluid diet on the day prior to colonoscopy, without hindering the quality of bowel cleanliness; second, that by making the diet flexible and simple, it would be easy to follow and adhere to, and be preferred.…”

Section: Introductionmentioning

confidence: 99%

The White Diet is preferred, better tolerated, and non‐inferior to a clear‐fluid diet for bowel preparation: A randomized controlled trial

Butt

Bunn

Paul

2016

J of Gastro and Hepatol

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“…Moreover, nausea, headaches and vomiting were significantly more common among the liquid-diet group. Another study randomized 230 outpatients receiving a preparation with a low-volume sulfate solution in a split dose, to follow a liquid diet or a low-residue diet of specified foods the day before colonoscopy [65] . Interestingly, the diet for each meal could be chosen from three options: easy-to-prepare, healthy, or restaurant.…”

Section: To Eat or Not To Eat: Facts About Diet And Quality Of Cleanmentioning

confidence: 99%

Achieving the best bowel preparation for colonoscopy

Parra‐Blanco¹,

Ruiz²,

Álvarez-Lobos³

et al. 2014

WJG

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Bowel preparation is a core issue in colonoscopy, as it is closely related to the quality of the procedure. Patients often find that bowel preparation is the most unpleasant part of the examination. It is widely accepted that the quality of cleansing must be excellent to facilitate detecting neoplastic lesions. In spite of its importance and potential implications, until recently, bowel preparation has not been the subject of much study. The most commonly used agents are high-volume polyethylene glycol (PEG) electrolyte solution and sodium phosphate. There has been some confusion, even in published meta-analyses, regarding which of the two agents provides better cleansing. It is clear now that both PEG and sodium phosphate are effective when administered with proper timing. Consequently, the timing of administration is recognized as one of the central factors to the quality of cleansing. The bowel preparation agent should be administered, at least in part, a few hours in advance of the colonoscopy. Several low volume agents are available, and either new or modified schedules with PEG that usually improve tolerance. Certain adjuvants can also be used to reduce the volume of PEG, or to improve the efficacy of other agents. Other factors apart from the choice of agent can improve the quality of bowel cleansing. For instance, the effect of diet before colonoscopy has not been completely clarified, but an exclusively liquid diet is probably not required, and a low-fiber diet may be preferable because it improves patient satisfaction and the quality of the procedure. Some patients, such as diabetics and persons with heart or kidney disease, require modified procedures and certain precautions. Bowel preparation for pediatric patients is also reviewed here. In such cases, PEG remains the most commonly used agent. As detecting neoplasia is not the main objective with these patients, less intensive preparation may suffice. Special considerations must be made for patients with inflammatory bowel disease, including safety and diagnostic issues, so that the most adequate agent is chosen. Identifying neoplasia is one of the main objectives of colonoscopy with these patients, and the target lesions are often almost invisible with white light endoscopy. Therefore excellent quality preparation is required to find these lesions and to apply advanced methods such as chromoendoscopy. Bowel preparation for patients with lower gastrointestinal bleeding represents a challenge, and the strategies available are also reviewed here. Core tip: Bowel preparation for colonoscopy is a central issue related to the quality of the procedure. There are different agents for bowel preparation that can be administered with different schedules. We review the most commonly used agents, as well as new agents and combinations. Moreover, certain considerations should be taken into account for special populations in order to improve safety, efficacy and tolerance. Regimens for bowel preparation in special situations are discussed, such as for pedi...

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A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation

Cited by 57 publications

References 10 publications

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

The White Diet is preferred, better tolerated, and non‐inferior to a clear‐fluid diet for bowel preparation: A randomized controlled trial

Achieving the best bowel preparation for colonoscopy

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