The impact of diet liberalization on bowel preparation for colonoscopy

Abstract

Background and study aims Dietary restrictions are integral to colonoscopy preparation and impact patient satisfaction. Utilizing split-dose, lower-volume polyethylene glycol 3350-electrolyte solution (PEG-ELS), this study compared colon preparation adequacy of a low-residue diet to clear liquids using a validated grading scale. Patients and methods This was a prospective, randomized, single-blinded, single-center non-inferiority study evaluating diet the day prior to outpatient colonoscopy. Subjects were randomized to a Low-Residue diet for breakfast and lunch, or Clears only. All subjects received split dose PEG-ELS. The primary endpoint was preparation adequacy using the Boston Bowel Preparation Scale (BBPS), with adequate defined as a score > 5. Secondary endpoints included mean BBPS scores for the entire colon and individual segments, satisfaction, adverse events, polyp and adenoma detection rates, and impact on sleep and daily activities. Results Final analysis included 140 subjects, 72 assigned to Clears and 68 to Low-Residue. The Low-Residue diet was non-inferior to Clears (risk difference = – 5.08 %, P = 0.04) after adjusting for age. Mean colon cleansing scores were not significantly different overall and for individual colonic segments. Satisfaction with the Low-Residue diet was significantly greater (P = 0.01). The adenoma detection rate was not statistically significantly different between study groups, but the number of adenomas detected was significantly greater with Clears (P = 0.01). Adverse events and impact on sleep and activities did not differ significantly between diet arms. Conclusions A low-residue diet for breakfast and lunch the day prior to colonoscopy was non-inferior to clear liquids alone for achieving adequate colon cleansing when using split dose PEG-ELS.

Regime for Bowel Preparation in Patients Scheduled to Colonoscopy

“…Same with our findings, this study found LRD not only did not compromise the bowel preparation, but bettered patient tolerance as well. Remaining 32 was performed by Walter and colleagues used BBPS to assess the bowel preparation quality and supported LRD was not-inferior to CLD, in keeping with our findings.…”

Evaluation of the combined effect of factors influencing bowel preparation and adenoma detection rates in patients undergoing colonoscopy

“…This is consistent with a recent RCT. In a prospective, randomised, single-centre non-inferiority trial, Walter et al concluded that the LRD a day before colonoscopy was non-inferior to CLD for getting adequate bowel cleansing using a split-dose regimen 32. In our study, ADR was higher in the SDR+LDR versus SDR+CLD (34.7% vs 29.6%), but the results were not statistically significant, p=0.167.…”

Impact of diet restriction on bowel preparation for colonoscopy

“…[ 10 , 11 ] Several studies have evaluated the efficacy of diet liberalization to LRD on the bowel preparation compared to CLD. [ 14 , 18 , 20 , 21 ] In these studies, diet liberalization did not adversely affect bowel preparations and improved patient willingness to repeat the bowel preparation and tolerability of preparation solutions. Still, data regarding the effect of regular diet (RD) on the bowel preparation is lacking and RD on the day before colonoscopy is not recommended yet.…”

“…Specifically, whole grains uptake was significantly associated with inadequate bowel preparation among forbidden food categories (fiber-rich vegetables, seaweeds, whole grains, and seedy fruits), even though statistical significance was disappeared in multivariable analysis. In literature review, data showing comparable outcome of LRD on the bowel preparation with CLD are easily available, [ 14 , 15 , 21 , 22 ] but studies evaluating the effect of RD are very limited. [ 17 , 18 , 23 ] Jung et al [ 17 ] showed similar rate of adequate bowel preparation between RD and CLD (83.3% vs 83.5%) in healthy outpatients, recommending RD avoiding fiber-rich foods as possible diet instructions prior to colonoscopy.…”