Controlled Dietary Restriction With a Prepackaged Low-Residue Diet Before Colonoscopy Offers Better-Quality Bowel Cleansing and Allows the Use of a Smaller Volume of Purgatives: A Randomized Multicenter Trial

Prepackaged formula low-residue diet vs. self-prepared low-residue diet before colonoscopy: A multicenter randomized controlled trial

Background and aims

Compared with self-prepared LRD, a prepackaged low-residue diet (LRD) can improve patient compliance, but whether it can further improve the quality of bowel preparation is uncertain. The study aimed to compare the application of the prepackaged formula LRD with self-prepared LRD in bowel preparation for colonoscopy.

Methods

A multicenter randomized controlled trial was conducted in 15 centers. The eligible subjects were randomly assigned to one of two groups: the formula LRD group and the self-prepared LRD group. On the day before the colonoscopy, subjects in the self-prepared LRD group were instructed to consume a restricted LRD prepared by themselves, while subjects in the formula LRD group were given six bags of prepackaged formula LRD and instructed to consume them according to their individual need. The primary outcome was an adequate bowel preparation rate. Secondary outcomes mainly included Boston Bowel Preparation Scale (BBPS) scores, dietary restriction compliance rate, tolerance, satisfaction, adenoma detection rate (ADR), and adverse reactions. The trial was registered at ClinicalTrials.gov under the identifier NCT03943758.

Results

A total of 550 subjects were recruited. Compared with the self-prepared LRD group, the formula LRD group showed a higher adequate bowel preparation rate (94.5 vs. 80.4%; P < 0.01), BBPS scores (7.87 ± 1.13 vs. 6.75 ± 1.47; P < 0.01), dietary compliance rate (92.4 vs. 78.9%; P < 0.01), tolerance (P < 0.01 in degree of hunger, intensity of physical strength, and negative influence on daily activities), satisfaction (8.56 ± 1.61 vs. 7.20 ± 2.02; P < 0.01), and ADR (25.6 vs. 16.0%; P < 0.01). There was no significant difference in adverse reactions.

Conclusion

Compared with self-prepared LRD, the formula LRD showed similar safety and higher bowel preparation quality, compliance, and tolerance in bowel preparation. More formula LRDs could be designed according to different dietary habits and ethnic populations, and further researches are warranted to confirm their effect.

Clinical trial registration

https://register.clinicaltrials.gov, identifier: NCT03943758.

Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy: A Meta-analysis

This meta-analysis aimed to evaluate the impact of prepackaged low-residue diet (PLRD) on bowel preparation for colonoscopy. We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases from inception to August 2020. Randomized controlled trials (RCTs) comparing PLRD with clear liquid diet (CLD) or self-prepared LRD were considered for inclusion. The analysis calculated the odds ratio (OR) for the rate of adequate bowel preparation, patient tolerance, willingness to repeat bowel preparation, tolerability of bowel preparation, and overall adverse effects. Five RCTs published between 2006 and 2019 (N = 561) were included in our meta-analysis. Compared with the traditional CLD or self-prepared LRD, PLRD showed significantly higher rates of adequate bowel preparation (OR, 2.16; 95% confidence interval [CI], 1.18-3.98; p = .01), patient tolerance (OR, 1.99; 95% CI, 1.30-3.07; p = .002), and willingness to repeat the bowel preparation (OR, 1.68; 95% CI, 1.05-2.70; p = .03), with no differences in adverse events (OR, 0.93; 95% CI, 0.59-1.46; p = .75). Prepackaged low-residue diet improved bowel preparation quality, patient tolerance, and willingness to repeat bowel preparations. Importantly, PLRD does not increase the incidence of adverse events. This suggests that it is effective and safe to use PLRD for bowel preparation before colonoscopy.

Favorable outcomes of prepackaged low-residue diet on bowel preparation for colonoscopy: Endoscopist-blinded randomized controlled trial

BACKGROUND AND AIM

2 L polyethylene glycol plus an ascorbic acid (PEGA) is known to be as effective. However, 2 L polyethylene glycol-based regimens are often still difficult for patients to tolerate. Therefore, we conducted this study to evaluate the potential of 1 L PEGA with prepackaged low-residue diet (PLD) as an alternative to 2 L PEGA before colonoscopy.

METHODS

The subjects were randomly assigned to either of the two groups. The 2 L PEGA group received 2 L PEGA split regimen. The 1 L PEGA with PLD group received PLD on the day preceding colonoscopy and 1 L PEGA. All endoscopic procedures were performed by one physician who did not know patients allocation. Bowel preparation status were graded using Boston Bowel Preparation Score (BBPS). A questionnaire regarding tolerability and safety was administered. This trial is registered at ClinicalTrials.gov (NCT03329339).

RESULTS

A total of 173 patients completed the study (86 in the 2 L PEGA group and 87 in the 1 L PEGA with PLD group). Bowel preparation was adequate in 88.4% (76/86) of patients in the 2 L PEGA group and 93.1% of patients in the 1 L PEGA with PLD group (81/87, P = 0.28). The patients in the 1 L PEGA with PLD group had higher whole Boston Bowel Preparation Scale score (P = 0.02) and expressed more satisfaction and willingness to repeat the procedure (P < 0.01). There was no significant difference with respect to compliance or safety.

CONCLUSION

1 L PEGA with PLD showed equivalent efficacy, greater satisfaction, and more willingness to repeat compared with 2 L PEGA for bowel preparation.