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.
BACKGROUND
Bowel preparation is burdensome, and less-demanding preparation procedures are needed. Few studies have investigated the effects of low-residue diet and prepackaged low-residue diet in combination with low-volume polyethylene glycol-electrolyte lavage solution during colonoscopy preparation.


OBJECTIVE
We compared self-prepared low-residue diets with prepackaged low-residue diets in combination with low-volume polyethylene glycol.


METHODS
This was a single-blinded, 3-arm, multicenter, randomized controlled trial.


METHODS
Colonoscopies were conducted in outpatient settings at 3 centers in Taiwan.


METHODS
The study included 180 patients (age range, 20-75 years) who were scheduled for colonoscopy.


METHODS
Three groups were compared: group A included self-prepared, 1-day, low-residue diets with a same-day 2.0-L single-dose of polyethylene glycol; group B included prepackaged low-residue diets plus 2.0 L of polyethylene glycol; and group C included prepackaged low-residue diets plus 1.5 L of polyethylene glycol.


METHODS
The outcome measures were adherence, bowel-cleansing level, and patient satisfaction.


RESULTS
One third of the subjects in group A, but none in the prepackaged low-residue diets groups, violated the dietary restrictions. The proportion of right-segment preparation failure was 15.0%, 1.7%, and 6.7% (p = 0.025). Accordingly, treatment B was superior to A (p = 0.008). Among subjects violating the low-residue diets guideline, the right-segment preparation failure rate was 25%. According to a multivariate analysis, low-residue diet compliance (adjusted OR = 6.55 (95% CI, 1.83-23.43)) and BMI were predictors of right-sided preparation adequacy, but the volume of polyethylene glycol ingested was not a predictor. Compared with group A, a greater proportion of subjects in groups B and C reported satisfaction.


CONCLUSIONS
Patients with high BMI and severe constipation were excluded from this study. This study included only an Asian population.


CONCLUSIONS
The prepackaged low-residue diet provides excellent adherence, better bowel cleansing, and a better experience than a self-prepared low-residue diet. With good dietary compliance, 1.5 L of polyethylene glycol provides effective preparation.
1 Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 3 Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan 4 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan 5 Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 6 Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan 7 Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
Chu-Kuang
CK
Chou
Chi-Yang
CY
Chang
Chun-Chao
CC
Chang
Li-Chun
LC
Chang
Wen-Feng
WF
Hsu
Chi-Yi
CY
Chen
Hsiu-Po
HP
Wang
Han-Mo
HM
Chiu
D000328:Adult; D015992:Body Mass Index; D002400:Cathartics / Q000008:administration & dosage / Q000009:adverse effects; D003108:Colonic Diseases / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D004035:Diet Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D057240:Patient Preference; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects; D011300:Preoperative Care / Q000379:methods*; D013501:Surface-Active Agents / Q000008:administration & dosage / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000379:methods*
D002400:Cathartics; D013501:Surface-Active Agents; D011092:Polyethylene Glycols