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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

Chou, Chu-Kuang M.D.; Chang, Chi-Yang Ph.D.; Chang, Chun-Chao M.D.; Chang, Li-Chun M.D.; Hsu, Wen-Feng M.D.; Chen, Chi-Yi M.D.; Wang, Hsiu-Po M.D.; Chiu, Han-Mo M.D., Ph.D.

doi: 10.1097/DCR.0000000000000675
Original Contributions: Endoscopy
Open

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.

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

SETTING: Colonoscopies were conducted in outpatient settings at 3 centers in Taiwan.

PATIENTS: The study included 180 patients (age range, 20–75 years) who were scheduled for colonoscopy.

INTERVENTIONS: 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.

MAIN OUTCOME MEASURES: 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.

LIMITATIONS: 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

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Financial Disclosure: The prepackaged low-residue diet sets (Enimaclin, Ezaki-Glico Co. Ltd.) were sponsored by Jie Wei Biomedical Technology Co., Ltd., Taichung, Taiwan.

Correspondence: Han-Mo Chiu, M.D., Ph.D., Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, Taiwan. E-mail: hanmochiu@ntu.edu.tw

© 2016 The American Society of Colon and Rectal Surgeons