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Randomized Controlled Trial
. 2019 Apr;62(4):491-497.
doi: 10.1097/DCR.0000000000001305.

Randomized Clinical Trial: A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy

Marco A Alvarez-Gonzalez  1   2 , Miguel A Pantaleon  1   2 , Juana A Flores-Le Roux  2   3 , Diana Zaffalon  1 , Jaume Amorós  4 , Xavier Bessa  1   2 , Agustin Seoane  1 , Juan Pedro-Botet  2   3 ; PROCOLON group
Affiliations
Randomized Controlled Trial

Randomized Clinical Trial: A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy

Marco A Alvarez-Gonzalez et al. Dis Colon Rectum. 2019 Apr.

Abstract

Background: Clinical guidelines recommend either a clear-liquid diet or a low-fiber diet for colonoscopy preparation. Participants in a screening program are usually motivated healthy individuals in which a good tolerability is important to improve adherence to potential surveillance colonoscopies.

Objective: Our aim was to assess whether or not a normocaloric low-fiber diet followed the day before a screening colonoscopy compromises the efficacy of bowel cleansing and may improve the tolerability of bowel preparation.

Design: This is a randomized, endoscopist-blinded, noninferiority clinical trial.

Settings: The study was conducted at a tertiary care center.

Patients: A total of 276 consecutive participants of the Barcelona colorectal cancer screening program were included.

Intervention: Participants were randomly assigned to a clear-liquid diet or a normocaloric low-fiber diet the day before the colonoscopy. Both groups received 4 L of polyethylene glycol in a split-dose regimen.

Main outcome measures: Primary outcome was the adequate bowel preparation rate measured with the Boston bowel preparation scale. Secondary outcomes included tolerability, fluid-intake perception, hunger, side effects, and acceptability.

Results: Participants in both groups were similar in baseline characteristics. Adequate bowel preparation was achieved in 89.1% vs 95.7% in clear-liquid diet and low-fiber diet groups, showing not only noninferiority, but also superiority (p = 0.04). Low-fiber diet participants reported less fluid-intake perception (p = 0.04) and less hunger (p = 0.006), with no differences in bloating or nausea.

Limitations: The single-center design of the study could limit the external validity of the results. The present findings may not be comparable to other clinical settings.

Conclusion: A normocaloric low-fiber diet the day before a screening colonoscopy achieved better results than a clear-liquid diet in terms of adequate colon preparation. Moreover, it also improved the perception of hunger and excessive fluid intake. Registered at clinicaltrials.gov: NCT02401802. See Video Abstract at http://links.lww.com/DCR/A829.

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References

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