Stolpman David R, Solem Craig A, Eastlick Dianna, Adlis Susan, Shaw Michael J
*Department of Gastroenterology, Park Nicollet Clinic †Park Nicollet Institute, St Louis Park ‡Department of Internal Medicine, Division of Gastroenterology, University of Minnesota Medical School, Minneapolis, MN.
J Clin Gastroenterol. 2014 Nov-Dec;48(10):851-5. doi: 10.1097/MCG.0000000000000167.
To achieve an excellent bowel preparation, it is routine to require a clear liquid diet on the day before the procedure. Unfortunately, this dietary modification may be poorly tolerated. We examine whether a change in precolonoscopy dietary restriction can lead to better patient tolerance without compromising examination quality.
This is a prospective, blinded, randomized controlled trial of patients undergoing screening or surveillance colonoscopy. The primary objective measures the effect of dietary modification on bowel prep quality. Secondary endpoints include polyp detection, patient tolerance, withdrawal time, and patient acceptance. A total of 200 patients were randomized to either (a) a low-residue diet for breakfast and lunch the day before the procedure or (b) clear liquids all day before the procedure. All patients underwent an identical low-volume sodium sulfate split prep. Bowel prep quality was scored using the Boston Bowel Preparation Scale (BBPS). A t test with TOST was used for noninferiority. Secondary endpoints were compared using χ analysis.
Overall, 96.5% of patients had a good or excellent bowel prep (BBPS=6, 7, 8, or 9). LRD prep quality was noninferior to CLD prep quality (LRD 7.8 vs. CLD 8.1). Polyp detection rates were similar (68% vs. 65.4%, P=0.6899). Patient tolerance and acceptance did not differ. Withdrawal times were equivalent between both groups (16.2 vs. 16.5 min, P=NS).
Patients allowed to have a limited low-residue diet before colonoscopy achieve a bowel prep quality that is noninferior to patients on a strict clear liquid diet limitation. Furthermore, polyp detection rates, patient tolerance, and patient acceptance were similar between the 2 groups.
为了实现良好的肠道准备，通常在检查前一天要求患者食用清流食。不幸的是，这种饮食调整可能耐受性较差。我们研究结肠镜检查前饮食限制的改变是否能在不影响检查质量的情况下提高患者耐受性。
这是一项对接受筛查或监测结肠镜检查患者的前瞻性、盲法、随机对照试验。主要目标是衡量饮食调整对肠道准备质量的影响。次要终点包括息肉检出率、患者耐受性、退镜时间和患者接受度。总共200名患者被随机分为两组：（a）检查前一天早餐和午餐食用低渣饮食；（b）检查前一天全天食用清流食。所有患者均接受相同的小剂量硫酸钠分次肠道准备。使用波士顿肠道准备量表（BBPS）对肠道准备质量进行评分。采用带有TOST的t检验进行非劣效性分析。使用χ分析比较次要终点。
总体而言，96.5%的患者肠道准备良好或优秀（BBPS = 6、7、8或9）。低渣饮食组的肠道准备质量不劣于清流食组（低渣饮食组7.8分 vs. 清流食组8.1分）。息肉检出率相似（68% vs. 65.4%，P = 0.6899）。患者耐受性和接受度无差异。两组的退镜时间相当（16.2分钟 vs. 16.5分钟，P = 无统计学意义）。
结肠镜检查前允许食用有限低渣饮食的患者，其肠道准备质量不劣于严格限制清流食的患者。此外，两组之间的息肉检出率、患者耐受性和患者接受度相似。
