Avalos Danny J, Sussman Daniel A, Lara Luis F, Sarkis Fayez S, Castro Fernando J
From the Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, the Department of Gastroenterology, University of Miami/Jackson Memorial Hospital, Miami, Florida, the Department of Gastroenterology, Cleveland Clinic Florida, Weston, and the University of Miami/JFK GME Consortium, Atlantis, Florida.
South Med J. 2017 Jun;110(6):399-407. doi: 10.14423/SMJ.0000000000000662.
Precolonoscopy dietary regimens often are restricted to clear liquids; however, the superiority of a clear liquid diet (CLD) for bowel preparation quality is ambiguous. We performed a meta-analysis of randomized trials comparing bowel preparation outcomes between a low-residue diet (LRD) or regular diet (RD) compared with a CLD.
MEDLINE, clinicaltrials.gov, Cochrane Central Register, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Web of Science databases were used to conduct a search for randomized controlled trials from 1976 to March 2015. Of 122 relevant references, 12 studies met our inclusion criteria, 7 studies of which were classified as being of high quality. Pooled estimates of bowel preparation quality were defined as adequate versus inadequate. Secondary outcomes included tolerability, willingness to repeat bowel preparation, adverse events, and adenoma detection rate. Pooled estimates of relative risk (RR) were used for dichotomous variables and standardized mean difference for continuous variables.
In the high-quality studies, there were no differences in bowel preparation quality among the LRD/RD and CLD groups (RR 0.98; 95% confidence interval [CI] 0.93-1.04). Analysis of secondary outcomes included all of the studies. Tolerability (RR 1.04, 95% CI 1.01-1.08) and willingness to repeat favored the liberalized diet arm (RR 1.08, 95% CI 1.01-1.16). There was no significant difference in the adenoma detection rate, whereas hunger was more common in the CLD group.
An LRD/RD provided no difference in bowel preparation quality as compared with a CLD. As such, it may be reasonable for patients without risk factors for poor preparation to undergo an LRD until lunch the day before their colonoscopy given that bowel preparation tolerability and willingness to repeat were greater among groups with a liberalized diet.
结肠镜检查前的饮食方案通常限制为清流食；然而，清流食（CLD）在肠道准备质量方面的优越性尚不明确。我们对比较低渣饮食（LRD）或常规饮食（RD）与清流食在肠道准备结果方面的随机试验进行了荟萃分析。
利用MEDLINE、clinicaltrials.gov、Cochrane中央注册库、Scopus、Embase、护理学与健康相关文献累积索引以及科学网数据库，检索1976年至2015年3月期间的随机对照试验。在122篇相关参考文献中，12项研究符合我们的纳入标准，其中7项研究被归类为高质量研究。肠道准备质量的合并估计值定义为充分与不充分。次要结局包括耐受性、愿意再次进行肠道准备的意愿、不良事件以及腺瘤检出率。二分类变量采用相对危险度（RR）的合并估计值，连续变量采用标准化均数差。
在高质量研究中，LRD/RD组和CLD组在肠道准备质量方面无差异（RR 0.98；95%置信区间[CI] 0.93 - 1.04）。次要结局分析纳入了所有研究。耐受性（RR 1.04，95% CI 1.01 - 1.08）和愿意再次进行肠道准备的意愿有利于饮食放宽组（RR 1.08，95% CI 1.01 - 1.16）。腺瘤检出率无显著差异，而饥饿在CLD组更为常见。
与CLD相比，LRD/RD在肠道准备质量方面无差异。因此，对于没有肠道准备不佳风险因素的患者，在结肠镜检查前一天午餐前采用LRD可能是合理的，因为饮食放宽组的肠道准备耐受性和愿意再次进行肠道准备的意愿更高。
