Department of Digestive Diseases, Hospital del Mar, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Spain.
Dis Colon Rectum. 2019 Apr;62(4):491-497. doi: 10.1097/DCR.0000000000001305.
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.
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.
This is a randomized, endoscopist-blinded, noninferiority clinical trial.
The study was conducted at a tertiary care center.
A total of 276 consecutive participants of the Barcelona colorectal cancer screening program were included.
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.
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.
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.
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.
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.
临床指南建议结肠镜检查准备时采用清流质饮食或低纤维饮食。筛查计划的参与者通常是动机健康的个体，良好的耐受性对于提高对潜在监测结肠镜检查的依从性很重要。
我们旨在评估在筛查结肠镜检查前一天是否遵循低热量低纤维饮食会影响肠道清洁效果，或者是否可以提高肠道准备的耐受性。
这是一项随机、内镜医生设盲、非劣效性临床试验。
该研究在一家三级保健中心进行。
共纳入 276 名巴塞罗那结直肠癌筛查计划的连续参与者。
参与者被随机分配到清流质饮食组或低热量低纤维饮食组，在结肠镜检查前一天食用。两组均接受 4L 聚乙二醇分剂量方案。
主要结局指标是采用波士顿肠道准备量表测量的充分肠道准备率。次要结局指标包括耐受性、液体摄入感知、饥饿感、副作用和可接受性。
两组参与者在基线特征方面相似。清流质饮食组和低热量低纤维饮食组的充分肠道准备率分别为 89.1%和 95.7%，不仅显示出非劣效性，而且具有优越性（p=0.04）。低热量低纤维饮食组参与者报告的液体摄入感知较少（p=0.04）和饥饿感较低（p=0.006），但腹胀或恶心无差异。
该研究的单中心设计可能会限制结果的外部有效性。目前的发现可能与其他临床环境无法比较。
与清流质饮食相比，在筛查结肠镜检查前一天采用低热量低纤维饮食在充分肠道准备方面取得了更好的效果。此外，它还改善了饥饿感和过度液体摄入的感知。在 clinicaltrials.gov 注册：NCT02401802。在 http://links.lww.com/DCR/A829 查看视频摘要。
