Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiology, Anqing Municipal Hospital (Anqing Hospital Affiliated to Anhui Medical University), Anqing, China.
Gastrointest Endosc. 2020 Sep;92(3):508-518.e3. doi: 10.1016/j.gie.2020.04.069. Epub 2020 May 4.
The aim of this study was to compare a low-residual diet (LRD) with a clear-liquid diet (CLD) for bowel preparation before colonoscopy.
A systematic literature search was performed in PubMed, Ovid, and Cochrane databases for randomized clinical trials comparing LRD with CLD for bowel preparation before colonoscopy. The last search was performed on September 20, 2019. The primary outcome was adequate bowel preparation. The outcomes were compared using systematic review with meta-analysis and trial sequential analysis (TSA).
Twenty randomized controlled trials published between 2005 and 2019 with 4323 participants were included. LRD was comparable with CLD for adequate bowel preparation (P = .79; odds ratio [OR], 0.96; 95% confidence interval [CI], 0.72-1.29). The detection rates for polyps (P = .68; OR, 1.04; 95% CI, 0.86-1.27) or adenomas (P = .78; OR, 1.03; 95% CI, 0.86-1.23) were similar between the groups. There were significantly fewer advents in individuals in the LRD group: nausea (P = .02; OR, 0.72; 95% CI, 0.56-0.94), vomiting (P = .04; OR, 0.61; 95% CI, 0.38-0.98), hunger (P < .001; OR, 0.36; 95% CI, 0.24-0.53), and headache (P = .02; OR ,0.64; 95% CI, 0.44-0.93). In addition, significantly more individuals in the LRD group found it easy to complete the diet (P = .01; OR, 1.86; 95% CI, 1.15-3.00) and showed willingness to repeat it (P = .005; OR, 2.23; 95% CI, 1.28-3.89). TSA demonstrated that the cumulative Z curve crossed both the traditional boundary and the trial sequential monitoring boundary for adequate bowel preparation.
The present study demonstrated that LRD was comparable with CLD in the quality of bowel preparation before colonoscopy. More clinical trials are needed to confirm other outcomes.
本研究旨在比较低残留饮食（LRD）与清液饮食（CLD）在结肠镜检查前的肠道准备中的效果。
在 PubMed、Ovid 和 Cochrane 数据库中进行了系统的文献检索，以比较 LRD 与 CLD 用于结肠镜检查前肠道准备的随机临床试验。最后一次检索于 2019 年 9 月 20 日进行。主要结局为肠道准备充分。采用系统评价和荟萃分析以及试验序贯分析（TSA）比较结局。
共纳入 2019 年发表的 20 项随机对照试验，共 4323 名参与者。LRD 在肠道准备充分方面与 CLD 相当（P=0.79；比值比 [OR]，0.96；95%置信区间 [CI]，0.72-1.29）。两组间息肉（P=0.68；OR，1.04；95% CI，0.86-1.27）或腺瘤（P=0.78；OR，1.03；95% CI，0.86-1.23）的检出率相似。LRD 组中不良反应的发生率明显较低：恶心（P=0.02；OR，0.72；95% CI，0.56-0.94）、呕吐（P=0.04；OR，0.61；95% CI，0.38-0.98）、饥饿（P<0.001；OR，0.36；95% CI，0.24-0.53）和头痛（P=0.02；OR，0.64；95% CI，0.44-0.93）。此外，LRD 组中更多的人认为该饮食方案容易完成（P=0.01；OR，1.86；95% CI，1.15-3.00），并表示愿意重复使用（P=0.005；OR，2.23；95% CI，1.28-3.89）。TSA 显示，累积 Z 曲线穿过了传统边界和试验序贯监测边界，提示 LRD 在肠道准备质量方面与 CLD 相当。
本研究表明，LRD 在结肠镜检查前的肠道准备质量方面与 CLD 相当。需要更多的临床试验来证实其他结局。
