Chen Engeng, Chen Li, Wang Fei, Zhang Wei, Cai Xianlei, Cao Gaoyang
Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.
Department of General Surgery, Ningbo Medical Center of Li Hui Li Hospital.
Medicine (Baltimore). 2020 Dec 4;99(49):e23541. doi: 10.1097/MD.0000000000023541.
Great value in the early identification and treatment of adenomatous polyps or early canceration using colonoscopy has been recognized. A clear colonoscopic vision brought by good intestinal preparation will become crucial. Several studies have completed using the low-residue diet (LRD) versus a clear liquid diet (CLD) the day before colonoscopy that presenting contradictory results. Therefore, a more comprehensive and updated meta-analysis is needed to summarize the findings on the effects of LRD and CLD on intestinal preparation and the quality of coloscopy.The comprehensive search was performed in PubMed/MEDLINE, Scopus, Cochrane databases (February 2020). LRD vs CLD before colonoscopy were included in this study. Mantel-Haenszel or DerSimonian and Laird models with the relative risk (RR) to evaluate differences in intestinal preparation, tolerance, readiness to repeat preparation, detected of a polyp, and overall adverse reactions.Total 16 studies (N = 3413) were eligible. Patients with LRD compared with CLD indicated significantly better of tolerability (RR 0.92;95% CI,0.85-0.99; P < .05) and willingness to repeat intestinal preparation (RR 0.86; 95% CI 0.79-0.93; P < .05), but no differences with adequate intestinal preparations, detected polyp or overall adverse reactions (all P > .05).Patients with LRD the day before colonoscopy show better tolerance and willingness to repeat intestinal preparation, and no difference with adequate intestinal preparations compared with CLD, but the recommended level of evidence is weak. However, in terms of the detection rate of intestinal adenomas, the LRD group is not weaker than the CLD group, for its evidence level is high, and can significantly reduce the hunger experience of patients.
结肠镜检查在腺瘤性息肉的早期识别和治疗或早期癌变方面的巨大价值已得到认可。良好的肠道准备带来的清晰结肠镜视野将变得至关重要。几项关于结肠镜检查前一天采用低残留饮食（LRD）与清流饮食（CLD）的研究得出了相互矛盾的结果。因此，需要进行更全面和更新的荟萃分析，以总结LRD和CLD对肠道准备及结肠镜检查质量影响的研究结果。在PubMed/MEDLINE、Scopus、Cochrane数据库（2020年2月）中进行了全面检索。本研究纳入了结肠镜检查前的LRD与CLD对比。采用Mantel-Haenszel或DerSimonian和Laird模型以及相对危险度（RR）来评估肠道准备、耐受性、重复准备的意愿、息肉检出情况及总体不良反应的差异。共有16项研究（N = 3413）符合条件。与CLD相比，LRD患者的耐受性（RR 0.92；95%CI，0.85 - 0.99；P < 0.05）和重复肠道准备的意愿（RR 0.86；95%CI 0.79 - 0.93；P < 0.05）显著更好，但在充分的肠道准备、息肉检出或总体不良反应方面无差异（所有P > 0.05）。结肠镜检查前一天采用LRD的患者耐受性和重复肠道准备的意愿更好，与CLD相比，在充分的肠道准备方面无差异，但推荐证据水平较弱。然而，就肠道腺瘤的检出率而言，LRD组并不弱于CLD组，因其证据水平较高，且能显著减轻患者的饥饿感。
