Department of Gastroenterology and Endoscopy, German Hospital, Buenos Aires, Argentina.
Department of General Surgery, German Hospital, Buenos Aires, Argentina.
Surg Endosc. 2022 Jun;36(6):3858-3875. doi: 10.1007/s00464-021-08703-8. Epub 2021 Sep 1.
Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy.
PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation.
Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99-1.05; I = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12-1.23; I = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84-0.94; I = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability.
Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.
结直肠癌（CRC）在全球范围内导致了大量的癌症死亡。为了降低死亡率，通过结肠镜检查检测息肉至关重要。结肠镜检查的成功取决于检查前一天给予的饮食。我们的目的是评估在计划结肠镜检查前一天使用低残留饮食（LRD）与清澈液体饮食（CLD）时的肠道准备效果、耐受性和不良反应。
检索了 PubMed/Medline、Embase、Cochrane 中央对照试验注册库（CENTRAL）和 Scopus 数据库。我们纳入了接受计划结肠镜检查用于 CRC 筛查和监测或用于诊断目的的患者的研究，这些研究比较了 LRD 与 CLD 在前一天结肠镜检查中的效果。主要结局是评估肠道准备的充分率，即有效性。次要结局是肠道准备的耐受性和不良反应。
纳入了 13 项 RCT（N=2587）。与 CLD 相比，接受 LRD 的患者肠道准备充分率没有差异（RR 1.02；95% CI 0.99-1.05；I=60%）。然而，LRD 改善了患者的耐受性（RR 1.17；95% CI 1.12-1.23；I=66%），不良反应更少（RR 0.89；95% CI 0.84-0.94；I=73%）。与 CLD 相比，使用 4L 聚乙二醇单次剂量或 LRD 每日纤维摄入量<2000 卡路里和<32 克的患者耐受性更好。
基于这些发现，我们强烈推荐 LRD 用于计划结肠镜检查的患者肠道准备。这种饮食也可以作为术前结肠准备，但这需要进一步的研究。
