BLOG: Pasta Salad, a Vanilla Smoothie, a Piña Colada—and a colonoscopy

In today’s researcher blog from DDW, L. Campbell Levy, MD, offers insight into his novel approach to bowel prep for colonoscopy involving a nutritionally balanced diet as an alternative to fasting.

Colonoscopy is a potentially life-saving procedure. Unfortunately as many as 25 million people — or roughly 40% of those who should be screened — simply don’t do it. One of the leading reasons they avoid them is that they hate the menu: they just can’t stand the fasting, combined with drinking a large volume of viscous liquid.

L. Campbell Levy

So, my colleagues and I at Dartmouth-Hitchcock Medical Center were eager to try out a novel approach: a delicious, edible, nutritionally balanced colon prep comprised of regular foods. Yes, a breakfast-lunch-dinner menu, with even a few snacks. No fasting, no gorging on strange-tasting liquid. Instead, a nutritionally balanced 24-hour diet with a laxative (PEG 3350) mixed in, along with sorbitol and ascorbic acid.

We reported our results at Digestive Disease Week 2015, the world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery, where we recounted how pleasantly surprised we were by the outcome:

We had planned to study up to 30 patients, until we found eight of 10 patients whose bowel-cleansing results were rated as good or excellent by their doctors. But we were able to halt the study after the first 10 patients because they all had successful colon cleansing, nine rated good and one excellent. Eight of the 10 patients had been able to finish 100% of the prep diet, and the other two finished 95%.

Perhaps most importantly, each patient was asked to rate the overall tolerability of the prep process, and every single patient rated it as “no problems.” Each indicated that he/she would be willing to take this preparation again for a subsequent procedure.

Our study enrolled patients ages 46 to 73 who were scheduled for colonoscopies for cancer screening or for surveillance of polyps, and they were given carefully measured portions of a diet that was a mix of light solid foods, such as cereal, pasta salad and pudding, with a plentiful variety of beverages, including juices, chicken consommé, a vanilla smoothie and a piña colada-type drink (without the alcohol) at dinner.

Our success does not imply that patients can just consume any food and drink along with laxatives. Working with food scientists, our amounts and doses were carefully calibrated. A larger phase 2 study of a more sophisticated edible prep with substantially more solid food is underway. To learn more about what’s on the menu, visit www.ddw.org.

L. Campbell Levy, MD, is assistant professor of medicine at the Geisel School of Medicine at Dartmouth and a staff physician in the Section of Gastroenterology and Hepatology at Dartmouth-Hitchcock Medical Center in Lebanon, NH.

For more information:

Levy LC, et al. Abstract Su1525. Presented at: Digestive Disease Week; May 15-19, 2015; Washington, D.C.

Disclosure: Levy reports no relevant financial relationships.