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Low-residue diet improves bowel prep, patient tolerance
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SAN ANTONIO — Patients who adhered to a single-day, low-residue diet prior to colonoscopy had a better bowel preparation and reported better tolerance compared with a clear liquid diet, according to study results presented at the American College of Gastroenterology Annual Meeting.
Jason Samarasena, MD, FACG, of the University of California, Irvine, Medical Center said that patients often say that diet restrictions and the bowel prep process can deter them from undergoing colonoscopy.
“Despite data supporting the use of low-residue diet over a clear liquid diet regimen, adoption in the U.S. has been slow,” Samarasena said in this presentation. “Our aim was to compare single-day, low-residue diet to clear liquid diet before bowel preparation with regard to bowel cleansing quality, toleration and satisfaction among a diverse U.S. patient population.”
In a dual center, randomized, single-blinded study, researchers randomly assigned patients who underwent colonoscopy to consume either a low-residue (n = 90) or clear liquid (n = 80) diet in the day prior to their procedure. For the low-residue diet, investigators provided patients with a list of food options for each meal of the day that included a protein, a carbohydrate and a fat. Both groups of patients consumed a 4-liter, split dose bowel prep prior to their colonoscopy.
Patients in the low-residue and clear liquid diet groups has similar mean BBPS (7.98 vs. 7.54). However, there was a higher number of adequate preparations in the low-residue group, defined as a BBPS great than 6 with no individual segment less than 2 (91.3% vs. 75.7%; P = .05).
Compared with clear liquid diet, patients in the low-residue diet group had lower evening hunger scores on a 10-point scale (7.03 vs. 5.5; P = .006), and had less nausea and bloating.
Additionally, patients in the low-residue group reported higher satisfaction (100% vs. 33%; P < .001) and a better overall colonoscopy experience compared with patients who consumed a clear-liquid diet.
Samarasena said their findings show that patients who use a low-residue diet before colonoscopy achieve bowel preparation that may be superior to patients on a clear liquid diet.
“These results are in line with the most recent guidelines on bowel preparation which endorse the use of low-residue diet prior to colonoscopy,” he said. “As a less restrictive dietary regimen, low-residue diet may help negate patient concerns about the bowel preparation experience and potentially improve participation in colorectal cancer prevention programs.” – by Alex Young
Reference:
Samarasena J, et al. Abstract 68. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosures: Samarasena reports no relevant financial disclosures.
Perspective
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Hassan Siddiki, MD
The clinical question here was how might we improve the quality of bowel cleanse for a colonoscopy, and that question is important for multiple reasons. First, patients with an adequate bowel cleanse is one of the quality indicators from both the ASGE and ACG. So, to have a high-quality unit doing colonoscopies for screening of CRC, it’s important that patients have good bowel preparation scores. Also, the quality of bowel prep is one of the determining factors for adenoma detection rates. If the bowel cleanse is not adequate, the risk for missing polyps and cancers is significant.
In this instance, the authors wanted to see if patients had better adherence to bowel prep by allowing them to consume a low-residue diet instead of only clear liquids.
However, more evidence is needed before advocating large-scale applicability of these results on changing clinical practice. We continue to recommend clear-liquid diets the day before, and an important reason for that would be the confusion on part of the patients and understanding of what a low-residue diet actually means. In a study, it may be feasible to give patients a clear understanding of what a low-residue diet is, but my concern for applying these results to large volume centers is that patients may not get clear instructions on what actually is a low-residue diet. So, the concern here would be if under the impression of low residue diet, patients consume food items that will adversely affect the amount of solid or semi-solid stool in their bowel preparation.
I think we have to be a little careful in equating an improved bowel preparation score with diagnosing polyps or cancers. So, what the authors are implying is that if you have a bowel preparation score that is adequate, which according to them is a bowel preparation score of 6 or more, then the authors can prove that this is not inferior to a clear-liquid diet. What they have not shown is if patients given a low-residue diet had more or less polyps or cancers. Primary outcome is adenoma and cancer detection and not bowel preparation score. The bottom line here is can you see polyps or not. Maybe it doesn’t matter if the bowel preparation score is 6 or 7, if you are not diagnosing more polyps.
Eventually, I would be interested in seeing if the ADR was different between the two groups.
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