Randomized Clinical Trial : A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy
Álvarez-González, Marco Antonio (Hospital del Mar (Barcelona, Catalunya))
Pantaleón Sánchez, Miguel Ángel (Hospital del Mar (Barcelona, Catalunya))
Flores-Le Roux, Juana Antonia (Universitat Autònoma de Barcelona. Departament de Medicina)
Zaffalon, Diana (Hospital del Mar (Barcelona, Catalunya))
Amorós Martínez, Jaume (Universitat Oberta de Catalunya)
Bessa Caserras, Xavier (Hospital del Mar (Barcelona, Catalunya))
Seoane, Agustin (Hospital del Mar (Barcelona, Catalunya))
Pedro-Botet, Juan (Universitat Autònoma de Barcelona. Departament de Medicina)

Date:	2019
Abstract:	Clinical guidelines recommend either a clear-liquid diet or a low-fiber diet for colonoscopy preparation. Participants in a screening program are usually motivated healthy individuals in which a good tolerability is important to improve adherence to potential surveillance colonoscopies. Our aim was to assess whether or not a normocaloric low-fiber diet followed the day before a screening colonoscopy compromises the efficacy of bowel cleansing and may improve the tolerability of bowel preparation. This is a randomized, endoscopist-blinded, noninferiority clinical trial. The study was conducted at a tertiary care center. A total of 276 consecutive participants of the Barcelona colorectal cancer screening program were included. Participants were randomly assigned to a clear-liquid diet or a normocaloric low-fiber diet the day before the colonoscopy. Both groups received 4 L of polyethylene glycol in a split-dose regimen. Primary outcome was the adequate bowel preparation rate measured with the Boston bowel preparation scale. Secondary outcomes included tolerability, fluid-intake perception, hunger, side effects, and acceptability. Participants in both groups were similar in baseline characteristics. Adequate bowel preparation was achieved in 89. 1% vs 95. 7% in clear-liquid diet and low-fiber diet groups, showing not only noninferiority, but also superiority (p = 0. 04). Low-fiber diet participants reported less fluid-intake perception (p = 0. 04) and less hunger (p = 0. 006), with no differences in bloating or nausea. The single-center design of the study could limit the external validity of the results. The present findings may not be comparable to other clinical settings. A normocaloric low-fiber diet the day before a screening colonoscopy achieved better results than a clear-liquid diet in terms of adequate colon preparation. Moreover, it also improved the perception of hunger and excessive fluid intake.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Bowel preparation ; Colonoscopy ; Colorectal cancer screening
Published in:	Diseases of the Colon and Rectum, Vol. 62 (march 2019) , p. 491-497, ISSN 1530-0358

DOI: 10.1097/DCR.0000000000001305
PMID: 30844973

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