Improved Tolerance and Satisfaction With Low-Residue Diet Compared to Clear Liquid Diet for Colon Cleansing Prior to Colonoscopy: Interim Results From a Multicenter Randomized Trial

Abstract

Introduction: Colon cancer deaths can be prevented by colonoscopy yet CRC screening participation remains low. Bowel preparation and the associated dietary restrictions are cited among the greatest deterrents. Low-residue diet on the day of purgative bowel cleansing, instead of a clear liquid diet, may improve patient satisfaction and tolerability while maintaining adequate cleansing. Methods: This study is a multicenter, randomized, single blinded, prospective trial involving adult patients undergoing outpatient colonoscopy. Patients were randomized to consume a clear liquid diet (CLD) or a planned low residue diet (LRD) for the full day prior to colonoscopy. Both groups consumed 4L split-dosed PEG-ELS. The aims of the study were to evaluate adequacy of bowel preparation and patient tolerance and satisfaction. Patient symptoms were evaluated via questionnaires administered pre and post bowel prep. Hunger and fatigue were graded on a 10-point scale. Nausea, vomiting, bloating, abdominal cramping, and overall discomfort were graded on a 5-point scale. Satisfaction with the diet, willingness to repeat the same preparation (diet and purgative) and overall experience were assessed. Interim analysis of patient tolerance and satisfaction results were carried out. Results: A total of 45 patients who underwent colonoscopy between January to April 2015 were included in this interim analysis. Evening hunger scores just prior to purgative intake were significantly lower in the LRD than CLD group, 4.62 vs 6.47 respectively (p=0.03). Morning hunger scores were also significantly lower in the LRD than CLD group, 3.28 vs 6.42 respectively (p < 0.01).Morning post-prep fatigue scores were significantly lower in the LRD than CLD group, 2.46 vs 5.17 respectively. Mean symptom scores for nausea, vomiting, bloating, abdominal cramping and overall discomfort did not differ significantly between the groups. Satisfaction with diet was reported in significantly more patients in the LRD group than CLD, 100% vs 47% respectively (p < 0.01). Conclusion: Results of this interim analysis demonstrate less hunger and fatigue with higher diet satisfaction in patients using low residue diet as compared to clear liquid diet. This study supports the idea that a low residue diet the full day prior to colonoscopy may improve patient satisfaction and tolerability of bowel preparation as compared to a full day of clear liquid diet.