Low-residue Diet Group Research Articles

Dietary restriction after cold snare polypectomy of colorectal polyp for prevention of delayed bleeding.

Cold snare polypectomy (CSP) for small colorectal polyps is a safe technique; however, there is little evidence on whether dietary restriction after CSP is essential. This study aimed to determine whether dietary restriction after CSP is necessary to prevent delayed bleeding. This is a randomized, controlled, non-inferiority trial conducted between November 2021 and March 2022. Patients with non-pedunculated small colorectal polyps (<10 mm) and who did not take anticoagulants were randomly allocated to two groups: (i) the normal diet (ND) group, and (ii) the low-residue diet (LRD) group. The ND group was instructed to eat anything after CSP, whereas the LRD group was advised to take LRD for 3 days after CSP. The primary endpoint was the occurrence of delayed major bleeding that needed endoscopic hemostasis. A total of 193 patients (average 57.5 years old, 51.9% male) were enrolled in the study. Subsequently, 97 and 96 patients were allocated to the ND and LRD group, respectively. The occurrence of delayed major bleeding was 1.0% in the ND group and 2.1% in the LRD group (95% confidence interval [CI]: -4.4% to 2.4%; difference: -1.1%), which showed the non-inferiority of the ND group. In addition, there was no difference between the two groups with respect to the occurrence of minor delayed bleeding (3.1% and 4.2%, respectively; difference: -1.1% [95% CI: -6.4% to 4.2%]). Dietary restriction after CSP for low-bleeding-risk colorectal polyps is not necessary for the prevention of delayed bleeding (Registration number: UMIN000045669).

Revisiting bowel preparation: The quest for the optimal low‐residue diet duration

Revisiting bowel preparation: The quest for the optimal <scp>low‐residue</scp> diet duration

Prepackaged formula low-residue diet vs. self-prepared low-residue diet before colonoscopy: A multicenter randomized controlled trial.

Compared with self-prepared LRD, a prepackaged low-residue diet (LRD) can improve patient compliance, but whether it can further improve the quality of bowel preparation is uncertain. The study aimed to compare the application of the prepackaged formula LRD with self-prepared LRD in bowel preparation for colonoscopy. A multicenter randomized controlled trial was conducted in 15 centers. The eligible subjects were randomly assigned to one of two groups: the formula LRD group and the self-prepared LRD group. On the day before the colonoscopy, subjects in the self-prepared LRD group were instructed to consume a restricted LRD prepared by themselves, while subjects in the formula LRD group were given six bags of prepackaged formula LRD and instructed to consume them according to their individual need. The primary outcome was an adequate bowel preparation rate. Secondary outcomes mainly included Boston Bowel Preparation Scale (BBPS) scores, dietary restriction compliance rate, tolerance, satisfaction, adenoma detection rate (ADR), and adverse reactions. The trial was registered at ClinicalTrials.gov under the identifier NCT03943758. A total of 550 subjects were recruited. Compared with the self-prepared LRD group, the formula LRD group showed a higher adequate bowel preparation rate (94.5 vs. 80.4%; P < 0.01), BBPS scores (7.87 ± 1.13 vs. 6.75 ± 1.47; P < 0.01), dietary compliance rate (92.4 vs. 78.9%; P < 0.01), tolerance (P < 0.01 in degree of hunger, intensity of physical strength, and negative influence on daily activities), satisfaction (8.56 ± 1.61 vs. 7.20 ± 2.02; P < 0.01), and ADR (25.6 vs. 16.0%; P < 0.01). There was no significant difference in adverse reactions. Compared with self-prepared LRD, the formula LRD showed similar safety and higher bowel preparation quality, compliance, and tolerance in bowel preparation. More formula LRDs could be designed according to different dietary habits and ethnic populations, and further researches are warranted to confirm their effect. https://register.clinicaltrials.gov, identifier: NCT03943758.

A single‐center retrospective study comparing 1‐day and 3‐day low‐residue diets for bowel preparation

AbstractA low‐residue diet (LRD) is recommended as part of bowel preparation before a colonoscopy. However, the optimal duration of the LRD is unclear. A retrospective cross‐sectional study was therefore conducted at E‐Da Dachang Hospital. We compared bowel preparations using the Aronchick score and other quality metrics during two consecutive periods: May 2019 to December 2019 (3‐day LRD) and January 2020 to August 2020 (1‐day LRD). A total of 2823 patients were enrolled (1592 in the 3‐day LRD group and 1231 in the 1‐day LRD group). The most common bowel cleansing agent was sodium picosulfate and magnesium citrate (SPMC, 84.2%), followed by polyethylene glycol (PEG, 10.0%) and sodium phosphate (5.8%). Compared with patients in the 3‐day LRD group, patients in the 1‐day LRD group had higher SPMC use (88.1% vs 81.3%, P &lt; .001) and supplemental laxative use (25.9% vs 19.3%, P &lt; .001). The proportion of adequate bowel preparation (84.2% vs 85.1%, P = .563), cecal intubation rate, adenoma detection rate, and right‐side adenoma detection rate were not significantly different between 1‐day LRD and 3‐day LRD groups. More advanced adenomas (5.9% vs 3.4%, P = .002) and sessile serrated lesions (8.9% vs 6.3%, P = .014) were observed in the 1‐day LRD group. In addition, the types of laxatives (SPMC, sodium phosphate, and PEG) and the use of supplemental laxatives did not affect bowel preparation scores. In conclusion, a 1‐day LRD led to bowel preparation similar to that achieved through a 3‐day LRD regardless of the type of primary cleansing agent or the use of supplemental laxatives.

A Systematic Review and Meta-Analysis of Low-Residue Diet Versus Clear Liquid Diet: Which Is Better for Bowel Preparation Before Colonoscopy?

The goal of this systematic review was to compare the clear liquid diet and the low-residue diet to determine which is better for bowel preparation before colonoscopy. A literature search for randomized controlled trials on the effects of employing the clear liquid diet and low-residue diets before colonoscopy was conducted in major online English databases (PubMed, Web of Science, and Ovid EMBASE). After the systematic review of all 16 studies, the outcomes including quality of bowel preparation, tolerance, willingness to repeat, and adverse effects were analyzed through meta-analysis. The statistical analysis was performed by using RevMan 5.3 software. No statistically significant difference was observed between the low-residue diet and clear liquid diet groups (odds ratio [95% confidence interval] = 1.19 [0.79, 1.81]; p = .41). There was no statistically significant difference between the Boston Bowel Preparation Scale (standard mean difference [95% confidence interval] =-0.04 [-0.21, -0.14]; p = .68) Ottawa Bowel Preparation Scale (standard mean difference [95% confidence interval] =-0.04 [-0.19, 0.11]; p = .59) scores of the two groups. The quality indicators for colonoscopy of the two groups were not statistically significant. However, patient tolerance to the low-residue diet was higher (odds ratio [95% confidence interval] = 1.86 [1.47, 2.36]; p < .01). More patients in the low-residue diet group were willing to repeat the low-residue diet for bowel preparation (odds ratio [95% confidence interval] = 2.34 [1.72, 3.17]; p < .01). More patients in the clear liquid diet group experienced hunger, nausea, and vomiting. People who employed the low-residue diet before colonoscopy had the same quality of bowel preparation as those with clear liquid diet. Meanwhile, the tolerance of people with low-residue diet was better than people with clear liquid diet, and these people were more willing to repeat the colonoscopy with less adverse events.

Single-Day Low-Residue Diet Prior to Colonoscopy Demonstrates Improved Bowel Preparation Quality and Patient Tolerance over Clear Liquid Diet: A Randomized, Single-Blinded, Dual-Center Trial

Patients often refer to bowel preparation and associated dietary restrictions as the greatest deterrents to having a colonoscopy completed or performed. Large studies comparing a low-residue diet (LRD) and a clear liquid diet (CLD) are still limited. The aim of this study is to compare LRD and CLD with regard to bowel preparation quality, tolerance, and satisfaction among a diverse patient population. This study is a dual-center, randomized, single-blinded, prospective trial involving adult patients undergoing outpatient colonoscopy at the University of California Irvine Medical Center and an affiliated Veterans Administration hospital. Patients were randomized to consume either a CLD or a planned LRD for the full day prior to colonoscopy. Both groups consumed 4L split-dosed PEG-ELS. The adequacy of bowel preparation was evaluated using the Boston Bowel Preparation Score (BBPS). Adequate preparation was defined as a BBPS ≥ 6 with no individual segment less than a score of 2. Hunger and fatigue pre - and post-procedure were graded on a ten-point scale. Nausea, vomiting, bloating, abdominal cramping, overall discomfort, satisfaction with the diet, willingness to repeat the same preparation and overall experience were assessed. A total of 195 subjects who underwent colonoscopy from October 2014 to October 2017 were included. The mean BBPS for the LRD and CLD groups was 8.38 and 7.93, respectively (p = 0.1). There was a significantly higher number of adequate preparations in the LRD group compared to CLD (p = 0.05). Evening hunger scores just before starting the bowel preparation were significantly lower in the LRD than the CLD group, 2.81 versus 5.97, respectively (p = 0.006). Subjects in the LRD group showed significantly less nausea (p = 0.047) and bloating (p = 0.04). Symptom scores for vomiting, abdominal cramping, and overall discomfort were similar between the groups. Satisfaction with diet was significantly higher in the LRD group than CLD, 72% versus 37.66%, respectively (p < 0.001). The overall colonoscopy experience and the satisfaction with the preparation itself were also better reported in the LRD group (p < 0.001 and p = 0.002, respectively). This study, which included a diverse group of patients, demonstrated that patients using a LRD before colonoscopy achieve a bowel preparation quality that is superior to patients on a CLD restriction. This study shows that a low-residue diet improves patient satisfaction and results in significantly better tolerability of bowel preparation. As a less restrictive dietary regimen, the low-residue diet may help improve patient participation in colorectal cancer screening programs.

Comparable quality of bowel preparation with single-day versus three-day low-residue diet: Randomized controlled trial.

There is controversy about the length of low-residue diet (LRD) for colonoscopy preparation. The aim of the study was to compare one-day vs. three-day LRD associated to standard laxative treatment for achieving an adequate colonoscopy preparation in average risk subjects with positive fecal immunochemical test undergoing screening colonoscopy. A non-inferiority, randomized, controlled, parallel-group clinical trial was performed in the setting of average risk colorectal cancer screening program. Participants were randomized to receive 1-day vs. 3-day LRD in addition to standard polyethilenglicol treatment. Adequacy of preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Primary outcome was achieving a BBPS≥2 in all colon segments. Analysis was performed for a non-inferiority margin of 5%, a 95% statistical power and one-sided 0.05 significance level. A total of 855 patients were randomized. Adequate bowel preparation was similar between groups: 97.9% of patients in the 1-day LRD group vs 96.9% in the 3-day LRD group achieved the primary outcome (P-value for non-inferiority<0.001). The percentage of patients with BBPS scores≥8 was superior in the 1-day LRD group (254 vs 221 in the 3-day LRD group, P=0.032). The 1-day regimen was better tolerated than the 3-day diet. 47.7% (vs 28.7%, P<0.05) of patients rated the 1-day LRD as very easy to follow. The 1-day LRD is non-inferior to 3-day LRD for achieving an adequate colon cleansing before average risk screening colonoscopy and it is better tolerated.

Increasing the low residue diet to 3 days does not improve the bowel cleansing in hard to prepare patients: Post hoc analysis of a randomized controlled trial

BackgroundRecent evidence suggests that the number of low residue diet (LRD) days does not influence the bowel cleansing quality in non-selected patients. However, there are not data in the subgroup of patients with risk factors of inadequate bowel cleansing. ObjectiveThe aim of this study was to assess whether a 3-day LRD improved the bowel cleansing quality in patients with risk factors of poor bowel cleansing. Patients and methodsPost hoc analysis of a randomized controlled trial carried out between December 2017 and March 2018 in a tertiary care hospital. Patients with high risk of poor bowel cleansing were selected following a validated score. The patients were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the main outcome. Results135 patients (1-day LRD group=67, 3-day LRD=68) were included. The rate of adequate cleansing quality was not significantly different between the groups in the ITT analysis: 76.1%, 95% CI: [64.6–84.8] vs. 79.4%, 95% CI: [68.2–87.4]; odds ratio (OR) 1.2, 95% CI [0.54–2.73]) or in the PP analysis: 77.3%, 95% CI: [65.7–85.8] vs. 80.3%, 95% CI: [69.0–88.3]; OR 1.2, 95% CI [0.52–2.77]). Compliance with the diet or cleansing solution, satisfaction or difficulties with the LRD and the polyp/adenoma detection rates were not significantly different. ConclusionOur results suggest that 1-day LRD is not inferior to 3-day LRD in patients with risk factors of inadequate bowel cleansing.

Comparison of the effect of 1-day and 2-day low residue diets on the quality of bowel preparation before colonoscopy.

Background/Aim:Low residue diet (LRD) has a similar quality of bowel preparation with clear liquid diet before colonoscopy, but improved patient tolerance. However, the optimal LRD duration is still controversial. In this study, we have compared the effect of a 1-day LRD and 2-day LRD on the quality of bowel preparation and patient tolerance.Patients and Methods:Our prospective, randomized, single-blind trial, single-blind, trial compared two dietary regimens administered the day before colonoscopy. All patients were administered PEG-ES and simethicone for bowel preparation. The primary outcome measure was bowel preparation quality. The secondary outcome measures were insertion time, withdrawal time, polyp detection rate, patient tolerance, and willingness to use the same diet for bowel preparation again. Bowel preparation quality was evaluated using the Boston bowel preparation scale (BBPS). Patient tolerance was evaluated using a hunger-comfort scale.Results:There was no significant difference in bowel preparation quality between the 2 groups. The 1-day LRD group had a BBPS score of 6.48 ± 1.59 points, while the 2-day LRD group had a score of 6.42 ± 1.06 points (P > 0.05). The groups reported similar colonoscope insertion times, withdrawal times, polyp detection rates and patient tolerance scores (hunger-comfort scores). The numbers of patients who reported that compliance as easy or very easy were 126 (78.2%) in the 1-day group versus 88 (55.0%) in the 2 day group (P < 0.05) and the numbers who were willing to use the diet again in the future were 154 (95.7%) in the 1-day group versus 131 (81.9%) in the 2 day group (P < 0.05).Conclusion:LRD duration (1 day or 2 days) had no significant effect on bowel preparation quality. Patients in the 1-day LRD group had higher tolerance and satisfaction levels than patients in the 2-day LRD group. However, overall satisfaction was higher with the 1-day LRD group than with the 2-day LRD group.

123 Single Day Low Residue Diet Prior to Colonoscopy Shows Improved Bowel Preparation Quality and Patient Tolerance Over Clear Liquid Diet: Final Results From a Randomized, Single-Blinded, Dual Center Study

INTRODUCTION: Patients often cite bowel preparation and associated dietary restrictions as the greatest deterrents to having a colonoscopy completed or performed. Large studies comparing low residue diet (LRD) and clear liquid diet (CLD) are still limited. The aim of this study was to compare LRD and CLD with regards to bowel preparation quality, tolerance, and satisfaction among a diverse patient population. METHODS: This study is a dual center, randomized, single blinded, prospective trial involving adult patients undergoing outpatient colonoscopy at the University of California Irvine Medical Center and a Veterans Administration hospital. Patients were randomized to consume either a CLD or a planned LRD for the full day prior to colonoscopy. Both groups consumed 4L split-dosed PEG-ELS. The adequacy of bowel preparation was evaluated using the Boston Bowel Preparation Score (BBPS). Adequate preparation was defined as a BBPS ≥7. Hunger and fatigue pre and post procedure were graded on a 10-point scale. Nausea, vomiting, bloating, abdominal cramping, overall discomfort, satisfaction with the diet, willingness to repeat the same preparation and overall experience were assessed. RESULTS: A total of 170 subjects who underwent colonoscopy from October 2014 to October 2017 were included. The mean BPPS for the LRD and CLD groups was 7.98 and 7.54, respectively. There was a significantly higher number of adequate preparations in the LRD group compared to CLD (P = 0.05). Evening hunger scores just before starting the bowel preparation were significantly lower in the LRD than CLD group, 5.5 vs 7.03, respectively (P = 0.006). Subjects in the LRD group showed significantly less nausea (P = 0.047) and bloating (P = 0.04). Symptom scores for vomiting, abdominal cramping, and overall discomfort were similar between the groups. Satisfaction with diet was significantly higher in the LRD group than CLD, 100% vs 33% respectively (P &lt; 0.001). The overall colonoscopy experience and the satisfaction with the preparation itself were also better reported in the LRD group (P = 0.002). CONCLUSION: This study demonstrated that the use of a LRD before colonoscopy achieves a superior bowel preparation quality compared to CLD. Low-residue diet also improves patient satisfaction and results in significantly better tolerability of bowel preparation. As a less restrictive dietary regimen, low-residue diet may help improve patient participation in colorectal cancer screening programs.

Impact of a 1-day versus 3-day low-residue diet on bowel cleansing quality before colonoscopy: a randomized controlled trial.

The aim of this study was to assess whether a 3-day low-residue diet (LRD) improved bowel cleansing quality compared with a 1-day LRD regimen. Consecutive patients scheduled for outpatient colonoscopy were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. The primary outcome was bowel cleansing quality as evaluated using the Boston Bowel Preparation Scale (BBPS) (adequate cleansing ≥ 2 points per segment). Secondary outcomes were adherence to and level of satisfaction with the LRD, difficulty following the dietary recommendations, and willingness to repeat the same LRD in the future. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. A superiority analysis was performed to demonstrate that a 3-day LRD regimen was superior to a 1-day LRD regimen with a margin of 10 %. 390 patients (1-day LRD group = 196, 3-day LRD = 194) were included. The cleansing quality was not significantly different between the groups: ITT analysis 82.7 % (95 % confidence interval [CI] 77.4 to 88.0) vs. 85.6 % (95 %CI 80.7 to 90.5), with odds ratio (OR) 1.2 (95 %CI 0.72 to 2.15); PP analysis 85.0 % (95 %CI 79.9 to 90.1) vs. 88.6 % (95 %CI 84.0 to 93.2), with OR 1.4 (95 %CI 0.88 to 2.52). No differences were found regarding adherence to the diet or cleansing solution, satisfaction or difficulty with the LRD, and the polyp/adenoma detection rates. 3-day LRD did not offer advantages over 1-day LRD in preparation for colonoscopy.

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

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.

The Impact of Diet Liberalization on Bowel Preparation for Colonoscopy

Purpose: Dietary restrictions pose a barrier to compliance with colonoscopy. We evaluated the effect of diet liberalization on the adequacy of bowel preparation. Methods: Single-center, prospective, randomized, investigator-blinded study comparing clear liquid diet (CLD) to low-residue diet (LRD) in patients undergoing outpatient colonoscopy. A LRD instruction sheet was provided to and reviewed with patients randomized to LRD. LRD was permitted up to 1 PM day prior to colonoscopy followed by clears up to 2.5 hours before colonoscopy. The CLD group was permitted clears day prior and up to 2.5 hours before colonoscopy. All patients took split dose (PM/AM) 2 L polyethylene glycol-electrolyte solution purgative (MoviPrep®). Preparation was scored using the Boston Bowel Preparation Scale (BBPS). Primary endpoint was the dichotomous index of preparation quality (adequate [BBPS > 5] vs. inadequate [BBPS ≤ 5]) for the whole colon. A one-sided Wald test for non-inferiority with a pre-specified margin of -13.5% was used. Secondary endpoints were: BBPS scores for whole colon and individual segments, purgative completion, polyp and adenoma detection, adverse events, satisfaction, and quality-of-life measures. This study was approved by Jefferson's IRB and registered at ClinicalTrials.gov. Results: One hundred eighty-eight patients were randomized, 48 withdrew prior to colonoscopy, and 140 were analyzed (72 CLD, 68 LRD). The groups were well-matched except the CLD group had more men (47.2% vs. 38.2%) and fewer with a colonoscopy indication of “symptoms” (13.9% vs. 23.9%). Preparation was adequate in 68 (94.4%) of the CLD group vs. 60 (88.2%) of the LRD group (risk difference -6.2; non-inferiority p=0.06, two-sided 95% CI -15.5%, 3.1%). Overall preparation completion was similar, but 79.1% of LRD group vs. 91% of CLD group completed >90% of the AM dose (p=0.09). There were no significant differences between the groups in BBPS scores for the whole (p=0.22), right (p=0.33), transverse (p=0.93), and left (p=0.08) colon. Polyp and adenoma detection (percent of patients with >1) was not significantly different between the study groups. However, the CLD group had a significantly greater number of polyps (IRR 1.43; 95% CI 1.04-1.96; p=0.03) and adenomas (median adenomas/patient, CLD vs. LRD: 1.0 vs. 0.53; IRR 1.84; 95% CI 1.16-2.91; p=0.01). Satisfaction was significantly greater with LRD vs. CLD (1.99 vs. 3.04; p=0.01). There were no significant differences in adverse events or productivity between the study groups. Conclusion: Using the endpoint of adequate bowel cleansing, a low-residue diet was not non-inferior to clear liquids. Total adenoma detection was superior with clear liquids, and satisfaction greater with a lowresidue diet. General adoption of a low-residue diet may result in more preparation failures. Disclosure - Dr. James Walter - None; Dr. Apurva Patel - None; Dr. Becky Matro - None; Dr. Leo Katz - None; Dr. Ramalinga Kedika - None; Rachael Grosso - None; Alexis Sharpe - None; Dr. Louis Broad - None; Dr. Daniel Quirk - None; Dr. Scott Keith - None; Dr. Constatine Daskalakis - None; Dr. Marianne Ritchie - None; Dr. Linda Greenbaum - None; Dr. Patricia Kozuch - None; Jocelyn Andrel Sendecki - None; Dr. David Kastenberg - Consultant: Salix Pharmaceuticals, Inc.

1024 Randomized Controlled Trial Comparing a Low Residue Diet vs. Clear Liquids in Patients Receiving a Reduced-Volume Oral Sulfate Solution for Colonoscopy Preparation

Background: For many patients, the bowel preparation prior to colonoscopy is the most difficult part of the procedure. Physical symptoms are significant, and many patients struggle to complete the preparation. Nonetheless, the importance of an optimal bowel clean-out cannot be overstated. Colon polyps, particularly if flat or right-sided, may be difficult to detect even under good conditions; they can be especially challenging to see if the prep quality is poor. To achieve an excellent bowel prep, many practices, including ours, require patients to follow a strict clear liquid diet on the day prior to the procedure. Unfortunately, this dietary modification is perhaps the most daunting part of the entire process. This study examines whether we can identify a bowel preparatory process that continues to provide excellent results and leads to better patient tolerance and acceptance. Aims and Methods: The study is a prospective, blinded, randomized controlled trial of patients undergoing screening or surveillance colonoscopy at our community-based GI practice. The primary objective of this study is to measure the effect of dietary modification on bowel prep quality. Secondary endpoints include polyp detection rates, patient tolerance, and patient acceptance. 200 patients were randomized to either a) low residue diet for breakfast and lunch the day before the procedure, or b) clear liquids all day prior to the procedure. All patients underwent an identical low volume sodium sulfate split prep ( Suprep ®, Braintree Labs.) Bowel prep quality was scored by blinded endoscopists using the Boston Bowel Prep Score (BBPS). A t-test with TOST analysis was used for equivalence. Comparison of secondary endpoints was done using Chi-square analysis. Results: Overall, 86.5 % of patients had a good or excellent bowel prep (BBPS = 7,8, or 9). The BBPS for patients who had a low residue breakfast and lunch on the day prior to the procedure was equivalent to the BBPS for patients on a clear liquid diet (mean BBPS 8.0 vs 8.2). Table 1. Polyp detection rates were similar between both groups (68% vs. 65.4%, p=0.6899). Patient tolerance and patient acceptance did not differ between the two groups, although more patients in the low residue diet group indicated a willingness to use the same preparation again (73.9% vs. 63.7%, p= 0.1013). Table 2. Conclusion: Patients allowed to have a low residue breakfast and lunch on the day prior to colonoscopy achieve an equivalent bowel preparation quality as patients on a strict clear liquid diet limitation. Furthermore, polyp detection rates (including adenomas, flat polyps, and right-sided lesions) were similar between the two groups. Interestingly, tolerance of the two diets was also similar, but there was a non-significant trend towards higher acceptance in the low residue diet group. Table 1. Bowel Preparation Testing for Equivalence