Background

Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy.

Methods

PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation.

Results

Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99–1.05; I² = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12–1.23; I² = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84–0.94; I² = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability.

Conclusion

Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.

中文翻译：

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低渣饮食对肠道准备的功效和耐受性：系统评价和荟萃分析

背景

结直肠癌 (CRC) 对全世界的癌症死亡率有显着影响。为了降低死亡风险，通过结肠镜检查息肉至关重要。结肠镜检查的成功取决于检查前一天的饮食。我们的目的是评估在预定的结肠镜检查前一天使用低残留饮食 (LRD) 与清流质饮食 (CLD) 相比进行肠道准备的有效性、耐受性和副作用。

方法

搜索了 PubMed/Medline、Embase、Cochrane 对照试验中央注册中心 (CENTRAL) 和 Scopus 数据库。我们纳入了为 CRC 筛查和监测或诊断目的而接受预定结肠镜检查的患者的研究，这些研究在结肠镜检查前一天将 LRD 与 CLD 进行了比较。疗效是主要结果，评估为充分肠道准备的比率。次要结果是肠道准备的耐受性和不良反应。

结果

包括13 个随机对照试验 ( N  = 2587)。与 CLD 相比，接受 LRD 的患者在充分的肠道准备方面没有差异（RR 1.02；95% CI 0.99–1.05；I ²  = 60%）。然而，与 CLD 相比，LRD 改善了患者的耐受性（RR 1.17；95% CI 1.12–1.23；I ²  = 66%）并且副作用更少（RR 0.89；95% CI 0.84–0.94；I ²  = 73%） . 使用单剂量 4L 聚乙二醇的 LRD 或 < 2000 kcal < 32 g 纤维/天的 LRD 的组具有更好的耐受性。

结论

基于这些发现，我们强烈建议使用 LRD 为接受预定结肠镜检查的患者进行肠道准备。这种饮食也可用作术前结肠准备，但这需要进一步研究。