A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation

Efficacy of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution for Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study

“…Despite more than 14 million colonoscopies being performed each year, the historic rates for adequate cleansing are unacceptably low and range from 70-82% (10)(11)(12)(13). Recent studies have shown that ingesting at least part of the purgative on the day of colonoscopy and coordinating the final dose of purgative with the start time of colonoscopy is more likely to result in adequate colon cleansing (2)(3)(4)(5). Generally, this is accomplished by splitting the purgative between the evening prior and the morning of colonoscopy.…”

“…With respect to diet, this was not highly restrictive as we chose a diet consisting of a low residue breakfast before 10 am on the day prior followed by clears up to 2.5 hours before colonoscopy. Though many physicians order a clear liquid diet for 24 hours, several studies support a less restrictive diet (4,17,18). Another consideration is that all but five colonoscopies were performed by one of the two endoscopists involved in this study.…”

“…Day-of-colon dosing can be achieved through two strategies -split (PM/AM) dosing where part of the purgative is administered the night prior to colonoscopy and the remainder within ~6 hours of the procedure, and morning-only (AM-only) dosing where the entire prep is taken on the day of colonoscopy (2)(3)(4)(5). By linking the final dose of purgative to the timing of colonoscopy, a greater chance of adequate cleansing is assured regardless of the time of colonoscopy.…”

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial

“…In that randomized controlled trial of 226 patients, the White Diet in conjunction with a 2‐L PEG with ascorbate bowel preparation was preferred by patients with less hunger and interference to daily activities without detriment to bowel preparation quality or colonoscopy performance compared with a clear fluid diet 15. Other randomized trials of diet liberalization during bowel preparation suggest that either low‐fiber13 or regular diet14 the day before colonoscopy with split‐dose bowel preparation is associated with improved tolerance and comparable or better colon cleansing compared with a clear fluid diet. In our study, patients taking the White Diet for 2 days reported higher overall satisfaction with the diet and higher satisfaction with the diet compared with any previous colonoscopy (>90% had clear fluid diet at previous colonoscopy).…”

“…Typically, patients are instructed to take a clear fluid diet the day prior to colonoscopy because high‐fiber foods may impair bowel preparation. Recent randomized trials, however, suggest that a low‐fiber diet13 or even regular diet14 the day before colonoscopy with split‐dose bowel preparation is associated with better tolerance of the preparation and comparable or better colon cleansing compared with a clear fluid‐only diet. The White Diet is a novel, low‐residue diet of white‐colored foods, which is better tolerated without detriment to bowel preparation quality compared to a clear fluid diet in patients undergoing colonoscopy 15…”