Efficacy of low residue enteral formula versus clear liquid diet during bowel preparation for colonoscopy: a randomised controlled pilot trial

Abstract

Objectives Conventional bowel preparation for colonoscopy confines patient to clear liquid diet the day before and such non-nutritive dietary regimen often caused discomfort and hunger. The purpose of this study is to determine the feasibility of feeding patient with low-residue, lactose-free semi-elemental enteral formula (PEPTAMEN®) compare to conventional clear liquid diet during bowel preparation before colonoscopy. Methods This was a randomised, endoscopist-blinded study. Patients were randomised into two groups, those receiving oral PEPTAMEN® and mechanical bowel preparation (A) and those receiving clear liquid while undergoing mechanical bowel preparation (B). Documentation was made with regard to the type of bowel cleansing agents used, completeness of the colonoscopy, cleanliness quality score, and hunger score. Results A total of 97 patients were included in the study, A = 48 and B = 49. Eight patients, who were not compliant to the bowel-cleansing agent or had an incomplete colonoscopic examination, were excluded from the study. In terms of the overall cleanliness score, no statistical significant difference was seen ( p = 0.25) between the two groups, A (fair or poor 37.5%, good or excellent 62.5%) and B (fair or poor 49%, good or excellent 51%) whereas the hunger score showed a significant difference ( p = 0.016), A (no hunger 41.7%, slight hunger 12.5%, hungry 12.5%) and B (no hunger 24.5%, slight hunger 38.8%, hungry 36.7%). Conclusions These data suggest that the addition of oral PEPTAMEN® as part of the bowel preparation regimen did not significantly alter the luminal cleanliness score during colonoscopy while alleviating hunger.

Low-residue versus clear liquid diet before colonoscopy

“…The analysis showed that a total of 5 studies (N = 933) involved the indicator of hunger. [ 13 , 15 , 19 , 21 , 26 ] In the pooled analysis, the hunger sensation in the CLD group (52.5%, 244/465) was significantly more severe than that in the LRD group (36.8%, 172/468). (RR, 1.64, 95% CI, 1.12–2.39; P < .05; I 2 = 81.4%, P < .01) (Fig.…”

A Systematic Review and Meta-Analysis of Low-Residue Diet Versus Clear Liquid Diet

“…Of the eligible articles, 12 ( n = 2205) ( Alvarez-Gonzalez et al, 2019 ; Butt, Bunn, Paul, Gibson, & Brown, 2016 ; Flemming, Green, Melicharkova, Vanner, & Hookey, 2015 ; Gee et al, 2019 ; Melicharkova, Flemming, Vanner, & Hookey, 2013 ; Mytyk et al, 2018 ; Rapier & Houston, 2006 ; Scott et al, 2005 ; Soweid et al, 2010 ; Stolpman et al, 2014 ; Thukral et al, 2019 ; Walter et al, 2017 ) evaluated the number of participants who achieved excellent or good bowel preparation. These studies used the BBPS, Aronchick Scale, or HCS to determine the eligibility criteria.…”

“…As shown in Figure 4 , six studies ( Alvarez-Gonzalez et al, 2019 ; Flemming et al, 2015 ; Gee et al, 2019 ; Gomez-Reyes et al, 2019 ; Stolpman et al, 2014 ; Walter et al, 2017 ) examined the polyp detection rates (PDRs), which were similar between the LRD and CLD groups (50.8% vs. 49.1%; OR [95% CI] = 1.07 [0.83, 1.38]; p = .60). Heterogeneity among the groups was not significant ( I 2 = 36%; p = .16).…”

“…Seven studies ( Gee et al, 2019 ; Gomez-Reyes et al, 2019 ; Mytyk et al, 2018 ; Park et al, 2009 ; Scott et al, 2005 ; Soweid et al, 2010 ; Thukral et al, 2019 ) reported detailed adverse effects during bowel preparation. We conducted a meta-analysis of adverse effects such as including hunger ( Gee et al, 2019 ; Scott et al, 2005 ; Soweid et al, 2010 ; Thukral et al, 2019 ), nausea ( Gomez-Reyes et al, 2019 ; Mytyk et al, 2018 ; Park et al, 2009 ; Scott et al, 2005 ; Soweid et al, 2010 ; Thukral et al, 2019 ), vomiting ( Gomez-Reyes et al, 2019 ; Mytyk et al, 2018 ; Park et al, 2009 ; Scott et al, 2005 ; Soweid et al, 2010 ; Thukral et al, 2019 ), and abdominal pain or discomfort ( Gomez-Reyes et al, 2019 ; Mytyk et al, 2018 ; Park et al, 2009 ; Scott et al, 2005 ; Soweid et al, 2010 ; Thukral et al, 2019 ). More participants in the CLD group consistently experienced hunger, nausea, and vomiting (hunger: OR, 0.34, and p < .01; nausea: OR, 0.73, and p = .03; vomiting: OR, 0.63, and p = .04).…”

Dedicated staff for patient education improves bowel preparation quality and reduces the cecal intubation time of colonoscopy: A single institution retrospective study

“…The bowel preparation quality was assessed by the examiner based on modified Aronchick scale (Table 2 ). [ 8 , 9 ] We defined bowel preparation quality as “good preparation” if it corresponded to modified Aronchick scale “Excellent” or “Good”. We also defined the quality as “adequate preparation” if it corresponded to “Excellent”, “Good”, or “Fair”.…”