lundi 23 mai 2016

Improving Colonscopy: Lose the Liquid Diet? (CME/CE)

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • Note that this small randomized study found that a low-residue diet was potentially superior to a clear-liquids diet in the setting of colonoscopy bowel preparation.
  • Be aware that larger studies are needed to validate this approach.

SAN DIEGO -- Patients undergoing colonoscopy who consumed a low-residue diet the day before the procedure, instead of a clear liquid diet, more often had an adequate bowel preparation and were much more likely to be satisfied with the experience, a researcher reported here.

In an interim analysis of a randomized study that included 83 patients, 91.3% of those given the low-residue diet the day before colonoscopy had an adequate preparation according to the Boston Bowel Preparation Scale (BBPS) compared with 75.7% of those restricted to a clear liquid diet alone (P=0.05), according to Jason B. Samarasena, MD, of the University of California Irvine.

And after the procedure, 97% of the low-residue diet group expressed satisfaction with the diet compared with 46% of the liquid diet group (P<0.001), he reported at the annual Digestive Disease Week (DDW).

"Colon cancer deaths can be prevented by colonoscopy, yet tens of millions of patients avoid this lifesaving screening, often citing the dietary restrictions the day before as a deterrent," he said.

Patients randomized to the conventional clear liquid diet were allowed to consume drinks such as broth, black coffee, and tea the day before colonoscopy. In contrast, the low-residue group were allowed to eat three meals that included small portions of foods such as eggs, yogurt, bread, rice, chicken breast, and ice cream.

"These foods are easily liquefied in the small intestine and can be washed out easily, so they don't interfere with the colonoscopy procedure," he said.

All participants consumed 4 L of polyethylene glycol/electrolyte preparation as a split dose. Hunger and fatigue were evaluated on 10-point scales.

The BBPS was chosen because it reflects the state of the bowel following the endoscopist's cleaning maneuvers to remove residual debris using streaming water and suction.

It's a segmental score, giving 3 points each to the right, transverse, and left segments of the colon, for a possible total of 9. An adequate score was higher than 6, with no individual segment having a score below 2."There's been some debate as to what is adequate preparation, and this is a rigorous endpoint," he told MedPage Today.

Mean BBPS scores were 7.98 and 7.54 for the low residue and clear liquid diet groups, respectively.

Hunger scores the night before the procedure were significantly lower in the low-residue group (3.5 versus 6.9, P=0.001), as were morning preprocedure fatigue scores (3.5 versus 6, P=0.01), Samarasena reported.

No differences between the groups were seen for overall discomfort, nausea, vomiting, or bloating.

"We hypothesized that the solid food helped stimulate bowel movements before the preparatory liquid, making the final cleansing process easier," he said.

"We further hypothesized that the solid food gave patients a higher energy level and possibly make them more tolerant of the entire process," he added.

Adding to patient satisfaction was the fact that patients on the clear liquid diet often have to miss a day of work because of the fasting requirement, whereas the low-residue diet permitted them to maintain normal activities, he pointed out.

"We hope this will change the way clinicians prepare their patients and in turn will help increase patients' willingness to participate in this vital screening process," he concluded.

Most studies of the low-residue diet for colonoscopy preparation have been done outside the U.S., he noted. "This study was done in a tertiary care center and a Veterans Administration hospital, with diverse patient populations, making the results more compelling," he said. "Hopefully our findings will alleviate the fear a lot of clinicians have in trying the low-residue diet. We showed superiority over the clear liquid diet, which really is a win for patients and for their doctors as well."

In a press conference at DDW, John Vargo, MD, of the Cleveland Clinic, said, "I think this is tantalizing. I could go for some pizza and chicken wings before my colonoscopy," he joked.

"But if you think about it, what are the barriers to screening? The prep can be prohibitive, even if you do a split prep [half the preparation given the evening before and half the morning of the procedure], it's still a large volume," he said.

"This is a first step, but as with any study like this, you'd like to see validation," said Vargo, who was not involved in the study.

Samarasena disclosed no relevant relationships with industry.

take posttest

Let's block ads! (Why?)

Improving Colonscopy: Lose the Liquid Diet? (CME/CE)

Aucun commentaire:

Enregistrer un commentaire