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There’s good news for your patients who dread the clear-liquid diet before a colonoscopy. A new study finds that patients who ate certain solid foods, considered “low residue,” were better prepared for their colonoscopies than individuals who followed the conventional liquid diet. Also, researchers saw that these patients who ate foods such as eggs, white bread, cheese, white rice, and chicken breast the day before their screening were more comfortable during the 24 hours leading up to the test than individuals who could have only apple juice, chicken broth, coffee, and similar clear liquids.
“Colon cancer deaths can be prevented by colonoscopy, yet tens of millions of patients avoid this life-saving screening,” said Jason Samarasena, MD, lead study author and associate clinical professor of medicine in the division of gastroenterology and hepatology at the University of California, Irvine. “Many people often cite the dietary restrictions the day before the colonoscopy as a deterrent for having this screening done.”
In this study, the clear-liquid diet (CLD) group could drink only broth, black coffee, tea, and other clear liquids. The low-residue diet (LRD) group was allowed small portions of protein, carbohydrate, and fat at three meals. For their day-before diet, LRD patients could choose from foods such as eggs, yogurt, certain cheeses, breads, butter, rice, lunch meat, chicken breast, and ice cream. Both groups then drank standard bowel-cleansing liquid on the night before and the morning of the procedure.
The study tracked 83 patients who underwent colonoscopies at a VA hospital and a tertiary care facility over one year. It compared results of those who consumed only a CLD on the day before the colonoscopy with those patients who ate a planned LRD that included limited portions of select solid foods.
With the LRD group, researchers found a “significantly higher” number of adequate bowel preparations. This group also expressed a considerably higher satisfaction level for the diet, 97%, compared to the CLD group’s 46%. Also, the individuals on the LRD reported “significantly lower” hunger scores on the evening of the prep process, as well as lower fatigue scores on the morning after.
Samarasena said the LRD contains foods that easily liquefy and don’t interfere with the colonoscopy. Researchers also hypothesize that solid foods stimulate bowel movements before the purgative and make the final cleansing easier. Researchers think the solid foods in the LRD gave patients a higher energy level, which possibly made them more tolerant of the entire process, Samarasena said. Patients on a CLD often miss a day of work because of the “fasting” requirement, while the LRD may enable patients to carry on more normal activities, because their diets the day before the colonoscopy are less drastic, he added.
Samarasena indicated that some gastroenterologists are reluctant to try an LRD. He said that this study included such patients from the VA hospital, and they benefited from the LRD approach.
“We hope this will change the way practitioners actually operate and, in turn, help increase patients’ willingness to participate in this vital screening process,” he said.
Mark Mayo, CASC, executive director at the ASC Association of Illinois, said, “It is not just patient tolerance with a diet or prep, but it is really an issue of improved compliance and successful bowel prep/visualization during the procedure and fewer cases cancelled because of patient non-compliance, patient failure to prep, patient changing his/her mind because of dissatisfaction with the prep process, or inadequate prep.”
The findings were presented at Digestive Disease Week 2016 in a study titled “Single day low residue diet prior to colonoscopy shows improved tolerance and bowel preparation quality over clear liquid diet: Interim results from a U.S. multicenter randomized controlled trial.”
The meeting is sponsored by the American Gastroenterological Association Institute, the American Society for Gastrointestinal Endoscopy, the Society for Surgery of the Alimentary Tract, and the American Association for the Study of Liver Diseases.
Financial Disclosure: Executive Editor Joy Dickinson, Nurse Planner Kay Ball, Physician Reviewer Steven A. Gunderson, DO, and Consulting Editor Mark Mayo report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Stephen W. Earnhart discloses that he is a stockholder and on the board for One Medical Passport.