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Vol. 44. Issue 3.
Pages 183-190 (March 2021)
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Vol. 44. Issue 3.
Pages 183-190 (March 2021)
Original Article
Increasing the low residue diet to 3 days does not improve the bowel cleansing in hard to prepare patients: Post hoc analysis of a randomized controlled trial
Aumentar la dieta baja en residuos a 3 días no mejora la limpieza intestinal en pacientes difíciles de preparar: análisis post-hoc de un ensayo controlado aleatorizado
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Antonio Z. Gimeno-Garcíaa,b,
Corresponding author
antozeben@gmail.com

Corresponding author.
, Raquel de la Barreda-Heusera,b, Cristina Reygosaa,b, Alberto Hernándeza,b, Carla Amarala,b, Isabel Mascareñob, David Nicolás-Péreza,b, Alejandro Jiméneza,b, Antonio J. Laraa,b, Anjara Hernándeza,b, Vanessa Felipea,b, José Luis Bautea,b, Onofre Alarcon-Fernándeza,b, Manuel Hernandez-Guerraa,b, Rafael Romeroa,b, Inmaculada Alonsoa,b, Yanira Gonzáleza,b, Zaida Adriana,b, Goretti Hernandeza,b, Domingo Hernandeza,b, Rosa Delgadoa,b, Enrique Quinteroa,b
a Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Departamento de Medicina Interna, Universidad de La Laguna, Spain
b Servicio de Endocrinología y Nutrición, Hospital San Juan de Dios, Santa Cruz de Tenerife, Spain
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Figures (1)
Tables (5)
Table 1. Predictive score of poor bowel preparation.6
Table 2. Baseline characteristics of the patients.
Table 3. Comparison of adequate bowel cleansing between study groups.
Table 4. Colonoscopy findings.
Table 5. Tolerance, acceptance and willingness to take the same diet.
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Additional material (3)
Abstract
Background

Recent evidence suggests that the number of low residue diet (LRD) days does not influence the bowel cleansing quality in non-selected patients. However, there are not data in the subgroup of patients with risk factors of inadequate bowel cleansing.

Objective

The aim of this study was to assess whether a 3-day LRD improved the bowel cleansing quality in patients with risk factors of poor bowel cleansing.

Patients and methods

Post hoc analysis of a randomized controlled trial carried out between December 2017 and March 2018 in a tertiary care hospital. Patients with high risk of poor bowel cleansing were selected following a validated score. The patients were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the main outcome.

Results

135 patients (1-day LRD group=67, 3-day LRD=68) were included. The rate of adequate cleansing quality was not significantly different between the groups in the ITT analysis: 76.1%, 95% CI: [64.6–84.8] vs. 79.4%, 95% CI: [68.2–87.4]; odds ratio (OR) 1.2, 95% CI [0.54–2.73]) or in the PP analysis: 77.3%, 95% CI: [65.7–85.8] vs. 80.3%, 95% CI: [69.0–88.3]; OR 1.2, 95% CI [0.52–2.77]). Compliance with the diet or cleansing solution, satisfaction or difficulties with the LRD and the polyp/adenoma detection rates were not significantly different.

Conclusion

Our results suggest that 1-day LRD is not inferior to 3-day LRD in patients with risk factors of inadequate bowel cleansing.

Keywords:
Low-residue diet
Risk factors of poor bowel cleansing
Boston Bowel Preparation Scale
Colonoscopy
Predictive score
Resumen
Antecedentes

La evidencia reciente sugiere que el número de días de dieta baja en residuos (DBR) no influye en la calidad de la limpieza intestinal en pacientes no seleccionados. Sin embargo, no hay datos en el subgrupo de pacientes con factores de riesgo de una limpieza intestinal insuficiente.

Objetivo

El objetivo de este estudio fue evaluar si una DBR de 3 días mejoraba o no la calidad de la limpieza intestinal en pacientes con factores de riesgo de limpieza intestinal deficiente.

Pacientes y métodos

Análisis post-hoc de un ensayo controlado aleatorizado realizado entre diciembre de 2017 y marzo de 2018 en un hospital de atención terciaria. Los pacientes con alto riesgo de limpieza intestinal deficiente se seleccionaron mediante una puntuación validada. Los pacientes se aleatorizaron a los grupos de DBR de un día o DBR de 3 días. Todos los pacientes recibieron una dosis dividida de 2l de polietilenglicol más ácido ascórbico. Se realizaron análisis por intención de tratar (IdT) y por protocolo (PP) para el criterio principal de valoración.

Resultados

Se incluyeron 135 pacientes (grupo DBR de un día=67, DBR de 3 días=68). No se observaron diferencias significativas en la tasa de calidad de limpieza suficiente entre los grupos en el análisis por IdT (76,1%; IC del 95%: [64,6-84,8] frente al 79,4 7%, IC del 95%: [68,2-87,4]; razón de posibilidades (OR): 1,2; IC del 95%: [0,54-2,73]) o en el análisis PP: (77,3%; IC del 95 %: [65,7-85,8] frente al 80,3%, IC del 95%: [69,0-88,3]; OR: 1,2; IC del 95% [0,52 -2,77]). No se observaron diferencias significativas en el cumplimiento de la dieta o con la solución limpiadora, en la satisfacción o las dificultades con la DBR y en las tasas de detección de pólipos/adenomas.

Conclusión

Nuestros resultados sugieren que la DBR de un día no es inferior a la DBR de 3 días en pacientes con factores de riesgo de limpieza intestinal insuficiente.

Palabras clave:
Dieta baja en residuos
Factores de riesgo de limpieza intestinal deficiente
Escala de preparación intestinal de Boston
Colonoscopia
Puntuación predictiva

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