P1466 - 1-Day vs 3-Day Low Residue Diet for Colonoscopy Bowel Cleansing: A Systematic Review

Hemant Goyal, MD, PGDCA (MBA)¹, Syed Ali Amir Sherazi, MD², Shweta Gupta, MD, MBA², Smit S. Deliwala, MD³, Pardeep Bansal, MD, FACG⁴, Abhilash Perisetti, MD⁵, Benjamin Tharian, MD, MRCP, FRACP⁵, Nirav Thosani, MD, MHA^6
1Wright Center for Graduate Medical Education, Scranton, PA; ²John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ³Michigan State University at Hurley Medical Center, Flint, MI; ⁴St. Vincent Mercy Medical Center, Toledo, OH; ⁵University of Arkansas for Medical Sciences, Little Rock, AR; ⁶University of Texas Health Science Center, Houston, TX

Introduction: Colonoscopy is the best method for colon cancer screening and to evaluate bowel abnormalities, including cancer. However, good bowel preparation is essential for a successful colonoscopy. Several studies have shown Low Residue Diet (LRD) to be better tolerated without any negative effects on bowel cleansing compared to Clear Liquid Diet. Several studies have compared 1-day vs. 3-day LRD for bowel cleansing. This study aims to compare the impact of the duration of LRD for colonoscopy bowel cleansing in adult patients.

Methods: We studied the Cochrane and MEDLINE/Ovid databases from inception to November 2020 with keywords “colonoscopy,” “bowel preparation,” “bowel cleaning,” “1-day,” and “3-day”. Initially, 107 studies were identified, which were further screened with title and abstracts. Seven studies were selected for full-text review. Two studies were also excluded as one of them had included pediatric patients, and another was a post-doc analysis. Four studies were included in the final analysis.

Results: All studies were single-institution studies conducted in Spain (2), Portugal (1), and Turkey (1) on elective patients only. Patients with significant comorbidities were excluded from all 4 studies, with 2 specifically excluding inflammatory bowel disease patients and one excluding patients with a history of poor bowel preparation in the past. Two studies included only morning colonoscopies, one from 8AM-4PM, and one did not specify the timing. Experienced endoscopists performed the procedure in 3 studies. All studies showed that 1-day LRD was not inferior to 3-day LRD to achieve adequate bowel cleansing, polyp detections, adenoma detection, and cecal intubations. Patients reported tolerating the 1-day LRD significantly better in 2 studies, with the other 2 showing equivalence between the groups (Table 1).

Discussion: 1-day LRD is not inferior to 3-day LRD for a select population of patients undergoing elective outpatient screening colonoscopies. However, there is no data to support or negate this finding in patients with significant comorbidities, specifically in patients with IBD who need serial screening colonoscopies. This group requires specific investigation in future studies.


Figure: Table 1. Study characteristics, outcomes and limitations

Study/Year	Country	Design	Sample Size	Procedure details	Outcomes	Limitations
Antonio Z. Gimeno-Garcia 2019	Spain	Prospective, Randomized Single-Blind trial	404	Elective Colonoscopies Morning session only Experienced endoscopists	3-day LRD did not offer an advantage over 1-day LRD for bowel cleansing or polyp detection.	Excluded patients with uncontrolled hypertension, heart failure, liver failure, ESRD, past history of inadequate bowel prep
Taveira 2019	Portugal	Prospective Randomized Single-blind trial	412	Elective colonoscopies Morning session only Experienced endoscopists ( >10-year experience)	3-day low fiber diet is not associated with added benefit compared to a 1-day diet for bowel preparation and significantly harder to perform	Excluded patients with IBD and cirrhosis
Digdem Ozer Etik 2019	Turkey	Prospective, Randomized Single blinded trial	506 (251 received clear liquid diet, not LRD)	Elective colonoscopies 8AM-4PM	1-day CLD was non-inferior to a 3-day combined diet, including 2.5 days of LRD for bowel cleansing, polyp detection rate, and patient tolerance	Excluded patients with IBD, previous colon surgery, and severe complicated systemic diseases
Machlab 2020	Spain	Prospective Randomized controlled Trial	855	Elective Positive FIT test Senior endoscopists	1-day LRD non-inferior to 3-day LRD to achieve adequate colon cleansing before average risk colonoscopy	Included average risk elective only, did not specify other details or exclusions, only experienced endoscopists performed the scope.

Table: Table 1. Study characteristics, outcomes and their limitations


Disclosures:
Hemant Goyal indicated no relevant financial relationships.
Syed Ali Amir Sherazi indicated no relevant financial relationships.
Shweta Gupta indicated no relevant financial relationships.
Smit Deliwala indicated no relevant financial relationships.
Pardeep Bansal indicated no relevant financial relationships.
Abhilash Perisetti indicated no relevant financial relationships.
Benjamin Tharian: BSC – Consultant. Medtronic – Consultant.
Nirav Thosani: Boston scientific – Consultant. Pentax America – Consultant.


Hemant Goyal, MD, PGDCA (MBA)¹, Syed Ali Amir Sherazi, MD², Shweta Gupta, MD, MBA², Smit S. Deliwala, MD³, Pardeep Bansal, MD, FACG⁴, Abhilash Perisetti, MD⁵, Benjamin Tharian, MD, MRCP, FRACP⁵, Nirav Thosani, MD, MHA⁶. P1466 - 1-Day vs 3-Day Low Residue Diet for Colonoscopy Bowel Cleansing: A Systematic Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.