A Systematic Review and Meta-Analysis of Low-Residue Diet Versus Clear Liquid Diet: Which Is Better for Bowel Preparation Before Colonoscopy?

Rui Wu, Wen-Ya Ji, Cheng Yang, Qiang Zhan, Rui Wu, Wen-Ya Ji, Cheng Yang, Qiang Zhan

Abstract

The goal of this systematic review was to compare the clear liquid diet and the low-residue diet to determine which is better for bowel preparation before colonoscopy. A literature search for randomized controlled trials on the effects of employing the clear liquid diet and low-residue diets before colonoscopy was conducted in major online English databases (PubMed, Web of Science, and Ovid EMBASE). After the systematic review of all 16 studies, the outcomes including quality of bowel preparation, tolerance, willingness to repeat, and adverse effects were analyzed through meta-analysis. The statistical analysis was performed by using RevMan 5.3 software. No statistically significant difference was observed between the low-residue diet and clear liquid diet groups (odds ratio [95% confidence interval] = 1.19 [0.79, 1.81]; p = .41). There was no statistically significant difference between the Boston Bowel Preparation Scale (standard mean difference [95% confidence interval] =-0.04 [-0.21, -0.14]; p = .68) Ottawa Bowel Preparation Scale (standard mean difference [95% confidence interval] =-0.04 [-0.19, 0.11]; p = .59) scores of the two groups. The quality indicators for colonoscopy of the two groups were not statistically significant. However, patient tolerance to the low-residue diet was higher (odds ratio [95% confidence interval] = 1.86 [1.47, 2.36]; p < .01). More patients in the low-residue diet group were willing to repeat the low-residue diet for bowel preparation (odds ratio [95% confidence interval] = 2.34 [1.72, 3.17]; p < .01). More patients in the clear liquid diet group experienced hunger, nausea, and vomiting. People who employed the low-residue diet before colonoscopy had the same quality of bowel preparation as those with clear liquid diet. Meanwhile, the tolerance of people with low-residue diet was better than people with clear liquid diet, and these people were more willing to repeat the colonoscopy with less adverse events.

Conflict of interest statement

The authors declare no conflicts of intere.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Gastroenterology Nurses and Associates.

Figures

FIGURE 1.
FIGURE 1.
Flowchart for filtering articles.
FIGURE 2.
FIGURE 2.
Quality assessment of the studies by Cochrane Collaboration's Tool for Assessing Risk of Bias. (A) Risk of bias graph. (B) Risk of bias summary.
FIGURE 3.
FIGURE 3.
Forest plot of quality of bowel preparation between LRD and CLD groups. (A) Number of people who were qualified for the excellent or good bowel preparation. (B) Score of the BBPS. (C) Score of the OBPS.
FIGURE 4.
FIGURE 4.
Forest plot of quality indicators, tolerance, and willingness for colonoscopy between LRD and CLD groups. (A) Polyp detection rate (PDR). (B) Adenoma detection rate (ADR). (C) Cecal intubation rate (CIR). (D) Tolerance of participants for colonoscopy between LRD and CLD groups. (E) Willingness of participants for colonoscopy between LRD and CLD groups.
FIGURE 5.
FIGURE 5.
Forest plot of adverse effects between LRD and CLD groups: (A) hunger, (B) nausea, (C) vomiting, and (D) abdominal pain or discomfort.

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