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The White Diet is preferred, better tolerated, and non‐inferior to a clear‐fluid diet for bowel preparation: A randomized controlled trial
Author(s) -
Butt Joshua,
Bunn Cate,
Paul Eldho,
Gibson Peter,
Brown Gregor
Publication year - 2016
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13078
Subject(s) - medicine , randomized controlled trial , bowel preparation , white (mutation) , gastroenterology , colonoscopy , colorectal cancer , cancer , biochemistry , chemistry , gene
Abstract Background and Aim: Dietary restrictions contribute to the unpleasantness of bowel preparation for colonoscopy. We compare the effectiveness and tolerability of a low residue diet of white‐colored foods (“White Diet”) with a clear‐fluid diet the day prior to colonoscopy in an endoscopist‐blinded randomized non‐inferiority trial. Methods: Adults undergoing outpatient colonoscopy were randomized with stratification by procedure timing to a White Diet or clear‐fluid diet. All received a 2‐L polyethylene glycol lavage solution with ascorbate, sodium sulfate, and electrolytes, the day‐before for morning and as a split‐dose for afternoon procedures. The primary end‐point was successful bowel preparation (A or B on the Harefield Cleansing Scale). Regimen tolerance/acceptance was assessed by questionnaire. An intention‐to‐treat analysis with a predefined non‐inferiority margin of 15% was used to compare efficacy. Results: A total of 226 patients (average age 52 years, 51% male) were randomized (111 clear diet, 115 White Diet). Bowel preparation was successful in 91% on the clear‐fluid diet vs 84.4% on the White Diet, difference being −6.6% (lower one sided 95% CI −13.8%), with no difference according to diet. The split‐dose regimen (in 55%) had a higher success rate than day‐before regimen (96% vs 80%, p < 0.001). The White Diet was preferred with less hunger and interference with daily activities ( p < 0.001). Procedural/withdrawal time and polyp/adenoma detection were similar between groups. Conclusions: The White Diet was preferred and better tolerated by patients without detriment to the success of bowel preparation or colonoscopy performance, especially with the split‐dose regimen.