S388 Low-Residue Diets Paired With Low Volume Preparations: A New Paradigm for Colonoscopy Bowel Prep – A Meta Analysis

Introduction: Adequate bowel preparation is important in achieving a high-quality colonoscopy. A clear liquid diet (CLD) is generally recommended prior to colonoscopy; however, it may be associated with patient discomfort, hunger, and poor tolerability, impacting adherence to preparation. Moreover, these challenges are often exacerbated by the use of traditional large-volume bowel preparations. Recent bowel preparations have moved towards smaller volumes to reduce patient discomfort. Low residue diet (LRD), when paired with low-volume bowel preparation, could possibly be a more comfortable alternative without compromising the quality of bowel cleansing. The aim of this systematic review and meta-analysis was to compare the efficacy and tolerability of LRD and CLD in adults undergoing low-volume (≤3 liters) bowel preparation. Methods: A literature review was conducted across multiple databases, including Cochrane Library, Scopus, Web of Science, PubMed, and ClinicalTrials.gov through October 2024. Only randomized controlled trials that compared LRD to CLD with low volume colonoscopy preparation were included. The primary outcome assessed was adequate bowel preparation. Secondary outcomes included tolerability, adverse events, polyp detection rates, adenoma detection rates, compliance with diet, cecal intubation rate, and readiness to repeat preparation. Results: A total of 8 studies with 2,338 patients were included. Overall, 1,117 patients underwent CLD preparation, and 1,221 patients underwent LRD preparation. Findings suggest that LRD is non-inferior to CLD regarding bowel preparation adequacy (odds ratio: 0.70, confidence interval [0.26, 1.88], P = 0.48). There were similar rates of tolerability, compliance, adverse events, polyp detection rate, adenoma detection rate, cecal intubation rate, and readiness to repeat bowel preparation across the CLD and LRD groups. Conclusion: Low-residue diets paired with low-volume bowel preparations are well-tolerated and effective alternatives to clear liquid diet and large volume bowel preparation for colonoscopy. Low residue and low volume preparations show similar patient compliance and comfort as clear liquid preparation without compromising preparation quality or diagnostic efficacy. These findings support the adoption of LRD and low volume bowel preparation as a recommendation in clinical practice, potentially enhancing patient experience.