Comparação entre uma dieta líquida hipocalórica e uma dieta normocalórica, ambas pobres em fibras, para preparo de colonoscopia: estudo prospectivo randomizado e controlado
Arquivos
Data
2023-02-16
Autores
Lescano, Manuel Lescano 
Orientadores
Miszputen, Sender Jankiel
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: 1) Avaliar a qualidade, tolerância e preferência do preparo para colonoscopia de uma dieta líquida hipocalórica, quando comparada com uma dieta normocalórica, ambas pobres em fibras 2) Reconhecer fatores preditores de preparo inadequado, e 3) Avaliar a associação entre a descrição dos efluentes retais referida pelo paciente antes da colonoscopia com a qualidade do preparo. Métodos: Trata-se de um estudo randomizado, controlado, observador “cego”, para comparar duas dietas de preparo para colonoscopia (dieta líquida hipocalórica e dieta normocalórica, ambas pobres em fibras). Foi utilizada a escala de Boston para avaliar a qualidade do preparo, sendo considerado adequado BBPS ≥ 6 na avaliação global e ≥ 2 em cada segmento. Foi prescrito o mesmo laxativo e o regime “split-dose” para ambos os grupos. Resultados: Foram incluídos 136 indivíduos em cada grupo. O preparo adequado foi alcançado em 90,4% dos indivíduos alocados no grupo da dieta líquida e 92,6% da normocalorica. Não houve diferença significativa na qualidade do preparo e na tolerância entre ambas as dietas. Observou-se maior aceitação de repetir o procedimento se necessário, no grupo da dieta normocalórica quando comparado ao da dieta líquida hipocalórica (p=0,005). O gênero masculino foi a única variável que se associou com o preparo inadequado (OR 0,40, IC 95% 0,17; 0,95, p=0,039). Na análise da amostra global e da dieta normocalórica, o relato de efluentes: escuro grosso, laranja escuro ou marrom grosso, apresentou maior chance de preparo inadequado (OR 4,26, IC 95% 1,51; 11,14, p=0,004 – toda a amostra e OR 6,32, IC 95% 1,20; 28,10, p=0,018 – dieta normocalórica). Conclusões: A dieta normocalórica pobre em fibras não é inferior que à líquida hipocalórica na qualidade do preparo para colonoscopia, ambas apresentam tolerância similar, porém com maior aceitação da dieta normocalórica quando comparada à líquida hipocalórica. O gênero masculino é uma variável associada ao mau preparo. O relato do efluente retal escuro grosso, laranja escuro ou marrom grosso pelo paciente é um preditor de preparo inadequado na análise do endoscopista.
Aims: 1) To evaluate the quality, tolerance and preference regarding the colonoscopy preparation of a low-fiber, normocaloric diet compared with a hypocaloric liquid diet; 2) To recognize prediction factors of an inadequate preparation; and 3) To evaluate the association between the description of the rectal effluents reported by patients and the quality of the preparation. Methods: This is a randomized, controlled, observer-blind study to compare two low-fiber colonoscopy preparation diets (hypocaloric liquid diet vs. normocaloric diet). The Boston Bowel Preparation Scale have been used to evaluate the quality of the preparations, being considered adequate BBPS ≥ 6 in the global assessment and ≥ 2 in each segment. The same laxative was used in both groups as well as the “split-dose” regimen. Results: A total of 136 individuals were enrolled in each group. Adequate preparation was achieved in 90.4% of the individuals allocated to the liquid diet group and 92.6% to the normocaloric group. There was no significant difference in the quality of preparation and tolerance between groups. A higher patient acceptance to repeat the procedure if necessary was observed in the normocaloric diet group compared with the hypocaloric liquid diet group (p = 0,005). Male sex was the only variable associated with inadequate preparation (OR 0,40, 95% IC 0.17-0,95, p = 0,039). In the global sample analysis and in the normocaloric diet, the report of thick dark, dark orange or thick brown effluents presented a greater chance of inadequate preparation (OR 4,36, 95% IC 1,50-11,14, p = 0,004 – global sample and OR 6,32, IC 95% 1,20; 28,10, p=0,018 – normocaloric diet). Conclusions: The low-fiber normocaloric diet has shown to not be inferior to the hypocaloric liquid diet regarding the quality of the colonoscopy preparation. Patient tolerance rates were similar between both diets, but a higher acceptance rate was observed with the normocaloric diet compared with the hypocaloric liquid diet. The male sex is a variable associated with inadequate preparation. The report of a thick dark, orange dark or thick brown effluent by the patients is a predictor of inadequate preparation in the endoscopist analysis.
Aims: 1) To evaluate the quality, tolerance and preference regarding the colonoscopy preparation of a low-fiber, normocaloric diet compared with a hypocaloric liquid diet; 2) To recognize prediction factors of an inadequate preparation; and 3) To evaluate the association between the description of the rectal effluents reported by patients and the quality of the preparation. Methods: This is a randomized, controlled, observer-blind study to compare two low-fiber colonoscopy preparation diets (hypocaloric liquid diet vs. normocaloric diet). The Boston Bowel Preparation Scale have been used to evaluate the quality of the preparations, being considered adequate BBPS ≥ 6 in the global assessment and ≥ 2 in each segment. The same laxative was used in both groups as well as the “split-dose” regimen. Results: A total of 136 individuals were enrolled in each group. Adequate preparation was achieved in 90.4% of the individuals allocated to the liquid diet group and 92.6% to the normocaloric group. There was no significant difference in the quality of preparation and tolerance between groups. A higher patient acceptance to repeat the procedure if necessary was observed in the normocaloric diet group compared with the hypocaloric liquid diet group (p = 0,005). Male sex was the only variable associated with inadequate preparation (OR 0,40, 95% IC 0.17-0,95, p = 0,039). In the global sample analysis and in the normocaloric diet, the report of thick dark, dark orange or thick brown effluents presented a greater chance of inadequate preparation (OR 4,36, 95% IC 1,50-11,14, p = 0,004 – global sample and OR 6,32, IC 95% 1,20; 28,10, p=0,018 – normocaloric diet). Conclusions: The low-fiber normocaloric diet has shown to not be inferior to the hypocaloric liquid diet regarding the quality of the colonoscopy preparation. Patient tolerance rates were similar between both diets, but a higher acceptance rate was observed with the normocaloric diet compared with the hypocaloric liquid diet. The male sex is a variable associated with inadequate preparation. The report of a thick dark, orange dark or thick brown effluent by the patients is a predictor of inadequate preparation in the endoscopist analysis.
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Citação
LESCANO, Manuel Lescano. Comparação entre uma dieta líquida hipocalórica e uma dieta normocalórica, ambas pobres em fibras, para preparo de colonoscopia: estudo prospectivo randomizado e controlado. 2023. 78 f. Tese (Doutorado em Gastroenterologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.