Application of enhanced recovery after surgery in bowel preparation for colonoscopy procedures_West China Medical Journal

Authors：

MA Wenjuan ¹ , TANG Li ² , SHI Lei ³ , YANG Jinlin ² ,  HU Wen ^1,3

1. Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HU Wen, Email: wendy_nutrition@163.com

Keywords：

Enhanced recovery after surgery; dietary management; colonoscopy procedures; bowel preparation

DOI：

10.7507/1002-0179.202507240

Video：

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Objective To investigate the efficacy of dietary management based on the principles of enhanced recovery after surgery (ERAS) in bowel preparation for patients undergoing colonoscopy. Methods Patients undergoing colonoscopy procedures in the Department of Gastroenterology at West China Hospital, Sichuan University between December 2023 and December 2024 were randomly assigned to a control group and a trial group. The control group received conventional dietary management, comprising a self-prepared low-residue diet with fasting commencing at 22:00 on the preoperative evening. The trial group received dietary management based on the ERAS protocol, comprising pre-packaged low-residue meals on the day before surgery (lunch, dinner, and a 22:00 snack) plus 200 mL of clear liquids consumed 2 hours preoperatively. The Boston Scale and a subjective experience questionnaire (assessing preoperative and postoperative hunger, thirst, adverse reactions, etc.) were used to evaluate and compare bowel preparation quality and patient subjective experiences between the two groups. Results A total of 370 patients were included, comprising 194 in the control group and 176 in the trial group. Compared with the control group, the trial group showed no statistically significant difference in the Boston score for bowel preparation, the rate of adequate bowel preparation (78.41% vs. 71.65%), or the incidence of adverse reactions during bowel preparation or postoperatively (P>0.05). Patients in the trial group demonstrated higher subjective satisfaction with bowel cleansing (81.82% vs. 68.04%) and lower preoperative hunger [1.00 (0.00, 4.00) vs. 2.00 (0.00, 5.00)], with statistically significant differences (P<0.05). Conclusions Dietary management based on the ERAS concept does not increase the risk of bowel preparation failure or the incidence of adverse reactions during bowel preparation or postoperatively, compared with self-prepared low-residue diets. However, it reduces patients’ preoperative hunger and improves subjective satisfaction with bowel cleansing, making it worthy of promotion and application in clinical practice.

1.	Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy, 2017, 49(4): 378-397.
2.	Jacobson BC, Anderson JC, Burke CA, et al. Optimizing bowel preparation quality for colonoscopy: consensus recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 2025, 168(4): 798-829.
3.	Zhang YY, Niu M, Wu ZY, et al. The incidence of and risk factors for inadequate bowel preparation in elderly patients: a prospective observational study. Saudi J Gastroenterol, 2018, 24(2): 87-92.
4.	Zhang Y, Wang L, Wu W, et al. Predictors of inadequate bowel preparation in older patients undergoing colonoscopy: a systematic review and meta-analysis. Int J Nurs Stud, 2024, 149: 104631.
5.	中華醫學會消化內鏡學分會結直腸學組. 結腸鏡檢查腸道準備專家共識意見(2023, 廣州). 中華消化內鏡雜志, 2023, 40(6): 421-430.
6.	Pan P, Gu L, Zhao S, et al. Prepackaged formula low-residue diet vs. self-prepared low-residue diet before colonoscopy: a multicenter randomized controlled trial. Front Med (Lausanne), 2023, 10: 1029493.
7.	Zhang Y, Ding C, Li J, et al. Impact of prepackaged low-residue diet on bowel preparation for colonoscopy: a meta-analysis. Gastroenterol Nurs, 2021, 44(2): E29-E37.
8.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
9.	American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, 2017, 126(3): 376-393.
10.	Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration—A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 2023, 138(2): 132-151.
11.	Parmar R, Martel M, Rostom A, et al. Validated scales for colon cleansing: a systematic review. Am J Gastroenterol, 2016, 111(2): 197-204.
12.	Zhang N, Xu M, Chen X. Establishment of a risk prediction model for bowel preparation failure prior to colonoscopy. BMC Cancer, 2024, 24(1): 341.
13.	Gkolfakis P, Tziatzios G, Papanikolaou IS, et al. Strategies to improve inpatients’ quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Gastroenterol Res Pract, 2019, 2019: 5147208.
14.	Bucci C, Rotondano G, Hassan C, et al. Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc, 2014, 80(4): 566-576.e2.
15.	Shahini E, Sinagra E, Vitello A, et al. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: evidence from the literature. World J Gastroenterol, 2023, 29(11): 1685-1707.
16.	Luo L, Liu Y, Zhang L, et al. Optimizing bowel preparation for colonoscopy: a cross-sectional study of the Chinese population. Front Public Health, 2022, 10: 953441.
17.	Feng L, Guan J, Dong R, et al. Risk factors for inadequate bowel preparation before colonoscopy: a meta-analysis. J Evid Based Med, 2024, 17(2): 341-350.
18.	Wu KL, Rayner CK, Chuah SK, et al. Impact of low-residue diet on bowel preparation for colonoscopy. Dis Colon Rectum, 2011, 54(1): 107-112.
19.	曹紅, 桂艷. 內鏡中心結腸鏡檢查患者腸道準備質量的影響因素. 中國當代醫藥, 2025, 32(13): 152-155.
20.	Bendezú RA, Mego M, Monclus E, et al. Colonic content: effect of diet, meals, and defecation. Neurogastroenterol Motil, 2017, 29(2): e12930.
21.	Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2019. Endoscopy, 2019, 51(8): 775-794.
22.	Sharara AI, El Reda ZD, Harb AH, et al. The burden of bowel preparations in patients undergoing elective colonoscopy. United Eur Gastroenterol J, 2016, 4(2): 314-318.

1. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy, 2017, 49(4): 378-397.
2. Jacobson BC, Anderson JC, Burke CA, et al. Optimizing bowel preparation quality for colonoscopy: consensus recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology, 2025, 168(4): 798-829.
3. Zhang YY, Niu M, Wu ZY, et al. The incidence of and risk factors for inadequate bowel preparation in elderly patients: a prospective observational study. Saudi J Gastroenterol, 2018, 24(2): 87-92.
4. Zhang Y, Wang L, Wu W, et al. Predictors of inadequate bowel preparation in older patients undergoing colonoscopy: a systematic review and meta-analysis. Int J Nurs Stud, 2024, 149: 104631.
5. 中華醫學會消化內鏡學分會結直腸學組. 結腸鏡檢查腸道準備專家共識意見(2023, 廣州). 中華消化內鏡雜志, 2023, 40(6): 421-430.
6. Pan P, Gu L, Zhao S, et al. Prepackaged formula low-residue diet vs. self-prepared low-residue diet before colonoscopy: a multicenter randomized controlled trial. Front Med (Lausanne), 2023, 10: 1029493.
7. Zhang Y, Ding C, Li J, et al. Impact of prepackaged low-residue diet on bowel preparation for colonoscopy: a meta-analysis. Gastroenterol Nurs, 2021, 44(2): E29-E37.
8. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
9. American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, 2017, 126(3): 376-393.
10. Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration—A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 2023, 138(2): 132-151.
11. Parmar R, Martel M, Rostom A, et al. Validated scales for colon cleansing: a systematic review. Am J Gastroenterol, 2016, 111(2): 197-204.
12. Zhang N, Xu M, Chen X. Establishment of a risk prediction model for bowel preparation failure prior to colonoscopy. BMC Cancer, 2024, 24(1): 341.
13. Gkolfakis P, Tziatzios G, Papanikolaou IS, et al. Strategies to improve inpatients’ quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Gastroenterol Res Pract, 2019, 2019: 5147208.
14. Bucci C, Rotondano G, Hassan C, et al. Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc, 2014, 80(4): 566-576.e2.
15. Shahini E, Sinagra E, Vitello A, et al. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: evidence from the literature. World J Gastroenterol, 2023, 29(11): 1685-1707.
16. Luo L, Liu Y, Zhang L, et al. Optimizing bowel preparation for colonoscopy: a cross-sectional study of the Chinese population. Front Public Health, 2022, 10: 953441.
17. Feng L, Guan J, Dong R, et al. Risk factors for inadequate bowel preparation before colonoscopy: a meta-analysis. J Evid Based Med, 2024, 17(2): 341-350.
18. Wu KL, Rayner CK, Chuah SK, et al. Impact of low-residue diet on bowel preparation for colonoscopy. Dis Colon Rectum, 2011, 54(1): 107-112.
19. 曹紅, 桂艷. 內鏡中心結腸鏡檢查患者腸道準備質量的影響因素. 中國當代醫藥, 2025, 32(13): 152-155.
20. Bendezú RA, Mego M, Monclus E, et al. Colonic content: effect of diet, meals, and defecation. Neurogastroenterol Motil, 2017, 29(2): e12930.
21. Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2019. Endoscopy, 2019, 51(8): 775-794.
22. Sharara AI, El Reda ZD, Harb AH, et al. The burden of bowel preparations in patients undergoing elective colonoscopy. United Eur Gastroenterol J, 2016, 4(2): 314-318.

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