CT colonography: can we achieve an adequate bowel preparation without diet restriction?

To evaluate if an adequate bowel preparation for CT colonography, can be achieved without diet restriction, using a reduced amount of cathartic agent and fecal tagging. To investigate the influence of patients' characteristics on bowel preparation and the impact on patients' compliance. In total, 1446 outpatients scheduled for elective CT colonography were prospectively enrolled. All patients had the same bowel preparation based on a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) the day before the exam and a fecal tagging agent (60 ml of hyperosmolar oral iodinated agent) the day of the exam. No dietary restrictions were imposed before the exam. The bowel preparation was evaluated using a qualitative and quantitative score. Patients were grouped by age, gender, and presence of diverticula in both scores. Patients' compliance has been evaluated with a questionnaire after the end of the exam and with a phone-calling interview the day after the exam. According to the qualitative score, adequate bowel preparation was achieved in 1349 patients (93.29%) and no statistical differences were observed among the subgroups of patients. Quantitative scores demonstrated that colon distension was significantly better in younger patients and without diverticula. A good patients' compliance was observed and most patients (96.5%) were willing to repeat it. The lack of diet restriction does not affect the quality of CTC preparation and good patient's compliance could potentially increase the participation rate in CRC screening programs. An adequate quality bowel preparation for CT colonography can be achieved without diet restriction, using a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) and fecal tagging (60 ml of hyperosmolar oral iodinated agent). A bowel preparation based on the combination of a reduced amount of cathartic agent and fecal tagging, without diet restriction, allows obtaining good quality in more than 90% of patients. The bowel preparation scheme proposed reduces the distress and discomfort experienced by the patients improving adherence to CTC.