A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy

Qingsong Xie, Linghui Chen, Fengqing Zhao, Xiaohu Zhou, Pengfei Huang, Lufei Zhang, Dongkai Zhou, Jianfeng Wei, Weilin Wang, Shusen Zheng, Qingsong Xie, Linghui Chen, Fengqing Zhao, Xiaohu Zhou, Pengfei Huang, Lufei Zhang, Dongkai Zhou, Jianfeng Wei, Weilin Wang, Shusen Zheng

Abstract

Background: Standard-volume polyethylene glycol (PEG) gut lavage solutions are safe and effective, but they require the consumption of large volumes of fluid. A new lower-volume solution of PEG plus ascorbic acid has been used recently as a preparation for colonoscopy.

Aim: A meta-analysis was performed to compare the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy.

Study: Electronic and manual searches were performed to identify randomized controlled trials (RCTs) that compared the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy. After a methodological quality assessment and data extraction, the pooled estimates of bowel preparation efficacy during bowel cleansing, compliance with preparation, willingness to repeat the same preparation, and the side effects were calculated. We calculated pooled estimates of odds ratios (OR) by fixed- and/or random-effects models. We also assessed heterogeneity among studies and the publication bias.

Results: Eleven RCTs were identified for analysis. The pooled OR for preparation efficacy during bowel cleansing and for compliance with preparation for low-volume PEG plus ascorbic acid were 1.08 (95% CI = 0.98-1.28, P = 0.34) and 2.23 (95% CI = 1.67-2.98, P<0.00001), respectively, compared with those for standard-volume PEG. The side effects of vomiting and nausea for low-volume PEG plus ascorbic acid were reduced relative to standard-volume PEG. There was no significant publication bias, according to a funnel plot.

Conclusions: Low-volume PEG plus ascorbic acid gut lavage achieved non-inferior efficacy for bowel cleansing, is more acceptable to patients, and has fewer side effects than standard-volume PEG as a bowel preparation method for colonoscopy.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flowchart of the studies identified…
Figure 1. Flowchart of the studies identified for the meta-analysis.
Figure 2. Forest plot showing equal bowel…
Figure 2. Forest plot showing equal bowel preparation efficacy of low-volume PEG plus ascorbic acid and standard-volume PEG as bowel preparations for colonoscopy.
Figure 3. Forest plot depicting better compliance…
Figure 3. Forest plot depicting better compliance with low-volume PEG plus ascorbic acid than with standard-volume PEG as bowel preparations for colonoscopy.
Figure 4. Forest plot revealing fewer overall…
Figure 4. Forest plot revealing fewer overall adverse events with low-volume PEG plus ascorbic acid than with standard-volume PEG as bowel preparations for colonoscopy.
Figure 5. Forest plot showing less vomiting…
Figure 5. Forest plot showing less vomiting with low-volume PEG plus ascorbic acid than with standard-volume PEG as bowel preparations for colonoscopy.
Figure 6. Forest plot showing less nausea…
Figure 6. Forest plot showing less nausea with low-volume PEG plus ascorbic acid than with standard-volume PEG as bowel preparations for colonoscopy.
Figure 7. Funnel plot showing no significant…
Figure 7. Funnel plot showing no significant publication bias for the primary outcome.
Figure 8. Risk of bias grapy: review…
Figure 8. Risk of bias grapy: review author’s judgements about each risk of bias item presented as percentages across all included studies.

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