Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis

Robert E Clark, Jonathan D Godfrey, Abhishek Choudhary, Imran Ashraf, Michelle L Matteson, Matthew L Bechtold, Robert E Clark, Jonathan D Godfrey, Abhishek Choudhary, Imran Ashraf, Michelle L Matteson, Matthew L Bechtold

Abstract

Background: Quality of bowel preparation prior to colonoscopy is essential. Studies have shown a reduced volume of polyethylene glycol (PEG) with bisacodyl may improve visualization and tolerability, but results have varied. Therefore, a meta-analysis was performed to analyze the efficacy of a low-volume PEG bowel preparation with bisacodyl for bowel preparation prior to colonoscopy.

Methods: Multiple databases were searched (June 2012). Only randomized controlled trials in peer-reviewed journals on adult subjects comparing low-volume PEG (2 L) with bisacodyl versus 4 L PEG were included. Meta-analysis for the efficacy of low-volume PEG with bisacodyl and 4 L PEG were analyzed by calculating pooled estimates of number of satisfactory, excellent, and poor bowel preparations as well as adverse patient events (abdominal pain, nausea, vomiting, bloating).

Results: Six studies (N=1,540) met the inclusion criteria. No statistically significant differences were noted between low-volume PEG (2 L) with bisacodyl and 4 liters PEG for number of satisfactory (OR 0.86; 95% CI: 0.45-1.63, P=0.64), excellent (OR 1.08; 95% CI: 0.78-1.50, P=0.63), or poor bowel preparations (OR 0.68; 95% CI: 0.35-1.34, P=0.27). A statistically significant decrease in nausea (OR 0.57; 95% CI: 0.36-0.89, P=0.01), vomiting (OR 0.57; 95% CI: 0.40-0.81, P<0.01), and bloating (OR 0.65; 95% CI: 0.49-0.87, P<0.01) was noted for the low-volume PEG with bisacodyl as compared to 4 L PEG. No statistically significant differences were noted between the two groups for abdominal pain (P=0.62).

Conclusion: Low-volume PEG (2 L) with bisacodyl demonstrates less nausea, vomiting, and bloating without adversely affecting the bowel preparation.

Keywords: Polyethylene glycol; bisacodyl; colonoscopy; meta-analysis.

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Article search results for this meta-analysis
Figure 2
Figure 2
(A) Forest plots for quality of bowel preparation between low-volume polyethylene glycol (PEG) with bisacodyl compared to full-dose PEG for satisfactory, (B) excellent, (C) poor preparation
Figure 3
Figure 3
Forest plot for nausea between low-volume polyethylene glycol (PEG) with bisacodyl compared to full-dose PEG
Figure 4
Figure 4
Forest plot for vomiting between low-volume polyethylene glycol (PEG) with bisacodyl compared to full-dose PEG
Figure 5
Figure 5
Forest plot for bloating between low-volume polyethylene glycol (PEG) with bisacodyl compared to full-dose PEG
Figure 6
Figure 6
Funnel plot demonstrating no publication bias

References

    1. Kim WH, Cho YJ, Park JY, Min PK, Kang JK, Park IS. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc. 2000;52:600–605.
    1. Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97:1696–1700.
    1. Tooson JD, Gates LK., Jr Bowel preparation before colonoscopy. Choosing the best lavage regimen. (207-212).Postgrad Med. 1996;100:203–204. 214.
    1. Davis GR, Santa Ana CA, Morawski SG, Fordtran JS. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology. 1980;78(5 Pt 1):991–995.
    1. Seeff LC, Richards TB, Shapiro JA, et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology. 2004;127:1670–1677.
    1. Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–1802.
    1. Pontone S, Angelini R, Standoli M, et al. Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy. World J Gastroenterol. 2011;17:4689–4695.
    1. Jansen SV, Goedhard JG, Winkens B, van Deursen CT. Preparation before colonoscopy: a randomized controlled trial comparing different regimes. Eur J Gastroenterol Hepatol. 2011;23:897–902.
    1. Corporaal S, Kleibeuker JH, Koornstra JJ. Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy. Scand J Gastroenterol. 2010;45:1380–1386.
    1. Marmo R, Rotondano G, Riccio G, et al. Effective bowel cleansing before colonoscopy: A randomized study of split-dosage versus non-split dosage regimens of high-volume versus low-volume polyethylene glycol solutions. Gastrointest Endosc. 2010;72:313–20.
    1. Sharma VK, Chockalingham SK, Ugheoke EA, et al. Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation. Gastrointest Endosc. 1998;47:167–171.
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
    1. Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ. 2001;323:42–46.
    1. Adams WJ, Meagher AP, Lubowski DZ, King DW. Bisacodyl reduces the volume of polyethylene glycol solution required for bowel preparation. Dis Colon Rectum. 1994;37:229–233.
    1. Huppertz-Hauss G, Bretthauer M, Sauar J, et al. Polyethylene glycol versus sodium phosphate in bowel cleansing for colonoscopy: a randomized trial. Endoscopy. 2005;37:537–541.
    1. DiPalma JA, Wolff BG, Meagher A, Cleveland M. Comparison of reduced volume versus four liters sulfate-free electrolyte lavage solutions for colonoscopy colon cleansing. Am J Gastroenterol. 2003;98:2187–2191.
    1. Ker TS. Comparison of reduced volume versus four-liter electrolyte lavage solutions for colon cleansing. Am Surg. 2006;72:909–911.
    1. Kao D, Lalor E, Sandha G, et al. A randomized controlled trial of four precolonoscopy bowel cleansing regimens. Can J Gastroenterol. 2011;25:657–662.
    1. Hookey LC, Depew WT, Vanner SJ. Combined low volume polyethylene glycol solution plus stimulant laxatives versus standard volume polyethylene glycol solution: a prospective, randomized study of colon cleansing before colonoscopy. Can J Gastroenterol. 2006;20:101–105.
    1. Golub RW, Kerner BA, Wise WE, Jr, et al. Colonoscopic bowel preparations--which one? A blinded, prospective, randomized trial. Dis Colon Rectum. 1995;38:594–599.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever