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Taclob JA, Kalas MA, McCallum RW. Examining linaclotide for the treatment of chronic idiopathic constipation. Expert Opin Pharmacother 2024. [PMID: 39058326 DOI: 10.1080/14656566.2024.2386160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) is characterized by infrequent bowel movements and hard stools lasting for at least three months or longer. This disease affects 8-12% of the US population and 10-17% of the world population. Treatment and management involve identifying the primary cause, changing dietary habits, and adequate physical activity. Linaclotide is a guanylate cyclase-agonist acting locally in the luminal surface of the intestinal enterocyte leading to a signal transduction cascade, activation of the cystic fibrosis transmembrane conductance regulator (CFTR), thus increasing secretion of chloride and bicarbonate into the intestinal lumen with eventual increased intestinal fluid and faster transit time. AREAS COVERED We reviewed multiple studies and did a thorough literature review on CIC including its pathophysiology. Through this literature review we were able to discuss and give the context and rationale for drug regimens indicated for CIC. EXPERT OPINION The era we live in right now is akin to nutrient-rich and fertilized soil as knowledge and resources are abundant. The opportunities and potential are endless. Constipation being more extensively studied, our understanding of medications and diseases broadens, leading to novel medications being discovered. Linaclotide is a pioneer in this aspect and can pave the way for future generations.
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Affiliation(s)
- Jeff Angelo Taclob
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
| | - M Ammar Kalas
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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Zhao HY, Cai XF, Chen PP, Wang XB, Liu CX, Chen D, Xu J. Efficacy of linaclotide in combination with polyethylene glycol for bowel preparation in Chinese patients undergoing colonoscopy polypectomy: protocol for a randomised controlled trial. BMJ Open 2024; 14:e080723. [PMID: 39043596 DOI: 10.1136/bmjopen-2023-080723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Adequate bowel preparation is essential for successful colonoscopy and polypectomy procedures. However, a significant proportion of patients still exhibit suboptimal bowel preparation, ranging from 18% to 35%. The effectiveness of bowel preparation agents can be hampered by volume and taste, adversely affecting patient compliance and tolerance. Therefore, exploring strategies to minimise laxative volume and improve patient tolerance and adherence is imperative to ensure optimal bowel preparation quality. METHODS AND ANALYSIS This study is a two-arm, single-blinded, parallel-group randomised controlled trial designed to compare the efficacy of 2 L polyethylene glycol (PEG) combined with linaclotide with 4 L PEG in bowel cleansing. A total of 422 participants will be randomly assigned in a 1:1 ratio to either the intervention group (2 L PEG combined with 580 µg linaclotide) or the control group (4 L PEG). The primary outcome measure is bowel cleansing efficacy, which is assessed using the Boston Bowel Preparation Scale. Secondary outcomes include evaluating the tolerability and safety of the bowel preparation regimens, bowel diary assessments, postpolypectomy complications (such as bleeding and perforation) and the size and number of removed polyps. ETHICS AND DISSEMINATION The study has received approval from the Clinical Research Ethics Committee of The First Affiliated Hospital, Zhejiang University School of Medicine. The findings of this trial will serve as a valuable resource for clinicians and patients undergoing colonoscopy polypectomy by guiding the selection of appropriate bowel preparation regimens. Study findings will be disseminated to participants, presented at professional society meetings, and published in peer-reviewed journals. This trial was registered on the Chinese Clinical Trial Registry with registration number ChiCTR2300075410.
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Affiliation(s)
- Hui-Ying Zhao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Feng Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ping-Ping Chen
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Bin Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chao-Xu Liu
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Chen
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Xu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Wang L, Zhang Y, Li J, Ran Y, Wang X, Ma X, Yang Q, Wang F, Hu J, Zhuang K, Wang J, Quan X, Wang S, Meng R, Chen Y, Li X, Song Y, Han S, Hu H, Li L, Dai F. Efficacy of Polyethylene Glycol Electrolyte Powder Combined With Linaclotide for Colon Cleansing in Patients With Chronic Constipation Undergoing Colonoscopy: A Multicenter, Single-Blinded, Randomized Controlled Trial. Clin Transl Gastroenterol 2024; 15:e1. [PMID: 38713137 PMCID: PMC11196075 DOI: 10.14309/ctg.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Constipation is an independent risk factor for poor bowel preparation. This study aimed to evaluate the bowel cleansing efficacy and safety of polyethylene glycol (PEG) combined with linaclotide (lin) for colonoscopy in patients with chronic constipation (CC). METHODS This single-blinded, randomized, controlled, and multicenter study was conducted from July 2021 to December 2022 at 7 hospitals. Patients with CC who underwent colonoscopies were enrolled and randomly assigned to 4 groups with split-PEG regimens: 4L-PEG group, 4L-PEG+1d-Lin group, 3L-PEG+1d-Lin group, and 3L-PEG+3d-Lin group. The primary outcome was rates of adequate bowel preparation, defined as a total BBPS score ≥6 and a score ≥2 for each segment. Secondary outcomes were adverse effects, sleep quality, willingness to repeat the colonoscopy, adenoma detection rate, and polyp detection rate. RESULTS Five hundred two patients were enrolled. The rates of adequate bowel preparation (80.0% vs 60.3%, P < 0.001; 84.4% vs 60.3%, P < 0.001) and the total Boston Bowel Preparation Scale (BBPS) scores (6.90 ± 1.28 vs 6.00 ± 1.61, P < 0.001; 7.03 ± 1.24 vs 6.00 ± 1.61, P < 0.01) in the 4L-PEG+1d-Lin group and the 3L-PEG+3d-Lin group were superior to that in the 4L-PEG group. Compared with the 4L-PEG group, the 4L-PEG+1d-Lin group (66.7% vs 81.7%, P = 0.008) and the 3L-PEG+3d-Lin group (75.0% vs 81.7%, P = 0.224) had a lower percentage of mild adverse events. No statistically significant difference in willingness to repeat the colonoscopy, sleep quality, polyp detection rate, or adenoma detection rate was observed among groups. DISCUSSION PEG combined with linaclotide might be an effective method for bowel preparation before colonoscopy in patients with CC.
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Affiliation(s)
- Lianli Wang
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Zhang
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingyao Li
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Ran
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuehong Wang
- Division of Gastroenterology, Qinghai University Affiliated Hospital, Xining, China
| | - Xueqin Ma
- Division of Gastroenterology, Qinghai University Affiliated Hospital, Xining, China
| | - Qi Yang
- Division of Gastroenterology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Fang Wang
- Division of Gastroenterology, The Affiliated Hospital of Northwest University, Xi'an, China
| | - Jianping Hu
- Division of Gastroenterology, The First People's Hospital of Yinchuan, Yinchuan, China
| | - Kun Zhuang
- Division of Gastroenterology, Xi'an Central Hospital, Xi'an, China
| | - Jinhai Wang
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaojing Quan
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shenhao Wang
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruiting Meng
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yindi Chen
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuerong Li
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yahua Song
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuang Han
- Division of Gastroenterology, Honghui Hospital, Xi'an Jiao Tong University College of Medicine, Beilin District, Xi'an, China
| | - Huige Hu
- Division of Gastroenterology, Xi'an International Medic Center, Xi'an, China
| | - Laifu Li
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fei Dai
- Division of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Song J, Xu Y, Chen C, Qi X, Hu P, Ying X, Li H. The Effects of Combined Use of Linaclotide and Polyethylene Glycol Electrolyte Powder in Colonoscopy Preparation for Patients With Chronic Constipation. Surg Laparosc Endosc Percutan Tech 2024; 34:129-135. [PMID: 38444073 DOI: 10.1097/sle.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE The purpose of this study is to evaluate the safety and efficacy of linaclotide and polyethylene glycol (PEG) electrolyte powder in patients with chronic constipation undergoing colonoscopy preparation. PATIENTS AND METHODS We included 260 patients with chronic constipation who were scheduled to undergo a colonoscopy. They were equally divided into 4 groups using a random number table: 4L PEG, 3L PEG, 3L PEG+L, and 2L PEG+L. The 4 groups were compared based on their scores on the Boston Bowel Preparation Scale (BBPS) and Ottawa Bowel Preparation Quality Scale (OBPQS), adverse reactions during the bowel preparation procedure, colonoscope insertion time, colonoscope withdrawal time, detection rate of adenomas, and their willingness to repeat bowel preparation. RESULTS In terms of the score of the right half of the colon, the score of the transverse colon, the total score using BBPS, and the total score using OBPQS, the 3L PEG (polyethylene glycol)+L group was superior to groups 3L PEG and 2L PEG+L ( P <0.05), but comparable to the 4L PEG group ( P >0.05). The incidence rate of vomiting was higher in the 4L PEG group than in the 2L PEG+L group ( P <0.05). There was no statistically significant difference in the insertion time of the colonoscope between the 4 groups. The colonoscope withdrawal time in the 3L PEG+L group was shorter than in groups 4L PEG and 3L PEG ( P <0.05) and comparable to that in the 4L PEG group ( P >0.05). There was no statistically significant difference in the rate of adenoma detection among the 4 groups ( P >0.05). The 4L PEG group was the least willing of the 4 groups to undergo repeated bowel preparation ( P <0.05). CONCLUSION The 3L PEG+L is optimal among the 4 procedures. It can facilitate high-quality bowel preparation, reduce the incidence of nausea during the bowel preparation procedure, and encourage patients to undertake repeated bowel preparation.
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Affiliation(s)
- Jian Song
- Department of Gastroenterology, The Affiliated People's Hospital of Ningbo University, Ningbo, China
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He Y, Liu Q, Chen YW, Cui LJ, Cao K, Guo ZH. Bowel preparation protocol for hospitalized patients ages 50 years or older: A randomized controlled trial. World J Gastrointest Endosc 2024; 16:18-28. [PMID: 38313462 PMCID: PMC10835475 DOI: 10.4253/wjge.v16.i1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years. Therefore, the population that is ≥ 50 years in age requires long-term and regular colonoscopies. Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies. The standard bowel preparation regimen of 4-L polyethylene glycol (PEG) is effective but poorly tolerated. AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients ≥ 50 years in age. METHODS Patients were randomly assigned to group 1 (2-L PEG + 30-mL lactulose + a low-residue diet) or group 2 (4-L PEG). Adequate bowel preparation was defined as a Boston bowel preparation scale (BBPS) score of ≥ 6, with a score of ≥ 2 for each segment. Non-inferiority was prespecified with a margin of 10%. Additionally, the degree of comfort was assessed based on the comfort questionnaire. RESULTS The proportion of patients with a BBPS score of ≥ 6 in group 1 was not significantly different from that in group 2, as demonstrated by intention-to-treat (91.2% vs 91.0%, P = 0.953) and per-protocol (91.8% vs 91.0%, P = 0.802) analyses. Furthermore, in patients ≥ 75 years in age, the proportion of BBPS scores of ≥ 6 in group 1 was not significantly different from that in group 2 (90.9% vs 97.0%, P = 0.716). Group 1 had higher comfort scores (8.85 ± 1.162 vs 7.59 ± 1.735, P < 0.001), longer sleep duration (6.86 ± 1.204 h vs 5.80 ± 1.730 h, P < 0.001), and fewer awakenings (1.42 ± 1.183 vs 2.04 ± 1.835, P = 0.026) than group 2. CONCLUSION For hospitalized patients ≥ 50 years in age, the bowel preparation regimen comprising 2-L PEG + 30-mL lactulose + a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.
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Affiliation(s)
- Yu He
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qi Liu
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yi-Wen Chen
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Li-Jian Cui
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Zi-Hao Guo
- Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Wu LM, Xu CL, Xia XP, Lu GR. Linaclotide combined with polyethylene glycol regimen for bowel preparation in patients with chronic constipation: A prospective randomized controlled study. Shijie Huaren Xiaohua Zazhi 2023; 31:816-821. [DOI: 10.11569/wcjd.v31.i19.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The standard of bowel preparation sometimes is not met by using the 3 L polyethylene glycol electrolyte (PEG) method in patients with chronic constipation, which significantly impacts the diagnosis of colorectal diseases. Linaclotide can be utilized for the treatment of chronic idiopathic constipation. It is worth investigating whether linaclotide combined with 3 L PEG regimen can further optimize intestinal preparation in patients with chronic constipation.
AIM To evaluate the efficacy and comfort of linaclotide combined with PEG for bowel preparation in patients with chronic constipation by comparing with PEG.
METHODS From July 2021 to December 2022, 120 patients with chronic constipation who underwent colonoscopy at the Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University were selected as research subjects. Using the random number table method, the patients were randomly divided into either a control group or an observation group. Both groups were given 3 L PEG and methylene silicone oil, and the observation group was additionally given three linaclotide capsules. The score of Boston Bowel Preparation Scale (BBPS), colonoscopy entry time, the detection rate of polyps or adenomas, and the incidence of adverse reactions were compared between two groups. Independent sample t test and χ2 test were used for statistical comparisons.
RESULTS The BBPS scores of the right segment, the middle segment, and the left segment, as well as the BBPS score of the overall bowel were higher in the observation group (P < 0.05). The colonoscopy entry time was shorter in the observation group (P < 0.05). The detection rates of polyps and adenomas (22% [11/50] vs 46% [23/50]; 14% [7/50] vs 32% [16/50]) differed significantly between the control group and observation group (P < 0.05). The incidence of adverse reactions in the observation group was significantly shorter than that of the control group (P < 0.05).
CONCLUSION Compared with the 3 L PEG method, linaclotide combined with 3 L PEG regimen can achieve better bowel preparation effect, reduce the incidence of adverse reactions, and has higher safety, which is worthy of further clinical promotion.
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Affiliation(s)
- Li-Min Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Chang-Long Xu
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xuan-Ping Xia
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Guang-Rong Lu
- Department of Gastroenterology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Zhang C, Chen X, Tang B, Shan J, Qin J, He J, Wu X, Li J, Li A, Hao M, Wen L, Sun X. A novel ultra-low-volume regimen combining 1 L polyethylene glycol and linaclotide versus 2 L polyethylene glycol for colonoscopy cleansing in low-risk individuals: a randomized controlled trial. Gastrointest Endosc 2023; 97:952-961.e1. [PMID: 36572127 DOI: 10.1016/j.gie.2022.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The single dose of 2 L polyethylene glycol (PEG) has shown high cleaning efficacy and tolerability in low-risk patients. However, the dosage of this regimen is still challenging for many patients. We investigated the efficacy and tolerability of a novel ultra-low-volume regimen using 1 L PEG and linaclotide (1 L PEG+L) versus a single dose of 2 L PEG in low-risk patients. METHODS In this prospective, randomized, observer-blinded, multicenter study, low-risk adult patients scheduled for colonoscopy were enrolled and randomized (1:1) to receive the 1 L PEG+L regimen or the 2 L PEG regimen. The primary outcome was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale. Secondary outcomes included cecal intubation rate, cecal insertion time, withdrawal time, polyp detection rate and adenoma detection rate, tolerability, adverse events, and willingness to repeat bowel preparation. The full analysis set (FAS) and per-protocol set (PPS) were used for statistical analyses. RESULTS A total of 548 patients comprised the FAS, and 522 patients comprised the PPS. Noninferiority on adequate bowel cleansing of 1 L PEG+L vs 2 L PEG was established both in FAS (90.5% vs 91.6%, P = .644) and PPS (90.3% vs 92.4%, P = .390). There were no significant differences regarding the total score and each segment scores of the Boston Bowel Preparation Scale, cecal intubation rate, cecal insertion time, withdrawal time, polyp detection rate, and adenoma detection rate (all, P > .05). However, patients in the 1 L PEG+L group reported less nausea (7.7% vs 17.1%, P < .01) and vomiting (4.0% vs 10.9%, P < .01) and had a higher willingness to repeat bowel preparation (95.2% vs 82.2%, P < .01). CONCLUSIONS The regimen of 1 L PEG+L was not inferior to 2 L PEG on colon cleansing, with better tolerability and higher willingness to repeat the bowel preparation in a low-risk population. (Clinical trial registration number: ChiCTR2100053273.).
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Affiliation(s)
- Chen Zhang
- Department of Gastroenterology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Xia Chen
- Department of Gastroenterology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Bin Tang
- Department of Digestive, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan, China
| | - Jing Shan
- Department of Gastroenterology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Jiamin Qin
- Department of Gastroenterology, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan, China
| | - Juan He
- Department of Gastroenterology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xueqin Wu
- Department of Digestive, People's Hospital of Zhongjiang County, Zhongjiang, Sichuan, China
| | - Jiao Li
- Department of Gastroenterology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Aoshuang Li
- Department of Gastroenterology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Menghao Hao
- Department of Gastroenterology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Liming Wen
- Department of Gastroenterology, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan, China.
| | - Xiaobin Sun
- Department of Gastroenterology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China.
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Pan H, Zheng XL, Fang CY, Liu LZ, Chen JS, Wang C, Chen YD, Huang JM, Zhou YS, He LP. Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis. World J Clin Cases 2022; 10:7844-7858. [PMID: 36158495 PMCID: PMC9372824 DOI: 10.12998/wjcc.v10.i22.7844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/11/2021] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the “gold standard” for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate.
AIM To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.
METHODS We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.
RESULTS A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs (P < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms (P > 0.05).
CONCLUSION Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.
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Affiliation(s)
- Hui Pan
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, The Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Xiao-Ling Zheng
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, The Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Chao-Ying Fang
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Lan-Zai Liu
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Jian-Su Chen
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Chao Wang
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Yu-Dai Chen
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Jian-Min Huang
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Yu-Shen Zhou
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
| | - Li-Ping He
- Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
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