Adequate bowel cleansing is an important determinant of the efficacy of screening colonoscopy.
Polyethylene glycol (PEG)-based solutions are used commonly in bowel preparation, but their poor palatability and large volumes (4 L) influence compliance.
Adjunct therapies, such as bisacodyl, split-dose regimens, and lower-volume regimens have been tested.
Dr Brintha Enestvedt and colleagues performed a meta-analysis to determine whether a 4-L split dose of PEG is better than others for bowel cleansing before colonoscopy.
The team searched MEDLINE, the Cochrane Central Register of Controlled Trials and Database, recent abstracts from major conference proceedings, references from selected reviews and randomized trials (http://clinicaltrials.gov), and Google Scholar through 2011.
The researchers identified high-quality, randomized trials that compared 4-L split-dose PEG without adjunct therapy with other bowel preparation methods.
|The odds ratio for excellent or good bowel preparation quality for 4-L split-dose PEG was about 3.5|
|Clinical Gastroenterology & Hepatology|
The team considered 9 of 2477 trials in the analysis.
The researchers calculated pooled estimates of bowel preparation quality, preparation compliance, favorable overall experiences, willingness to repeat same preparation, and side effects.
The research team calculated pooled estimates of odds ratios by fixed- and random-effects models.
The researchers also assessed heterogeneity among studies and publication bias.
The overall pooled odds ratio for excellent or good bowel preparation quality for 4-L split-dose PEG was about 3.5, compared with other methods.
Although there was significant heterogeneity in results among studies, 7 of 9 reported a significant benefit from the 4-L split-dose PEG preparation.
There were no significant differences between PEG and others in preparation compliance, favorable overall experience, willingness to repeat the same preparation, abdominal cramping, nausea, or sleep disturbance.
The team found no significant publication bias based on funnel plot.
Dr Enestvedt's team concludes, "A meta-analysis showed that 4-L split-dose PEG is better than other bowel preparation methods for colonoscopy."
"Significant heterogeneity among studies might result from differences in patient demographics and protocols."
"A 4-L split dose of PEG should be considered the standard with which new bowel preparation methods are compared."