Efficacy and Tolerability of High- vs Low-Volume Split-Dose Bowel Cleansing Regimens for Colonoscopy: A Systematic Review and Meta-analysis

Abstract

BACKGROUND & AIMS: Efficacy of bowel preparation is an important determinant of outcomes of colonoscopy. It is not clear whether approved low-volume polyethylene glycol (PEG) and non-PEG regimens are as effective as high-volume PEG regimens when taken in a split dose. METHODS: In a systematic review of multiple electronic databases through January 31, 2019 with a registered protocol (PROSPERO: CRD42019128067), we identified randomized controlled trials that compared low-vs high-volume bowel cleansing regimens, administered in a split dose, for colonoscopy. The primary efficacy outcome was rate of adequate bowel cleansing, and the secondary efficacy outcome was adenoma detection rate. Primary tolerability outcomes were compliance, tolerability, and willingness to repeat. We calculated relative risk (RR) and 95% CI values and assessed heterogeneity among studies by using the I 2 statistic. The overall quality of evidence was assessed using the GRADE framework.

1L- vs. 4L-Polyethylene glycol for bowel preparation before colonoscopy among inpatients: A propensity score-matching analysis

“…Constipated patients may be equally well-prepared with either low-or high-volume preparations [18] . These findings are of high relevance, as low-volume bowel preps are better tolerated and have a milder negative impact on patient experience [19] .…”

Colon Cancer: A Clinician’s Perspective in 2019

“…Many patients do not tolerate high-volume colon cleansing regimens. A systematic review of 17 randomized controlled trials showed that low-volume, split-dose regimens were as effective as high-volume, split-dose regimens in colon cleansing with better tolerance and superior compliance [31]. Patients should be given easy-to-understand colonoscopy prep instructions to improve compliance.…”

Endocuff-assisted versus Cap-assisted Colonoscopy in Increasing Adenoma Detection Rate. A Meta-analysis

“…Unfortunately, ADR varies widely ranging from 5 to 37.5% [4] depending on both adjunctive factors, such as improvement in bowel preparation [7] and implementation of minimal withdrawal time [8], and technological innovations. A recent network meta-analysis published by our group showed that add-on devices, enhanced imaging techniques and low-cost optimization of existing resources (particularly water-aided colonoscopy) are associated with significant improvement in ADR and advanced ADR (aADR), whereas a clear benefit of…”