Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis

Abstract

AIMTo determine the best option for bowel preparation [sodium picosulphate or polyethylene glycol (PEG)] for elective colonoscopy in adult outpatients.METHODSA systematic review of the literature following the PRISMA guidelines was performed using Medline, Scopus, EMBASE, Central, Cinahl and Lilacs. No restrictions were placed for country, year of publication or language. The last search in the literature was performed on November 20th, 2017. Only randomized clinical trials with full texts published were included. The subjects included were adult outpatients who underwent bowel cleansing for elective colonoscopy. The included studies compared sodium picosulphate with magnesium citrate (SPMC) and PEG for bowel preparation. Exclusion criteria were the inclusion of inpatients or groups with specific conditions, failure to mention patient status (outpatient or inpatient) or dietary restrictions, and permission to have unrestricted diet on the day prior to the exam. Primary outcomes were bowel cleaning success and/or tolerability of colon preparation. Secondary outcomes were adverse events, polyp and adenoma detection rates. Data on intention-to-treat were extracted by two independent authors and risk of bias assessed through the Jadad scale. Funnel plots, Egger’s test, Higgins’ test (I2) and sensitivity analyses were used to assess reporting bias and heterogeneity. The meta-analysis was performed by computing risk difference (RD) using Mantel-Haenszel (MH) method with fixed-effects (FE) and random-effects (RE) models. Review Manager 5 (RevMan 5) version 6.1 (The Cochrane Collaboration) was the software chosen to perform the meta-analysis.RESULTS662 records were identified but only 16 trials with 6200 subjects were included for the meta-analysis. High heterogeneity among studies was found and sensitivity analysis was needed and performed to interpret data. In the pooled analysis, SPMC was better for bowel cleaning [MH FE, RD 0.03, IC (0.01, 0.05), P = 0.003, I2 = 33%, NNT 34], for tolerability [MH RE, RD 0.08, IC (0.03, 0.13), P = 0.002, I2 = 88%, NNT 13] and for adverse events [MH RE, RD 0.13, IC (0.05, 0.22), P = 0.002, I2 = 88%, NNT 7]. There was no difference in regard to polyp and adenoma detection rates. Additional analyses were made by subgroups (type of regimen, volume of PEG solution and dietary recommendations). SPMC demonstrated better tolerability levels when compared to PEG in the following subgroups: “day-before preparation” [MH FE, RD 0.17, IC (0.13, 0.21), P < 0.0001, I2 = 0%, NNT 6], “preparation in accordance with time interval for colonoscopy” [MH RE, RD 0.08, IC (0.01, 0.15), P = 0.02, I2 = 54%, NNT 13], when compared to “high-volume PEG solutions” [MH RE, RD 0.08, IC (0.01, 0.14), I2 = 89%, P = 0.02, NNT 13] and in the subgroup “liquid diet on day before” [MH RE, RD 0.14, IC (0.06,0.22), P = 0.0006, I2 = 81%, NNT 8]. SPMC was also found to cause fewer adverse events than PEG in the “high-volume PEG solutions” [MH RE, RD -0.18, IC (-0.30, -0.07), P = 0.002, I2 = 79%, NNT 6] and PEG in the “low-resid...

<p>Efficacy and Patient Tolerability of Split-Dose Sodium Picosulfate/Magnesium Citrate (SPMC) Oral Solution Compared to the Polyethylene Glycol (PEG) Solution for Bowel Preparation in Outpatient Colonoscopy: An Evidence-Based Review</p>

“…Clinical and Experimental Gastroenterology 2020:13 submit your manuscript | www.dovepress.com Similarly, in a recent systematic review and metaanalysis, Rocha et al 7 analyzed 16 RCTs and compared SPMC and PEG before elective outpatient colonoscopy. The authors concluded that SPMC and PEG can be used for split preparations as there are no difference in bowel cleaning success, tolerability, and adverse events, but SPMC should be the preferred choice for day-before preparations because of its improved tolerability.…”

“…However, the efficacy of colonoscopy in the detection of high-risk lesions is greatly dependent on the quality of the pre-colonoscopy bowel preparation 1,5 and, even in emergency procedures, adequate and thorough bowel preparation can improve patient safety and outcomes. [6][7][8][9][10][11][12][13][14] There are various factors, such as patient medical comorbidities, tolerance and compliance, and cost burden of preparations which are important considerations in selecting an agent. Polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate (SPMC) have emerged as two of the most commonly used agents worldwide.…”

Sodium picosulphate magnesium citrate versus 4L split-dose polyethylene glycol for bowel cleansing prior to colonoscopy in high fibre diet African patients

“…More so, in Africans with a typical high fibre diet pattern, there is the need for compliance to a minimum of 2-day dietary restriction unlike the one-day dietary restriction advocated by European gastroenterology society [ 14 ]. Currently, there is high level evidence from meta-analyses of international studies validating the efficacy and safety of PEG and SPMC for bowel preparation prior to colonoscopy however lacking in African patients with typical high fibre diet pattern [ 15 , 16 ]. There is a paucity of African literature on bowel preparation for colonoscopy using PEG and SPMC.…”

Forced Degradation Studies on Sodium Picosulfate and Separation of 15 Process Related Impurities/Degradants by HPLC

“…Sodium Picosulfate 4,4'-(2-pyridylmethylene) diphenyl bis (hydrogen sulfate) disodium [ Figure 1] belongs to a drug class known as a stimulant laxative [1] [2]. After being taken orally, it is metabolized into 4,4'-dihydroxydiphenyl-(2-pyridiyl) methane by the bacteria naturally present in the large intestine.…”