Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.5994
Peer-review started: May 28, 2017
First decision: June 23, 2017
Revised: June 29, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: August 28, 2017
To performed a systematic review and meta-analysis to determine any possible differences in terms of effectiveness, safety and tolerability between existing colon-cleansing products in patients with inflammatory bowel disease.
Systematic searches were performed (January 1980-September 2016) using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge for randomized trials assessing preparations with or without adjuvants, given in split and non-split dosing, and in high (> 3 L) or low-volume (2 L or less) regimens. Bowel cleansing quality was the primary outcome. Secondary outcomes included patient willingness-to-repeat the procedure and side effects/complications.
Out of 439 citations, 4 trials fulfilled our inclusion criteria (n = 449 patients). One trial assessed the impact of adding simethicone to polyethylene glycol (PEG) 4 L with no effect on bowel cleansing quality, but a better tolerance. Another trial compared senna to castor oil, again without any differences in term of bowel cleansing. Two trials compared the efficacy of PEG high-volume vs PEG low-volume associated to an adjuvant in split-dose regimens: PEG low-dose efficacy was not different to PEG high-dose; OR = 0.84 (0.37-1.92). A higher proportion of patients were willing to repeat low-volume preparations vs high-volume; OR = 5.11 (1.31-20.0).
In inflammatory bowel disease population, PEG low-volume regimen seems not inferior to PEG high-volume to clean the colon, and yields improved willingness-to-repeat. Further additional research is urgently required to compare contemporary products in this population.
Core tip: This is the first meta-analysis addressing the issue of bowel preparations in Inflammatory bowel disease (IBD) patients aiming to determine any differences in terms of effectiveness, safety and tolerability between existing colon-cleansing products. This work is especially timely considering that colonoscopy is used frequently in IBD patients for both diagnosis and surveillance, and that recommendation on how to prepare these patients prior to colonoscopy are based mostly on expert opinion. The results suggest that low-volume polyethylene glycol (PEG) preparation with adjuvants in split-dosing may represent a valid alternative to standard high-volume PEG with at least a similar efficacy and better acceptability.