Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2017; 23(32): 5994-6002
Published online Aug 28, 2017. doi: 10.3748/wjg.v23.i32.5994
Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease
Sophie Restellini, Omar Kherad, Talat Bessissow, Charles Ménard, Myriam Martel, Maryam Taheri Tanjani, Peter L Lakatos, Alan N Barkun
Sophie Restellini, Talat Bessissow, Peter L Lakatos, Alan N Barkun, Division of Gastroenterology, Department of Medicine, McGill University Health Center, Montreal, QC H3G1A4, Canada
Omar Kherad, Division of Internal Medicine, Department of Medicine, La Tour Hospital and University of Geneva, 1217 Geneva, Switzerland
Charles Ménard, Division of Gastroenterology, Department of Medicine, University of Sherbrooke, Sherbrooke, QC J1K2R1, Canada
Myriam Martel, Alan N Barkun, Department of Clinical Epidemiology, McGill University and the McGill University Health Center, Montreal, QC H3G1A4, Canada
Maryam Taheri Tanjani, Department of Family Medicine, Queens University, Kingston, ON K7L 3G2, Canada
Author contributions: Restellini S and Kherad O contributed equally to this work; Restellini S, Kherad O, Bessissow T, Ménard C, Martel M, Barkun AN conceptioned and design; Restellini S, Kherad O, Martel M, Taheri Tanjani M acquisition of data; Restellini S, Kherad O, Bessissow T, Ménard C, Martel M, Taheri Tanjani M, Barkun AN analysis and interpretation of the data; Restellini S, Kherad O, Bessissow T, Ménard C, Martel M, Barkun AN drafting of the article; Restellini S, Kherad O, Bessissow T, Ménard C, Martel M, Taheri Tanjani M, Lakatos PL and Barkun AN critical revision of the article for important intellectual content; Restellini S, Kherad O, Bessissow T, Ménard C, Martel M, Taheri Tanjani M, Lakatos PL, Barkun AN final approval of the article.
Conflict-of-interest statement: Restellini S, Kherad O, Bessissow T, Ménard C, Martel M, Lakatos PL and Taheri Tanjani M have no relevant conflicts of interest; Barkun AN has received fees for serving as a consultant and/or an advisory board member for Cook, Olympus and Pendopharm, and has received research funding from Boston Scientific, Cook and Pendopharm.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alan N Barkun, MD, Full Professor, Division of Gastroenterology, McGill University Health Center, Montreal General Hospital site, 1650 Cedar Avenue, room D7-346, Montréal, QC H3G 1A4, Canada. alan.barkun@muhc.mcgill.ca
Telephone: +1-514-9348309 Fax: +1-514-8348531
Received: May 26, 2017
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
Abstract
AIM

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Inflammatory bowel disease, Polyethylene glycol, Colonoscopy, Meta-analysis

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.