Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7844-7858
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7844
Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis
Hui Pan, Xiao-Ling Zheng, Chao-Ying Fang, Lan-Zai Liu, Jian-Su Chen, Chao Wang, Yu-Dai Chen, Jian-Min Huang, Yu-Shen Zhou, Li-Ping He
Hui Pan, Xiao-Ling Zheng, Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, The Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Chao-Ying Fang, Lan-Zai Liu, Jian-Su Chen, Chao Wang, Yu-Dai Chen, Jian-Min Huang, Yu-Shen Zhou, Li-Ping He, Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China
Author contributions: Pan H, Fang CY, Chen JS and Wang C contributed to data curation and writing the original draft; Zheng XL and Pan H contributed to the methodology; Zheng XL, Pan H and Fang CY contributed to the project administration; Chen YD, Huang JM and Zhou YS contributed to the supervision; Zheng XL and He LP contributed to the writing, reviewing and editing; all authors have read and approved the final manuscript.
Supported by Startup Fund for scientific research, Fujian Medical University, No. 2019QH1181.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Ling Zheng, MD, PhD, Chief Physician, Professor, Gastrointestinal Endoscopy Center, The Shengli Clinical Medical College, Fujian Medical University, No. 134 Dong Street, Gulou District, Fuzhou 350001, Fujian Province, China. shengli888220@163.com
Received: September 8, 2021
Peer-review started: September 8, 2021
First decision: December 4, 2021
Revised: December 11, 2021
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: August 6, 2022
Processing time: 316 Days and 17.8 Hours
Abstract
BACKGROUND

Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the “gold standard” for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate.

AIM

To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.

METHODS

We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.

RESULTS

A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs (P < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms (P > 0.05).

CONCLUSION

Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.

Keywords: Bowel preparation, Colonoscopy, Polyethylene glycol, Same-day single-dose, Split-dose, Meta-analysis

Core Tip: Same-day single-dose polyethylene glycol-based regimens for bowel preparation seemed to be equal or better than large-volume (≥ 3 L) split-dose polyethylene glycol solution in terms of bowel cleanliness and tolerability as long as the optimal preparation-to-colonoscopy interval and diet instruction for bowel preparation were respected.