Efficacy and Tolerability of High- vs Low-Volume Split-Dose Bowel Cleansing Regimens for Colonoscopy: A Systematic Review and Meta-analysis
- PMID: 31683057
- DOI: 10.1016/j.cgh.2019.10.044
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 I2 statistic. The overall quality of evidence was assessed using the GRADE framework.
Results: In an analysis of data from 17 randomized controlled trials, comprising 7528 patients, we found no significant differences in adequacy of bowel cleansing between the low- vs high-volume split-dose regimens (86.1% vs 87.4%; RR, 1.00; 95% CI, 0.98-1.02) and there was minimal heterogeneity (I2 = 17%). There was no significant difference in adenoma detection rate (RR, 0.96; 95% CI, 0.87-1.08) among 4 randomized controlled trials. Compared with high-volume, split-dose regimens, low-volume split-dose regimens had higher odds for compliance or completion (RR, 1.06; 95% CI, 1.02-1.10), tolerability (RR, 1.39; 95% CI, 1.12-1.74), and willingness to repeat bowel preparation (RR, 1.41; 95% CI, 1.20-1.66). The overall quality of evidence was moderate.
Conclusions: Based on a systematic review of 17 randomized controlled trials, low-volume, split-dose regimens appear to be as effective as high-volume, split-dose regimens in bowel cleansing and are better tolerated, with superior compliance.
Keywords: Adherence; Comparative; Endoscopy; Screening.
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
Similar articles
-
Split-Dose Preparations Are Superior to Day-Before Bowel Cleansing Regimens: A Meta-analysis.Gastroenterology. 2015 Jul;149(1):79-88. doi: 10.1053/j.gastro.2015.04.004. Epub 2015 Apr 8. Gastroenterology. 2015. PMID: 25863216
-
A Multicenter Randomized Controlled Trial Comparing Two Bowel Cleansing Regimens for Colonoscopy After Failed Bowel Preparation.Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1283-e1291. doi: 10.1016/j.cgh.2021.07.015. Epub 2021 Jul 10. Clin Gastroenterol Hepatol. 2022. PMID: 34256147 Clinical Trial.
-
Novel 1-L polyethylene glycol + ascorbate versus high-volume polyethylene glycol regimen for colonoscopy cleansing: a multicenter, randomized, phase IV study.Gastrointest Endosc. 2021 Oct;94(4):823-831.e9. doi: 10.1016/j.gie.2021.04.020. Epub 2021 Apr 30. Gastrointest Endosc. 2021. PMID: 33940043 Clinical Trial.
-
The Efficacy of Split-Dose Bowel Preparations for Polyp Detection: A Systematic Review and Meta-Analysis.Am J Gastroenterol. 2019 Jun;114(6):884-892. doi: 10.14309/ajg.0000000000000155. Am J Gastroenterol. 2019. PMID: 30865011
-
Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature.World J Gastroenterol. 2023 Mar 21;29(11):1685-1707. doi: 10.3748/wjg.v29.i11.1685. World J Gastroenterol. 2023. PMID: 37077514 Free PMC article. Review.
Cited by
-
A review of water exchange and artificial intelligence in improving adenoma detection.Tzu Chi Med J. 2020 Oct 5;33(2):108-114. doi: 10.4103/tcmj.tcmj_88_20. eCollection 2021 Apr-Jun. Tzu Chi Med J. 2020. PMID: 33912406 Free PMC article. Review.
-
The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting.Diagnostics (Basel). 2022 May 6;12(5):1155. doi: 10.3390/diagnostics12051155. Diagnostics (Basel). 2022. PMID: 35626310 Free PMC article.
-
Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era.Curr Oncol. 2021 Apr 23;28(3):1581-1607. doi: 10.3390/curroncol28030149. Curr Oncol. 2021. PMID: 33922402 Free PMC article. Review.
-
Colon Bowel Preparation in the Era of Artificial Intelligence: Is There Potential for Enhancing Colon Bowel Cleansing?Medicina (Kaunas). 2023 Oct 15;59(10):1834. doi: 10.3390/medicina59101834. Medicina (Kaunas). 2023. PMID: 37893552 Free PMC article. Review.
-
Bowel cleansing efficacy for colonoscopy: prospective, randomized comparative study of same-day dosing with 1-L and 2-L PEG + ascorbate.Endosc Int Open. 2021 Nov 12;9(11):E1602-E1610. doi: 10.1055/a-1520-4596. eCollection 2021 Nov. Endosc Int Open. 2021. PMID: 34790521 Free PMC article.
