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Meta-Analysis
. 2022 Jan;34(1):13-32.
doi: 10.1111/den.14015. Epub 2021 Jun 24.

Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: Systematic review and meta-analysis

Milou L M van Riswijk  1 , Kelly E van Keulen  1 , Peter D Siersema  1
Affiliations
Meta-Analysis

Efficacy of ultra-low volume (≤1 L) bowel preparation fluids: Systematic review and meta-analysis

Milou L M van Riswijk et al. Dig Endosc. 2022 Jan.

Abstract

Background and aims: High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1 L or less (≤1 L).

Methods: We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1 L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety.

Results: Bowel preparation with sodium picosulfate/magnesium citrate (SPMC; 19 trials, n = 10,287), 1L-polyethylene glycol with ascorbate (PEGA; 10 trials, n = 1717), sodium phosphate (NaP; 2 trials, n = 621), and oral sulfate solution (OSS; 3 trials, n = 597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I2 range: 86-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients.

Conclusion: Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.

Keywords: cathartics; colonoscopy; endoscopy; laxatives; meta-analysis.

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Conflict of interest statement

Author P.S. receives unrestricted grants from Pentax (Japan), Norgine (UK), Motus GI (USA), MicroTech (China) and The eNose Company (Netherlands) and is in the advisory board of Motus GI (USA) and Boston Scientific (USA). Authors MvR and KvK declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection. RCT, randomized controlled trial.
Figure 2
Figure 2
Pooled proportion for adequately prepped patients, sodium picosulfate with magnesium citrate (SPMC). CI, confidence interval.
Figure 3
Figure 3
Pooled efficacy for 1 L polyethylene glycol with ascorbate (PEGA).
Figure 4
Figure 4
Pooled efficacy for sodium phosphate solution (NaP). CI, confidence interval.
Figure 5
Figure 5
Pooled efficacy for oral sulfate solution (OSS). CI, confidence interval.
Figure 6
Figure 6
Forrest plots for pooled adenoma detection rate for fluid studies. (a) Sodium picosulfate with magnesium citrate (SPMC), (b) 1 L polyethylene glycol with ascorbate (PEGA), (c) sodium phosphate solution (NaP), (d) oral sulfate solution (OSS). CI, confidence interval.
Figure 7
Figure 7
Summary of risk of bias for fluid studies (Cochrane RoB2 tool). The Cochrane RoB2 tool assesses the risk of bias across five domains, including randomization process, protocol deviations, missing data, outcome measurement, and selection of the reported result. The overall risk of bias is determined by the highest risk within the subdomains. This figure summarizes the risk of bias within all included studies, as percentage of the total number of studies.
See this image and copyright information in PMC

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