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. 2023 May 26:10:1088630.
doi: 10.3389/fmed.2023.1088630. eCollection 2023.

Comparison of oral sodium phosphate tablets and polyethylene glycol lavage solution for colonoscopy preparation: a systematic review and meta-analysis of randomized clinical trials

Li Yao-Dong  1   2 , Wang Yi-Ping  3 , Mai Gang  4 , Han Yang-Yun  4 , Zhu Ling-Ling  3 , Deng Hong  1 , Deng Jia-Zheng  1 , Xiang Rong-Chao  4 , Li You-Wei  4 , Zhao Ming  1 , Ding Shun-Bin  1 , Ling Jing  1 , Shen Yang  1 , Dong Jia-Qi  1 , Deng Lei  1 , Song Xiong-Feng  1 , Zhang You-Jian  1 , Zhou Zuo-Qiong  2
Affiliations

Comparison of oral sodium phosphate tablets and polyethylene glycol lavage solution for colonoscopy preparation: a systematic review and meta-analysis of randomized clinical trials

Li Yao-Dong et al. Front Med (Lausanne). .

Abstract

Objective: To systematically compare the bowel cleaning ability, patient tolerance and safety of oral sodium phosphate tablets (NaPTab) and oral polyethylene glycol electrolyte lavage solution (PEGL) to inform clinical decision making.

Methods: PubMed, Embase, CBM, WanFang Data, CNKI, and VIP databases were searched for studies that used randomized controlled trials (RCTs) to compare the roles of NaPTab and PEGL in bowel preparation before colonoscopy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias in the included papers. A meta-analysis was performed using RevMan 5.3 software.

Results: A total of 13 RCTs were eligible for inclusion, including 2,773 patients (1,378 and 1,395 cases in the NaPTab and PEGL groups, respectively). Meta-analysis revealed no significant difference in the cleansing quality of the NaPTab and PEGL groups [RR 1.02, 95% CI (0.96-1.08), P = 0.46]. The incidence of nausea was lower in the NaPTab group than in the PEGL group [RR 0.67, 95% CI (0.58-0.76), p < 0.00001]. Patients rated the taste of NaPTab higher than PEGL [RR 1.33, 95% CI (1.26-1.40), P < 0.00001]. Willingness to repeat the treatment was also higher in the NaPTab group than in the PEGL group [RR 1.52, 95% CI (1.28-1.80), P < 0.00001]. Both serum potassium and serum calcium decreased in both groups after the preparation; however, meta-analysis revealed that both minerals decreased more in the NaPTab group than in the PEGL group [MD = 0.38, 95% CI (0.13-0.62), P = 0.006 for serum potassium and MD = 0.41, 95% CI (0.04-0.77), P = 0.03 for serum calcium]. Meanwhile, serum phosphorus increased in both groups after the preparation; however, levels increased more in the NaPTab group than in the PEGL group [MD 4.51, (95% CI 2.9-6.11), P < 0.00001].

Conclusions: While NaP tablets and PEGL were shown to have a similar cleaning effect before colonoscopy, NaP tablets had improved patient tolerance. However, NaP tablets had a strong effect on serum potassium, calcium, and phosphorus levels. For patients with low potassium, low calcium, and renal insufficiency, NaP tablets should be prescribed with caution. For those at high-risk for acute phosphate nephropathy, NaP tablets should be avoided. Given the low number and quality of included studies, these conclusions will require additional verification by large high-quality studies.

Systematic review registration: 10.37766/inplasy2023.5.0013, identifier: NPLASY202350013.

Keywords: bowel preparation; colonoscopy; meta-analysis; polyethylene glycol electrolyte lavage solution; sodium phosphate; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the literature search and selection process.
Figure 2
Figure 2
Quality evaluation of included studies.
Figure 3
Figure 3
Rate of excellent and good bowel cleaning quality.
Figure 4
Figure 4
Subgroup analysis according different volumes of PEGL.
Figure 5
Figure 5
Rate of excellent and good bowel cleaning quality.
Figure 6
Figure 6
Incidence of nausea.
Figure 7
Figure 7
Rate of excellent and good taste.
Figure 8
Figure 8
Willingness to repeat treatment.
Figure 9
Figure 9
Changes in serum potassium (mEq/L).
Figure 10
Figure 10
Changes in blood calcium (mg/dL).
Figure 11
Figure 11
Changes in blood phosphorus (mg/dL).
Figure 12
Figure 12
Funnel chart of bowel cleaning quality.
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