Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

Abstract

Critical heterogeneity precludes firm conclusion on the impact of adjuvants with existing bowel preparations. Additional research is required to better characterize the methods of administration and resulting roles of adjuvants in an era of split-dosing.

Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease

“…They were based on the combination of 2-L PEG with a stimulant laxative (bisacodyl), or an osmotically active agent (ascorbic acid). The impact of adjuvants on bowel preparations remains debated, with differing US and European society recommendations, but a recent meta-analysis suggests that adjuvants may improve tolerance when used with low-volume PEG preparations[ 28 ]. PEG low-dose associated to either bisacodyl or ascorbate may thus represent a potentially ideal low-volume cleansing product for patients with IBD[ 16 ].…”

“…Furthermore, simethicone remains an interesting adjuvant, decreasing luminal bubbles as reported by Lazzaroni et al[ 12 ] 1993 in IBD patients mirroring same results in overall population[ 12 , 29 ]. Society guidelines are disparate on this topic[ 14 , 16 ] but a recent meta-analysis suggest the addition of simethicone may further improve bowel preparation quality[ 28 ].…”

“…There is always a trade-off between cleansing efficacy and tolerance, especially when comparing high- to low-dose preparations[ 30 ]. In general population, PEG high-volume leads to cleaner preparations compared to PEG low-volume with an adjuvant when restricting the analysis to split-dosing, but with a lower tolerance[ 28 ]. Compliance may be limited by the inability of patients to ingest such a large volume of solution.…”

Strategies to Improve Inadequate Bowel Preparation for Colonoscopy

“…Adjuvants such as stimulants, prokinetics, and antifoaming have been evaluated to improve the quality and adherence to bowel preparation [(17); Table 1]. However, there are discrepancies over their use between American and European Societies of Gastrointestinal Endoscopy.…”

“…A recent meta-analysis, which aimed to assess the efficacy of adjuvants in bowel preparation, reported a better cleansing quality in patients who received adjuvants, regardless of the regimen of administration. However, results should be interpreted with caution due to the high heterogeneity of the studies (17).…”