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

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 (I 2 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.

The Effects of Combined Use of Linaclotide and Polyethylene Glycol Electrolyte Powder in Colonoscopy Preparation for Patients With Chronic Constipation

“…As even a very high dose of PEG has limited efficacy, various composite PLG regimens have been developed, for example, PEG can be mixed with sodium ascorbate, sodium citrate, bisacodyl, or lactulose. These combined regimens are comparable to the 4L PEG regimen in terms of the efficacy of the bowel preparation and reduce the dosage of PEG 13–16 …”

“…These combined regimens are comparable to the 4L PEG regimen in terms of the efficacy of the bowel preparation and reduce the dosage of PEG. [13][14][15][16] Linaclotide is a novel, orally administered guanylate cyclase-C (GC-C) agonist that acts on intestinal epithelial cells. On the one hand, by activating GC-C/cyclic adenosine monophosphate (cAMP), it increases the phosphorylation level of protein kinase G-II (PKG-II), and by activating cystic fibrosis transmembrane conductance regulator (CFTR), it promotes the secretion of intestinal lumen liquid, softens feces, and increases the peristalsis of the stomach and intestine, thereby making defecation more frequent.…”

Efficacy of different bowel preparation regimen volumes for colorectal cancer screening and compliance with European Society of Gastrointestinal Endoscopy performance measures

“…In this nationwide Dutch prospective endoscopy database study, we In contrast to a recent meta-analysis, we showed that the ESGE quality standard requirement for adequate bowel preparation was also met with an ultra-low volume regimen. 14 The efficacy of ultra- 20 These conflicting results likely suggest that for adequate assessment of bowel preparation quality, a higher number of individuals need to be included. The CIR of 97.4% in Poland is on par with our study, while the ADR of 29.8% was lower in the Polish national screening program.…”

“…Studies have shown that adequate patient instructions and lower volumes of bowel preparation increase patient compliance and willingness to repeat endoscopy 10,11 . However, reports on the effectiveness of ultra‐low volume bowel preparations pertaining to actual performance measures have suggested that they are not as effective as high‐ and low volume bowel preparations regimens 12–14 …”

Factors Affecting the Quality of Bowel Preparation Before Colonoscopy in Outpatient: A Prospective Observational Study

“…(Mahmood et al, 2018), but that is unavailable to change. So Increasing studies focus on improving bowel cleaning quality with some available strategies, including reinforcing patient education (Alvarez-Gonzalez et al, 2020;Kang et al, 2016), changing the type of laxative (Saito et al, 2021), the volume of laxative (Riswijk et al, 2021), preparation regimen(same-day dose/ split dose) (Barkun et al, 2020). Kim et al (2005) revealed that non-exercise was an independent risk factor of inadequate bowel preparation.…”