Oral sulfate solution versus low‐volume polyethylene glycol for bowel preparation: Meta‐analysis of randomized controlled trials

Abstract

Background and Aims Oral sodium sulfate (OSS) solution and low‐volume polyethylene glycol‐based solutions are two of the more common low‐volume purgatives used as colonoscopy preparations. Data on how these different low‐volume solutions compare are mixed. Our aim was to conduct a meta‐analysis of randomized controlled trials (RCTs) to compare OSS with low‐volume polyethylene glycol solutions (PEG) plus ascorbic acid (PEG + Asc) solution with respect to (i) satisfactory bowel preparation, (ii) excellent bowel preparation, and (iii) tolerability. Methods Studies were identified by searching 10 medical databases for reports published from 1974 until 2019. Only fully published RCTs comparing OSS and low‐volume PEG‐based products with regard to overall satisfactory bowel preparation were included. Pooling was conducted by both fixed‐effects and random effects models; results are presented from the random effects model when heterogeneity was significant. Results Seven studies (involving 2049 subjects) met the inclusion criteria. There was no difference between OSS and PEG + Asc with respect to adequate bowel preparation (risk ratio [RR] 1.02 [0.99–1.06]; P = 0.16). OSS did result in a higher chance of excellent bowel preparation (RR 1.18 [1.06–1.31]; P = 0.03). OSS was associated with a 30% increased risk of nausea (RR 1.35 [1.03–1.77]; P = 0.03) and more than double the risk of vomiting (RR 2.30 [1.63–2.23]; P < 0.05) compared with PEG + Asc. Begg's funnel plot indicated low probability of publication bias. Conclusions Individuals at low risk of inadequate bowel preparation who use OSS for bowel preparation are more likely to achieve excellent bowel preparation, but are more likely to experience nausea and vomiting than are individuals using low‐volume PEG‐based solutions.

Oral sulfate solution benefits polyp and adenoma detection during colonoscopy: Meta‐analysis of randomized controlled trials

“…18,19 However, it is unclear whether OSS can ultimately increase PDR and ADR, although several studies have demonstrated that OSS has comparable or better quality of bowl preparation than PEG formulations and has acceptable safety. 14,22,23 In this meta-analysis, by pooling the eight RCTs, we first revealed that OSS for bowel preparation was associated with a significantly increased PDR and ADR during colonoscopy, which suggested that OSS might be an efficacious regimen for patients scheduled for a colonoscopy. Additionally, from the result of the analysis of the bowel preparation score, it was suggested that OSS significantly improved bowel preparation.…”

“…An OSS regimen was associated with an increased excellent bowel preparation because the reduced volume may be more acceptable and tolerable; 48 however, a previous meta-analysis revealed a higher risk of nausea and vomiting in patients consuming the OSS regimen. 23 Currently, the definitive reasons for this result remain unknown; however, an unpleasant taste and flavor caused by the sulfate component has been suggested as a possible reason. 20,21 Trial sequential analysis, 53 which was conducted by TSA software 0.9.5.10 Beta (Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark, https://www.ctu.dk/tsa), was used to further examine whether a definitive conclusion could be obtained for the risk of nausea and vomiting based on the results of a previous meta-analysis.…”

“…Theoretically, excellent bowel preparation should be associated with the increased detection rate of colorectal lesions, because better bowel preparation makes it possible to detect smaller polyps and adenomas. According to the results of a previous meta‐analysis, 23 OSS would increase the detection of polyps and adenomas because it significantly increased the proportion of patients with excellent bowel preparation. However, among the included six RCTs that reported primary outcomes, only one found a significantly increased PDR 20 or ADR 47 in the OSS group.…”

“…18,19 Concurrently, several randomized controlled trials (RCTs) have demonstrated that, compared with PEG-based bowel preparation solutions, OSS has comparable or better efficacy and safety, as well as superior tolerability and acceptability. [20][21][22] A recent meta-analysis suggested that, compared with PEG plus ASC, an OSS regimen substantially increased the rate of excellent bowel preparation among individuals at low risk of inadequate bowel preparation; 23 however, it is unclear whether OSS actually increases the detection of precursor polyps, CRC, or other lesions 24 because the quality of bowel preparation is just a surrogate indicator for detection of colonic lesions. Therefore, the magnitude of benefit in detecting polyps and adenomas needs to further evaluated.…”

Bowel preparation for improving the quality of colonoscopy

“…A meta‐analysis of multiple randomized controlled trials (RCTs) comparing OSS with PEG + ASC elucidated that OSS for bowel preparation increases the rate of excellent bowel preparation (50.6% vs. 42.6%) in patients at low risk of inadequate bowel preparation. However, OSS was associated with a significantly increased risk of nausea (38.5% vs. 29.4%) and vomiting (10.8% vs. 4.7%) compared to PEG + ASC 5 …”