Abstract
BackgroundStandard-volume polyethylene glycol (PEG) gut lavage solutions are safe and effective, but they require the consumption of large volumes of fluid. A new lower-volume solution of PEG plus ascorbic acid has been used recently as a preparation for colonoscopy.AimA meta-analysis was performed to compare the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy.StudyElectronic and manual searches were performed to identify randomized controlled trials (RCTs) that compared the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy. After a methodological quality assessment and data extraction, the pooled estimates of bowel preparation efficacy during bowel cleansing, compliance with preparation, willingness to repeat the same preparation, and the side effects were calculated. We calculated pooled estimates of odds ratios (OR) by fixed- and/or random-effects models. We also assessed heterogeneity among studies and the publication bias.ResultsEleven RCTs were identified for analysis. The pooled OR for preparation efficacy during bowel cleansing and for compliance with preparation for low-volume PEG plus ascorbic acid were 1.08 (95% CI = 0.98–1.28, P = 0.34) and 2.23 (95% CI = 1.67–2.98, P<0.00001), respectively, compared with those for standard-volume PEG. The side effects of vomiting and nausea for low-volume PEG plus ascorbic acid were reduced relative to standard-volume PEG. There was no significant publication bias, according to a funnel plot.ConclusionsLow-volume PEG plus ascorbic acid gut lavage achieved non-inferior efficacy for bowel cleansing, is more acceptable to patients, and has fewer side effects than standard-volume PEG as a bowel preparation method for colonoscopy.
Highlights
Colorectal cancer, a major cause of cancer-associated morbidity and mortality, is one of the most common cancers [1]
The pooled odds ratios (OR) for preparation efficacy during bowel cleansing and for compliance with preparation for low-volume polyethylene glycol (PEG) plus ascorbic acid were 1.08 and 2.23, respectively, compared with those for standard-volume PEG
The side effects of vomiting and nausea for low-volume PEG plus ascorbic acid were reduced relative to standard-volume PEG
Summary
Colorectal cancer, a major cause of cancer-associated morbidity and mortality, is one of the most common cancers [1]. Screening is crucial for the early detection and removal of premalignant adenomas or localized cancers in order to reduce morbidity and mortality associated with colorectal cancer [4,5]. Some studies had reported that poor bowel preparation is associated with lower rates of adenoma detection, incomplete colonoscopy, and greater procedural technical difficulty [8,9,10]. Inadequate bowel preparation may lead to failure to detect lesions in the right colon [11]. A new lower-volume solution of PEG plus ascorbic acid has been used recently as a preparation for colonoscopy
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