P749 Comparison of bowel preparations for colonoscopy in inflammatory bowel disease- A systematic review and network meta-analysis of randomized trials

Abstract

Abstract Background Colonoscopy is important in the management inflammatory bowel disease. Adequate bowel preparation (IBD) is a prerequisite for colonoscopy and may be difficult to achieve in setting of IBD Methods We performed a systematic review and network meta-analysis of randomised trials of various bowel preparations used before colonoscopy in IBD. Various electronic databases were searched to identify eligible studies. A frequentist network meta-analysis was done to compare the effectiveness of various bowel preparations. Risk of bias was assessed using Cochrane risk of bias tool 2.0. Other outcomes were assessed qualitatively. Results We included 7 trials including 960 patients. All bowel preparation had a similar effectiveness of bowel preparation as compared to 4 litres of polyethylene glycol (PEG) (OR when compared with PEG4L: OSS- 1.1043 95% CI 0.6553-1.8610; PEG/Ascorbate 2L- 0.9838, 0.6519-1.4848; PEG 1L -1.0011, 0.5522-1.8150; PEG2L plus bisacodyl -1.0864, 0.7130-1.6554; PEG 4L plus simethicone -1.0069, 0.6721-1.5084; PEG/SPMC 1.5L -0.9966, 0.5569-1.7835; SPMC 2L -1.0996, 0.6123-1.9745 had a similar effectiveness. Low-volume preparations had better compliance, tolerance, and acceptance, and willingness to repeat. No difference in additional outcomes like change in disease activity after colonoscopy, procedure-related outcome after colonoscopy like cecal intubation rate, and change in electrolyte levels were found. Conclusion Various bowel preparations had similar effectiveness in respect to colonoscopy preparation in IBD patients. Low-volume preparations have better compliance, tolerance, and acceptance. The systematic review was limited by a small number of included RCTs.