Low-volume Polyethylene Glycol and Bisacodyl for Bowel Preparation Prior to Colonoscopy: A Meta-Analysis
Year: 2011
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Purpose: Quality of bowel preparation prior to colonoscopy is essential for adequate visualization of mucosa and polyps. However, many patients have a decreased tolerance to the traditional 4 liters of polyethylene glycol (PEG). Subsequently, studies have been performed evaluating a reduced volume of PEG with bisacodyl in an effort to improve visualization and tolerability with varying results. Therefore, a meta-analysis was performed to analyze the efficacy of a low-volume PEG bowel preparation with bisacodyl for bowel preparation prior to colonoscopy. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, CINAHL, PubMed, and recent abstracts from major conferences were searched (5/2011). Only RCTs on adult subjects comparing low-volume PEG (2 liters) with bisacodyl versus 4 liters PEG were included. Data extraction was performed by two independent reviewers. Metaanalysis for the efficacy of low-volume PEG with bisacodyl and 4 liters PEG were analyzed by calculating pooled estimates of number of satisfactory, excellent, and poor bowel preparations as well as adverse patient events (abdominal pain, nausea, vomiting, bloating). Separate analyses were performed for each main outcome by using odds ratio (OR) with fixed and random effects models. Heterogeneity was assessed by calculating the I2 measure of inconsistency. RevMan 5.1 was utilized for statistical analysis. Results: Five studies (N=1,120) met the inclusion criteria with mean age ranging from 54 to 63 years. No statistically significant differences were noted between low-volume PEG (2 liters) with bisacodyl and 4 liters PEG for number of satisfactory (OR 0.79; 95% CI: 0.33-1.90, p=0.6), excellent (OR 1.12; 95% CI: 0.70-1.78, p=0.64), or poor bowel preparations (OR 0.70; 95% CI: 0.35-1.37, p=0.29). A statistically significant decrease in nausea (OR 0.51; 95% CI: 0.28-0.92, p=0.02) and vomiting (OR 0.48; 95% CI: 0.31-0.74, p<0.01) was noted for the low-volume PEG with bisacodyl as compared to 4 liters PEG. No statistically significant differences were noted between the two groups for abdominal pain (p=0.37) and bloating (p=0.23). No publication bias was noted. Conclusion: Low-volume PEG (2 liters) with bisacodyl demonstrates less nausea and vomiting without adversely effecting the bowel preparation. Based upon these results, low-volume PEG with bisacodyl may be considered as a substitute to the traditional 4 liters PEG for bowel preparation prior to colonoscopy.
Institution: University of Missouri
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2140351926