Marco Spadaccini1, Leonardo Frazzoni2, Giuseppe Vanella3, James East4, Franco Radaelli5, Cristiano Spada6, Lorenzo Fuccio2, Robert Benamouzig7, Raf Bisschops8, Michael Bretthauer9, Evelien Dekker10, Mario Dinis-Ribeiro11, Monika Ferlitsch12, Ian Gralnek13, Rodrigo Jover14, Michal F Kaminski15, Maria Pellisé16, Konstantinos Triantafyllou17, Jeanin E Van Hooft10, Jean-Marc Dumonceau18, Clelia Marmo19, Sergio Alfieri20, Viveksandeep Thoguluva Chandrasekar21, Prateek Sharma21, Doug K Rex22, Alessandro Repici23, Cesare Hassan24. 1. Endoscopy Department, Humanitas University, Milan, Italy. Electronic address: marco.spadaccini@humanitas.it. 2. Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 3. Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy. 4. Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom. 5. Valduce Hospital, Como, Italy. 6. Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy. 7. Gastroenterology Unit, Bobigny, France. 8. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 9. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Institute of Health and Society, University of Oslo Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway. 10. Department of Gastroenterology and Hepatology Amsterdam University Medical Centers, Amsterdam, the Netherlands. 11. CIDES/CINTESIS, Faculty of Medicine, University of Porto, Porto, Portugal. 12. Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Austria. 13. Institute of Gastroenterology and Hepatology Emek Medical Center, Afula, Israel. 14. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain. 15. Department of Gastroenterology, Hepatology and Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. 16. Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. 17. Ηepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Athens University, Athens, Greece. 18. Gedyt Endoscopy Center, Buenos Aires, Argentina. 19. Division of Surgical Digestive System, University Hospital Second University of Naples, Naples, Italy. 20. Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 21. Kansas City Veterans Affairs Hospital, Kansas City, Missouri. 22. Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana. 23. Endoscopy Department, Humanitas University, Milan, Italy. 24. Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
Abstract
BACKGROUND & AIMS: Efficacy of bowel preparation is an important determinant of outcomes of colonoscopy. It is not clear whether approved low-volume polyethylene glycol (PEG) and non-PEG regimens are as effective as high-volume PEG regimens when taken in a split dose. METHODS: In a systematic review of multiple electronic databases through January 31, 2019 with a registered protocol (PROSPERO: CRD42019128067), we identified randomized controlled trials that compared low- vs high-volume bowel cleansing regimens, administered in a split dose, for colonoscopy. The primary efficacy outcome was rate of adequate bowel cleansing, and the secondary efficacy outcome was adenoma detection rate. Primary tolerability outcomes were compliance, tolerability, and willingness to repeat. We calculated relative risk (RR) and 95% CI values and assessed heterogeneity among studies by using the I2 statistic. The overall quality of evidence was assessed using the GRADE framework. RESULTS: In an analysis of data from 17 randomized controlled trials, comprising 7528 patients, we found no significant differences in adequacy of bowel cleansing between the low- vs high-volume split-dose regimens (86.1% vs 87.4%; RR, 1.00; 95% CI, 0.98-1.02) and there was minimal heterogeneity (I2 = 17%). There was no significant difference in adenoma detection rate (RR, 0.96; 95% CI, 0.87-1.08) among 4 randomized controlled trials. Compared with high-volume, split-dose regimens, low-volume split-dose regimens had higher odds for compliance or completion (RR, 1.06; 95% CI, 1.02-1.10), tolerability (RR, 1.39; 95% CI, 1.12-1.74), and willingness to repeat bowel preparation (RR, 1.41; 95% CI, 1.20-1.66). The overall quality of evidence was moderate. CONCLUSIONS: Based on a systematic review of 17 randomized controlled trials, low-volume, split-dose regimens appear to be as effective as high-volume, split-dose regimens in bowel cleansing and are better tolerated, with superior compliance.
BACKGROUND & AIMS: Efficacy of bowel preparation is an important determinant of outcomes of colonoscopy. It is not clear whether approved low-volume polyethylene glycol (PEG) and non-PEG regimens are as effective as high-volume PEG regimens when taken in a split dose. METHODS: In a systematic review of multiple electronic databases through January 31, 2019 with a registered protocol (PROSPERO: CRD42019128067), we identified randomized controlled trials that compared low- vs high-volume bowel cleansing regimens, administered in a split dose, for colonoscopy. The primary efficacy outcome was rate of adequate bowel cleansing, and the secondary efficacy outcome was adenoma detection rate. Primary tolerability outcomes were compliance, tolerability, and willingness to repeat. We calculated relative risk (RR) and 95% CI values and assessed heterogeneity among studies by using the I2 statistic. The overall quality of evidence was assessed using the GRADE framework. RESULTS: In an analysis of data from 17 randomized controlled trials, comprising 7528 patients, we found no significant differences in adequacy of bowel cleansing between the low- vs high-volume split-dose regimens (86.1% vs 87.4%; RR, 1.00; 95% CI, 0.98-1.02) and there was minimal heterogeneity (I2 = 17%). There was no significant difference in adenoma detection rate (RR, 0.96; 95% CI, 0.87-1.08) among 4 randomized controlled trials. Compared with high-volume, split-dose regimens, low-volume split-dose regimens had higher odds for compliance or completion (RR, 1.06; 95% CI, 1.02-1.10), tolerability (RR, 1.39; 95% CI, 1.12-1.74), and willingness to repeat bowel preparation (RR, 1.41; 95% CI, 1.20-1.66). The overall quality of evidence was moderate. CONCLUSIONS: Based on a systematic review of 17 randomized controlled trials, low-volume, split-dose regimens appear to be as effective as high-volume, split-dose regimens in bowel cleansing and are better tolerated, with superior compliance.
Authors: Anouk M Wijnands; Maarten Te Groen; Yonne Peters; Ad A Kaptein; Bas Oldenburg; Frank Hoentjen; Maurice W M D Lutgens Journal: Inflamm Bowel Dis Date: 2022-07-01 Impact factor: 7.290
Authors: Antonio Z Gimeno-García; Goretti Hernández; José Luis Baute Dorta; Cristina Reygosa; Raquel de la Barreda; Alberto Hernandez-Bustabad; Carla Amaral; Yaiza Cedrés; Rocío Del Castillo; David Nicolás-Pérez; Alejandro Jiménez; Onofre Alarcon-Fernández; Manuel Hernandez-Guerra; Rafael Romero; Inmaculada Alonso; Yanira González; Zaida Adrian; Domingo Hernandez; Laura Ramos; Marta Carrillo; Vanessa Felipe; Anjara Hernández; Consuelo Rodríguez-Jiménez; Enrique Quintero Journal: Front Med (Lausanne) Date: 2021-03-22