TY - JOUR
T1 - Efficacy and Tolerability of High- vs Low-Volume Split-Dose Bowel Cleansing Regimens for Colonoscopy: A Systematic Review and Meta-analysis
AU - Spadaccini, Marco
AU - Frazzoni, Leonardo
AU - Vanella, Giuseppe
AU - East, James
AU - Radaelli, Franco
AU - Spada, Cristiano
AU - Spada, Cristiano
AU - Fuccio, Lorenzo
AU - Benamouzig, Robert
AU - Bisschops, Raf
AU - Bretthauer, Michael
AU - Dekker, Evelien
AU - Dinis-Ribeiro, Mario
AU - Ferlitsch, Monika
AU - Gralnek, Ian
AU - Jover, Rodrigo
AU - Kaminski, Michal F.
AU - Pellisé, Maria
AU - Triantafyllou, Konstantinos
AU - Van Hooft, Jeanin E.
AU - Dumonceau, Jean-Marc
AU - Marmo, Clelia
AU - Alfieri, Sergio
AU - Chandrasekar, Viveksandeep Thoguluva
AU - Sharma, Prateek
AU - Rex, Doug K.
AU - Repici, Alessandro
AU - Hassan, Cesare
PY - 2020
Y1 - 2020
N2 - 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 I-2 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 (I-2 [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.
AB - 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 I-2 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 (I-2 [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.
KW - Adherence
KW - Screening
KW - Endoscopy
KW - Comparative
KW - Adherence
KW - Screening
KW - Endoscopy
KW - Comparative
UR - http://hdl.handle.net/10807/248255
U2 - 10.1016/j.cgh.2019.10.044
DO - 10.1016/j.cgh.2019.10.044
M3 - Article
SN - 1542-3565
VL - 18
SP - 1454-1465.e14
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
ER -