Efficacy and Tolerability of Linaclotide Combined with Polyethylene Glycol for Bowel Preparation: A Meta-Analysis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Colonoscopy is the gold standard for both screening and prevention of colorectal cancer (CRC). The success of the procedure relies heavily on adequate bowel preparation to enhance diagnostic accuracy and therapeutic outcomes. Polyethylene glycol (PEG) is the standard bowel prep solution, but its high volume can cause patient discomfort and non-compliance. Combining PEG with linaclotide may offer comparable cleansing efficacy with better tolerability. This meta-analysis aims to evaluate the effectiveness and safety of linaclotide combined with PEG for bowel preparation. Methods: This meta-analysis, following Cochrane and PRISMA guidelines, compared linaclotide plus PEG versus PEG alone for bowel preparation. Comprehensive searches across multiple databases until March 2023 included randomized controlled trials with adults undergoing colonoscopy. Data extraction used PICOS criteria and a predefined Excel template. Statistical analyses were conducted using RevMan with a random-effects model, considering results significant at p < 0.05. Results: Of 1533 screened studies, seven with 3213 patients were included. The linaclotide plus PEG group had 1708 patients, and the PEG only group had 1505. Adequate bowel preparation showed no significant difference between groups (OR: 1.23; 95% CI: 0.94, 1.61; I2 = 0%). Total Boston Bowel Preparation Scale (BBPS) scores were also similar (MD: 0.30; 95% CI: -0.02, 0.62; I2 = 93%). The left colon BBPS score showed significant improvement with linaclotide (MD: 0.09; 95% CI: 0.01, 0.17; I2 = 77%). Fewer adverse events were noted in the linaclotide group, including less abdominal discomfort (RR: 0.42; 95% CI: 0.21, 0.83; I2 = 87%), pain (RR: 0.47; 95% CI: 0.24, 0.91; I2 = 43%), bloating (RR: 0.46; 95% CI: 0.24, 0.90; I2 = 72%), nausea (RR: 0.66; 95% CI: 0.49, 0.89; I2 = 25%), and vomiting (RR: 0.55; 95% CI: 0.33, 0.92; I2 = 38%). Other outcomes, including cecal intubation rate, polyp detection rate, adenoma detection rate, sleep disturbance, and withdrawal time, showed no significant differences. Conclusion: This meta-analysis suggests that linaclotide plus PEG provides similar bowel cleansing efficacy to standard PEG with improved patient tolerability. Additionally, no substantial differences were observed in other procedural metrics, such as cecal intubation and detection rates. Further research is needed to standardize bowel preparation protocols, confirm these findings across diverse populations, and optimize colonoscopy outcomes. (Figure Presented).

Volume

119

Issue

10

First Page

S350

Last Page

S351

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