Meta-analysis: the relative efficacy of oral bowel preparations for colonoscopy 1985–2010
Article first published online: 24 NOV 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 2, pages 222–237, January 2012
How to Cite
Belsey, J., Crosta, C., Epstein, O., Fischbach, W., Layer, P., Parente, F. and Halphen, M. (2012), Meta-analysis: the relative efficacy of oral bowel preparations for colonoscopy 1985–2010. Alimentary Pharmacology & Therapeutics, 35: 222–237. doi: 10.1111/j.1365-2036.2011.04927.x
- Issue published online: 15 DEC 2011
- Article first published online: 24 NOV 2011
- Publication data Submitted 22 July 2011 First decision 7 August 2011 Resubmitted 26 October 2011 Accepted 2 November 2011 EV Pub Online 24 November 2011
Aliment Pharmacol Ther 2012; 35: 222–237
Background Previous reviews of bowel preparation for colonoscopy have given contradictory answers.
Aim To provide a definitive insight, using PRISMA-compliant methodology.
Methods A comprehensive literature review identified randomised controlled trials comparing bowel preparation regimens. Data for quality of bowel preparation were pooled in multiple meta-analyses exploring a range of inclusion criteria.
Results A total of 104 qualifying studies were identified, the majority of which involved comparisons of sodium phosphate (NaP) or polyethylene glycol (PEG). There was no significant difference demonstrated between NaP and PEG overall (OR = 0.82; 95% CI = 0.56–1.21; P = 0.36). Cumulative meta-analysis demonstrated that this conclusion has been qualitatively similar since the mid 1990s, with little quantitative change for the past 10 years. Amongst studies with previous day dosing in both study arms there was a significant advantage in favour of PEG (OR = 1.78; 95% CI = 1.13–2.81; P = 0.006). Studies focussing on results in the proximal colon also favoured PEG (OR = 2.36; 95% CI = 1.16–4.77; P = 0.012). PEG was also significantly more effective than non-NaP bowel preparation regimens (OR = 2.02; 95% CI = 1.08–3.78; P = 0.03). Other comparisons showed no significant difference between regimens.
Conclusions Although there is no compelling evidence favouring either of the two most commonly used bowel preparation regimens, this may reflect shortcomings in study design. Where studies have ensured comparable dosage, or the clinically relevant outcome of proximal bowel clearance is considered, PEG-based regimens offer the most effective option.