Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis

Table 1 Studies characteristics

STUDY	SITE	POPULATION	INTERVENTION (ITT/PP)	COMPARISON (ITT/PP)	OUTCOMES
Regev et al[34]	1	29 to 86 y	Pico-Salax (1+1+1)/0 sachets	New-Meroken® 3/0 L	Bowel cleansing quality
	Israel		+ (200/h for 16h)/0 mL of water		Cecal intubation
		ITT: 68	+ clear liquid diet	+ clear liquid diet	General discomfort
		PP: 68	39/39	29/29	Medication Intake
					Adverse events
Lawrance et al[35]	1	18 to 75 y	Pico® (1+1)/0 sachets for morning procedure or	ColonLytely® 4/0 L for morning procedure or	Bowel cleansing quality
	Australia
			Pico 1/1 sachets for afternoon procedure	ColonLytely® 4/0 L for afternoon procedure
			+ liquid	+ clear liquid 2/0
		ITT: 634	+ low residue diet	284/279	Medication Intake
		PP: 625	171/169
			CB fleet® (45+45)/0 mL
			+ (750+750)/0 mL of water for morning procedure or		Mucosal inflammation
			CB fleet® 45/45 mL
			+ 750/750 mL of water for afternoon procedure
			+ low residue diet
			179/177
Kao et al[36]	1	18 to 75 y	SPMC (1+1+MC)/0 sachets for morning procedure or	PEG 4/0 L for morning procedure or	Bowel cleansing quality
	Canada
			SPMC (1+1)/MC sachets for afternoon procedure	PEG 2/2 L for afternoon procedure	Bowel cleansing quality according to the procedure time
		ITT: 834	+ liquid	+ liquid	Tolerability
		PP: 790	+ clear liquid diet	+ clear liquid diet
			194/194	218/210	Adherence
			NaP 45/45/0 mL for morning procedure or	PEG 2/0 L + bisacodyl 20/0 mg for morning procedure or	Sleeping hours
			NaP 0/45/45 mL for afternoon procedure	PEG 0/2 L + bisacodyl 20/0 mg for afternoon procedure	Willingness to reuse
			+ liquid	+ liquid	Safety
			+ clear liquid diet	+ clear liquid diet
			164/164	214/210	Ischemic colitis
Katz et al[15]	12	18 to 80 y	Prepopik® (1+1)/0 sachets	Half-Lytely e bisacodyl Tablets® 2/0 L	Bowel cleansing quality
	USA
			+ (1200+720)/0 mL of liquid	+ 10/0 mg bisacodyl	Acceptability
					Tolerability
		ITT: 603	+ clear liquid diet	+ clear liquid diet	Medication Intake
		PP: 598			Ease to use medication
			300/296	303/302	General experience
					Taste
					Willingness to reuse
					Adverse events
Manes et al[37]	3	18 to 85 y	CitraFleet® (1+1)/0 sachets	Moviprep® 2/0 L	Bowel cleansing quality
	Italy
			+ 3/0 L of liquid for morning procedure or	+ 1/0 L of liquid for morning procedure or	Bowel cleansing quality of right colon
		ITT: 293	CitraFleet® 1/1 sachets	Moviprep® 1/1 L	Polyps detected
		PP: 285	+ 1.5/1.5 L of liquid for afternoon procedure	+ 500/500 mL of liquid for afternoon procedure	Acceptance
			+ low-fiber diet	+ low-fiber diet	Tolerability
			145/140	148/145	Adherence
					Adverse events
Rex et al[15]	10	18 to 80 y	Prepopik® 1/1 sachets	Half-Lytely e bisacodyl Tablets® 2/0 L	Bowel cleansing quality
	USA
			+ 1200/720 mL of liquid	+ bisacodyl 10/0 mg	Acceptability
				+ clear liquid diet	Tolerability
		ITT: 608	+ clear liquid diet		Ease to use medication
		PP: 601			Medication Intake
					Taste
			NA/305	NA/298	Willingness to reuse medication
					Adverse events
					Colonoscopy before
Jeon et al[38]	1	20 to 80 y	Picolight powder® (1+1)/1 sachet	Coolprep powder® 1/1 L	Bowel cleansing quality
	South Korea
			+ (1+1)/1 L of water	+ 500/500 mL of water	Cecal intubation
			+ low-fiber diet	+ low-fiber diet	Withdrawal time
		ITT: 430			ADR
		PP: 388			PDR
					Tolerability
			215/195	215/193	Satisfaction
					Adverse events
Kang et al[39]	1	18 to ou mais	Picolight® 0/(1+1)	Colyte® 2/2 L	Bowel cleansing quality
	South Korea
			+ 0/≥ 1 L of water	+ low-fiber diet	Tolerability
		ITT: 197	+ low-fiber diet	99/99	Adverse events
		PP: 197	98/98		Sleep time quantity
					PDR
					ADR
Kim et al[40]	1	18 to 75 y	SPMC 1/1 sachets	PEG 0/4 L	Bowel cleansing quality
	South Korea
			+ 1/1 L of liquid		Adherence
			+ low-fiber diet	+ low-fiber diet	Medication Intake
		ITT: 200	50/50	50/50
		PP: 200	SPMC (1+1)/1 sachets	PEG 2/2 L	Tolerability
			+ (1+1)/1 L of liquid		Taste
			+ low-fiber diet	+ low-fiber diet	Biochemical changes
			50/50	50/50	Adverse events
Kim et al[41]	1	18 to 80 y	Picolight (1+1)/0 sachets	Standard PEG 4/0 L	Acceptability
	South Korea		+ 2L of water		Adherence to instructions
		ITT: 194	+ bisacodyl 10/0 mg	+ bisacodyl 10/0 mg	Bowel cleansing quality
		PP: 184	+ low-fiber diet (ZeroCol)	+ semi-fluid diet	Adverse events
			97/94	97/90	Willingness to reuse medication
Leitao et al[28]	3	18 to 80 y	CitraFleet® 1/1 sachets	Enddealk® 2/1L	Bowel cleansing quality
	Norway
			+ 2/2 L of water	+ 0/1 L of liquid	Tolerability
		ITT: 368	+ no-grains diet	+ diet without crops	Adherence
		PP: 368			PDR
			179/179	189/189	Cecal intubation time
					Cecal intubation
Kim et al[29]	13	20 to 75 y	sachets	Standard PEG 2/2 L	Bowel cleansing quality
	South Korea
			+ 2/2 L of water	no bisacodyl	Satisfaction
			+ bisacodyl 10/0 mg	+ low-fiber diet	Tolerability
			+ low-fiber diet		Medication Intake
		ITT: 387	193/181	194 / 184	Ease to use
		PP: 365			Taste
					Willingness to reuse
					Adverse events
Munsterman et al[30]	1	18 to 80 y	Picoprep® 1/1 sachets for morning procedure or	Kleanprep® 3/1 L for morning procedure or	Bowel cleansing quality
	Netherlands
		ITT: 173	Picoprep® 1/1 sachets for afternoon procedure	Kleanprep® 2/2 L for afternoon procedure
		PP: 172	+ 2/2 L of water	+ additional liquid	Tolerability
			+ low-fiber diet	+ low-fiber diet
			88/87	85/85
Pohl et al[31]	17	40 to 80 y	CitraFleet® (1+1)/0 sachets	Moviprep® 1/1 L	Patients with at least one polyp or flat lesion
	Germany
		ITT: 399	+ 250mL/h of water after sachet	+ 500/500 mL of liquid	Patients with at least one adenoma
		PP: 398			Cancer detection rate
			+ fibers restriction diet	+ fibers restriction diet	Flat lesion detection rate
			NA/197	NA/201	Advanced lesions detection rate
Yoo et al[32]	1	18 to 80 y	Picolight® 1/1 sachets	Coolprep® 1/1 L	Bowel cleansing quality
	South Korea
			+ 1/1 L of water	+ 500/500 mL of water	Bubble score
		ITT: 200	+ low-fiber diet	+ low-fiber diet	Tolerability
		PP: 200
			100/100	100/100	Satisfaction
Kojecky et al[33]	3	18 to 99 y	Picoprep® 2/0 sachets	Fortrans™ 4/0 L	Length of preparation
	Czech Republic		+ 2L of water	94/102
		ITT: 612	92/102	Fortrans™ 3/1 L	Time to colonoscopy
				87/102
		PP: 584	OR	Moviprep™ 2/0 L
				+ 1/0 L of fluids
			Picoprep® 1/1 sachets	96/102	Bowel cleansing quality
			+ 1/1 L of water
			86/102	Moviprep™ 1/1
				+ 0.5/0.5 L of fluids
				93/102	Tolerability score
			+ low residue diet	+ low residue diet

* In intervention and control columns, slash separates different days and plus sign separates different doses on the same day; * ITT: number of randomized patients (intention to treat); * PP: number of treated patients (per protocol); * NR: not reported in full-text; * PDR: polyp detection rate; * ADR: adenoma detection rate.

Table 2 Assessment of risk of bias by JADAD scale

#	STUDY	Randomized? (1 pt)	Randomization method	Adequate randomization? (1 pt)	Double blind? (1 pt)	Masking method	Adequate masking? (1 pt)	Loss description? (1 pt)	Jadad (0-5 pts)	GENERAL QUALITY
1	Regev et al[34]	Yes	Randomization per patients' ID (odd or even numbers)	No	No	Endoscopist blind for the preparation regimen	No	Yes	2	Intermidiate
2	Lawrance et al[35]	Yes	Randomized using Generator Pro 1.69 (Segobit software) in ratio 2:1:1 (PEG:NaP:Pico)	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
3	Kao et al[36]	Yes	Randomization in blocks of 8 and stratified per AM/PM using a computer-generated table	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
4	Katz et al[15]	Yes	Randomization numbers allocated sequentially by voice system	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
5	Manes et al[37]	Yes	Randomization by computer-generated sequence	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
6	Rex et al[15]	Yes	Randomization numbers allocated sequentially by voice system	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
7	Jeon et al[38]	Yes	Randomization by computer-generated table	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
8	Kang et al[39]	Yes	Randomization in blocks using website randomization.com	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
9	Kim et al[40]	Yes	Not described	No	No	Endoscopist blind for the preparation regimen	No	No	1	Low
10	Kim et al[41]	Yes	Randomization by computer-generated sequence	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
11	Leitao et al[28]	Yes	Randomization 1:1 with blocks of 10 by endoscopy-unit secretary	Yes	No	Endoscopist blind for the preparation regimen	No	No	2	Intermidiate
12	Kim et al[29]	Yes	Randomization by computer-generated table	Yes	No	Not described	No	No	2	Intermidiate
13	Munsterman et al[30]	Yes	Randomization by computer-generated 1:1 stratified by age (18-64) or (65-80)	Yes	No	Endoscopist blind for the preparation regimen	No	No	2	Intermidiate
14	Pohl et al[31]	Yes	Randomization 1:1 in blocks of 4 by statistician list-generated	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
15	Yoo et al[32]	Yes	Randomization 1:1 in blocks of 4 by a a computer-generated list	Yes	No	Endoscopist blind for the preparation regimen	No	Yes	3	High
16	Kojecky et al[33]	Yes	Randomization 1:1 using a software generated random table	Yes	No	Endoscopist blind for the preparation regiment	No	Yes	3	High