Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7844
Peer-review started: September 8, 2021
First decision: December 4, 2021
Revised: December 11, 2021
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: August 6, 2022
Processing time: 316 Days and 17.8 Hours
High volume (4 L) split-dose regimens (SpDs) of polyethylene glycol (PEG) have been recommended as the gold-standard regimen for bowel preparation, but its large volume of fluids and poor tolerability have become sources of patient dissatisfaction.
The same-day single-dose (SSD) PEG has been recommended as an alternative for bowel preparation. However, its superiority compared to other regimens is a matter of debate.
To seek one PEG-based regimen for bowel preparation with characteristics of equal cleansing efficacy, reducing the preparation volume and improving patient tolerance.
We conducted a systematic review and meta-analysis to compare the efficacy and tolerability of SSD PEG-based arm vs large-volume (≥ 3 L) SpDs PEG solutions for bowel preparation before colonoscopy, regardless of adjuvant laxative use.
A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation, right colon Boston Bowel Preparation Scale and right colon Ottawa Bowel Preparation Scale between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The use of SSDs had advantages of less sleep disturbance and lower incidence of abdominal pain. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure than patients receiving SpDs (P < 0.05).
Regardless of adjuvant laxative use, the (2 L/4 L) SSDs PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability.
Given its efficacy and tolerability, the low-volume (2 L) SSD PEG regimen has huge prospects as a superior alternative to SpDs regimens as long as the optimal preparation-to-colonoscopy interval and dietary instructions for bowel preparation are respected.