Efficacy and acceptability of bowel preparation strategies for inflammatory bowel disease colonoscopy: Systematic review and meta-analysis
Nigam GB., Gordon M., Sinopoulou V., Tomar A., Din S., Vance M., Wilson A., East JE.
Abstract Patients with inflammatory bowel disease (IBD) frequently undergo colonoscopy, each requiring bowel preparation. European Society of Gastrointestinal Endoscopy (ESGE) 2019 guidelines recommended high- or low-volume polyethylene glycol (PEG)-based bowel prep for IBD patients; however other non-PEG-based preparations (sulphate and picosulphate-based) have now been studied in IBD. We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and the World Health Organization International Clinical Trials Registry Platform for randomized controlled trials (RCTs) up to December 2024. Primary outcome was bowel prep success; secondary outcomes included tolerability, acceptability, cecal intubation rates (CIR) and safety. Pooled estimates used risk ratio (RR) and GRADE to assess evidence certainty. Ten RCTs (1479 IBD patients) were included. There was no difference in prep success (relative risk [RR] 0.98, 95% confidence interval [CI] 0.88–1.09; I2 = 33%, 2 RCTs; moderate certainty evidence) between 2 L vs. 4 L PEG, but higher acceptability for 2 L (RR 0.69, 95% CI 0.59–0.80; I2 = 18%, 2 RCTs; high certainty evidence). Low-volume non-PEG vs. PEG are probably similar for prep success (RR 0.96, 95% CI 0.90–1.01; I2 = 6%,3 RCTs; moderate certainty evidence). The evidence on tolerability and acceptability was very uncertain. Subgroup analysis revealed comparable effectiveness of picosulphate-based (RR 0.89, 95% CI 0.78–1.01; I2 = 0%,1 RCT) and sulphate-based preps (RR 0.98, 95% CI 0.91–1.05; I2 = 28%, 2 RCTs) compared with low-volume PEG. Safety data were inconsistently reported. High-certainty evidence supports low-volume PEG as comparably successful to high-volume PEG, with higher acceptability. Moderate-certainty evidence indicates similar success between non-PEG and PEG-based preps. Both low-volume PEG and non-PEG-based preps are supported for use in IBD, broadening options beyond current ESGE guidelines.