Endoscopy 2018; 50(02): 159-176
DOI: 10.1055/s-0043-119638
Review
© Georg Thieme Verlag KG Stuttgart · New York

Do adjuvants add to the efficacy and tolerance of bowel preparations? A meta-analysis of randomized trials

Sophie Restellini*
Division of Gastroenterology and Hepatology, Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland
Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
,
Omar Kherad*
Internal Medicine Department, La Tour Hospital and University of Geneva, Switzerland
,
Charles Menard
Department of Medicine, University of Sherbrooke, Sherbrooke, Canada
,
Myriam Martel
Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
,
Alan N. Barkun
Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
Division of Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, Canada
› Author Affiliations
Further Information

Publication History

submitted 17 April 2017

accepted after revision 17 July 2017

Publication Date:
24 October 2017 (eFirst)

Abstract

Background and study aims Recommendations on adjuvant use with bowel preparations remain disparate. We performed a meta-analysis determining the clinical impact of adding an adjuvant to polyethylene glycol (PEG), sodium phosphate, picosulfate (PICO), or oral sulfate solutions (OSS)-based regimens.

Methods Systematic searches were made of MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge for randomized trials from January 1980 to April 2016 that assessed preparations with or without adjuvants, given in split and non-split dosing, and PEG high- (> 3 L) or low-dose (≤ 2 L) regimens. Bowel cleansing efficacy was the primary outcome. Secondary outcomes included patient willingness to repeat the procedure, and polyp and adenoma detection rates.

Results Of 3093 citations, 77 trials fulfilled the inclusion criteria. Overall, addition of an adjuvant compared with no adjuvant, irrespective of the type of preparation and mode of administration, yielded improvements in bowel cleanliness (odds ratio [OR] 1.23 [1.01 – 1.51]) without greater willingness to repeat (OR 1.40 [0.91 – 2.15]). Adjuvants combined with high-dose PEG significantly improved colon cleansing (OR 1.96 [1.32 – 2.94]). The odds for achieving adequate preparation with low-dose PEG with an adjuvant were not different to high-dose PEG alone (OR 0.95 [0.73 – 1.22]), but yielded improved tolerance (OR 3.22 [1.85 – 5.55]). However, split high-dose PEG yielded superior cleanliness to low-dose PEG with adjuvants (OR 2.53 [1.25 – 5.13]). No differences were noted for OSS and PICO comparisons, or for any products regarding polyp or adenoma detection rates.

Conclusions Critical heterogeneity precludes firm conclusion on the impact of adjuvants with existing bowel preparations. Additional research is required to better characterize the methods of administration and resulting roles of adjuvants in an era of split-dosing.

* Both authors contributed equally.


Table e1 – e5