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Which is the optimal bowel preparation for colonoscopy - a meta-analysis.
1Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Colorectal Centre, Melbourne, Australia.
Summary
Sodium phosphate (NaP) is the most effective bowel preparation agent compared to polyethylene glycol (PEG) and sodium picosulphate (SPS). NaP also demonstrated better patient completion rates, though caution is advised for patients with renal or cardiovascular issues.
Area of Science:
- Gastroenterology
- Clinical Pharmacy
- Evidence-Based Medicine
Background:
- Effective bowel preparation is crucial for successful colonoscopies.
- Various agents exist, including sodium phosphate (NaP), polyethylene glycol (PEG), and sodium picosulphate (SPS).
- Comparative effectiveness and patient tolerability of these agents require clear elucidation.
Purpose of the Study:
- To compare the efficacy of different bowel preparation agents.
- To assess patient completion rates and adverse events associated with NaP, PEG, and SPS.
Main Methods:
- A meta-analysis of randomized controlled trials published between January 1990 and July 2005.
- Searches were conducted in MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials.
- Forest plot review was utilized for data synthesis.
Main Results:
- Sodium phosphate (NaP) demonstrated superior bowel cleansing compared to PEG (OR 0.75) and SPS (OR 0.52).
- Patient completion rates were significantly higher for NaP versus PEG (OR 0.16) and comparable for SPS versus PEG (OR 0.56).
- Adverse events were similar between NaP and PEG (OR 0.98), but PEG showed more adverse events than SPS (OR 3.82); NaP caused asymptomatic electrolyte imbalances.
Conclusions:
- NaP is more effective for bowel cleansing than PEG or SPS, with comparable adverse event profiles.
- Patient adherence is better with NaP and SPS compared to PEG.
- Caution is recommended with NaP in patients with cardiovascular or renal impairment due to potential biochemical changes.