Adjunctive linaclotide improves bowel cleansing and patient experience in polyethylene glycol-based bowel preparation

Adequate bowel preparation is critical for successful colonoscopy but is often compromised by the large volume and poor palatability of polyethylene glycol (PEG) solutions, leading to poor patient adherence. Linaclotide, a secretagogue, may enhance the efficacy and tolerability of PEG-based regimens. We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating the addition of linaclotide to various PEG-based bowel preparation regimens (including different PEG volumes and formulations such as PEG with ascorbic acid). Primary outcomes were the rate of adequate bowel preparation and bowel preparation scores (Boston Bowel Preparation Scale [BBPS] and Ottawa Bowel Preparation Scale [OBPS]). Secondary outcomes included polyp detection rate (PDR), adenoma detection rate (ADR), and patient tolerance. Data were pooled using a random-effects model, and results were expressed as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). Nine RCTs with 2228 participants were included. The pooled analysis showed that regimens containing linaclotide as an adjunct to PEG-based solutions significantly increased the rate of adequate bowel preparation compared to control regimens (91.2% vs. 84.3%; OR: 1.89, 95% CI: 1.34-2.66, p < 0.01) and yielded better BBPS (MD: 1.15, 95% CI: 0.28-2.01, p < 0.01) and OBPS scores (MD: - 0.75, 95% CI: - 1.19 to - 0.31, p < 0.01). Notably, low-volume PEG plus linaclotide showed no statistically significant difference in the rate of adequate bowel preparation compared to high-volume PEG alone. The linaclotide combination groups also demonstrated significantly improved patient tolerability, with a lower incidence of adverse symptoms (abdominal pain, bloating, nausea, vomiting) and a higher willingness to repeat the preparation. There were no significant differences in PDR or ADR between groups. The adjunctive use of linaclotide significantly improves the quality of bowel preparation and enhances patient tolerance for PEG-based regimens. It enables effective cleansing with a low-volume PEG solution, offering a promising strategy to improve patient compliance and experience without compromising preparation quality.