P4105 - Efficacy and Safety of Polyethylene Glycol Alone vs Combined Polyethylene Glycol and Linaclotide as Colonoscopy Preparation Regimens: A Systematic Review and Meta-Analysis

Umar Akram, ¹, Eeman Ahmad, MBBS², Ahmed Raza, ¹, Eeshal Fatima, MBBS³, Shahzaib Ahmed, MBBS², Syed Adeel Hassan, MBBS⁴, Faryal Altaf, MD⁵, Zaheer Qureshi, MD^6
1Allama Iqbal Medical College, Lahore, Punjab, Pakistan; ²Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Punjab, Pakistan; ³Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ⁴University of Kentucky, Lexington, KY; ⁵BronxCare Health System, Bronx, NY; ⁶The Frank H. Netter M.D. School of Medicine at Quinnipiac University, Bronx, NY

Introduction: Colonoscopy, an essential modality for detecting colorectal diseases, relies on effective bowel preparation. Suboptimal preparation can lead to misdiagnosis in 10%-25% of colonoscopies thereby increasing the risk for increased procedural times. While polyethylene glycol (PEG) solutions are recommended, their poor tolerance prompts exploration of alternatives like linaclotide. However clinical data regarding combined efficacy remains limited. Our study aims to evaluate the efficacy and safety of PEG with versus without linaclotide in colonoscopy preparation.

Methods: A literature search was done from inception till June 2024 on PubMed, Embase, Cochrane CENTRAL, and clinicaltrials.gov. Only randomised controlled trials comparing PEG with versus without linaclotide in patients undergoing colonoscopy were included. Statistical analyses were performed using R version 4.3.3. The random effects model was used and odds ratios (ORs) and mean differences (MDs) were calculated with their 95% confidence intervals (CIs). Doi plots were made, and the Luis Furuya-Kanamori (LFK) index was used to assess publication bias. Cochrane risk of bias (RoB2) tool was used for quality assessment.

Results: A total of 5 studies consisting of 1991 patients were included in our study. 931 patients received PEG alone, while 1060 patients received PEG with linaclotide. The mean age of the participants ranged from 45-52 years. The pooled results show that PEG alone was significantly associated with a better adenoma detection rate (OR = 1.31, 95% CI = 1.11 - 1.54, p-value = 0.01). However, a nonsignificant association of adequate bowel preparation (OR = 1.41, 95% CI = 0.51 - 3.91, p-value = 0.28), polyp detection rate (OR = 1.05, 95% CI = 0.62 - 1.77, p-value = 0.80), Boston bowel preparation scale score (MD = 0.28, 95% CI = -0.09 - 0.66, p-value = 0.11), cecal incubation time (MD = 0.11, 95% CI = -0.90 - 1.11, p-value = 0.76) and cecal intubation rate (MD = 0.91, 95% CI = 0.00 - 469.33, p-value = 0.88) with either group was found. We also analyzed common adverse events such as nausea, bloating, and abdominal pain. The overall risk of bias was low in all studies.

Discussion: While PEG alone demonstrated a higher adenoma detection rate, both regimens showed comparable safety profiles and effectiveness in other measured outcomes. These findings highlight the importance of optimising bowel preparation strategies to ensure both diagnostic accuracy and patient safety during colonoscopy.


Disclosures:


Umar Akram, ¹, Eeman Ahmad, MBBS², Ahmed Raza, ¹, Eeshal Fatima, MBBS³, Shahzaib Ahmed, MBBS², Syed Adeel Hassan, MBBS⁴, Faryal Altaf, MD⁵, Zaheer Qureshi, MD⁶. P4105 - Efficacy and Safety of Polyethylene Glycol Alone vs Combined Polyethylene Glycol and Linaclotide as Colonoscopy Preparation Regimens: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.