Penn State Health Milton S. Hershey Medical Center Hershey, PA
Muhammad Shahzil, MD1, Ali Akram Qureshi, 2, Fariha Hasan, MD3, Zainab Jamil, 2, Talha Bin. Kashif, 2, Ammad Javaid Chaudhry, MD4, Muhammad Saad Faisal, MD4, Muhammad Ali Khaqan, MD5, Umer Farooq, DM6 1Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 2King Edward Medical University, Lahore, Punjab, Pakistan; 3Cooper University Hospital, Philadelphia, PA; 4Henry Ford Health, Detroit, MI; 5John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 6Saint Luke's University Hospital, St. Louis, MO
Introduction: Colonoscopy is the gold standard for both screening and prevention of colorectal cancer (CRC). The success of the procedure relies heavily on adequate bowel preparation to enhance diagnostic accuracy and therapeutic outcomes. Polyethylene Glycol (PEG) is the standard bowel prep solution, but its high volume can cause patient discomfort and non-compliance. Combining PEG with linaclotide may offer comparable cleansing efficacy with better tolerability. This meta-analysis aims to evaluate the effectiveness and safety of linaclotide combined with PEG for bowel preparation.
Methods: This meta-analysis, following Cochrane and PRISMA guidelines, compared linaclotide plus PEG versus PEG alone for bowel preparation. Comprehensive searches across multiple databases until March 2023 included randomized controlled trials with adults undergoing colonoscopy. Data extraction used PICOS criteria and a predefined Excel template. Statistical analyses were conducted using RevMan with a random-effects model, considering results significant at p < 0.05.
Results:
Of 1533 screened studies, seven with 3213 patients were included. The linaclotide plus PEG group had 1708 patients, and the PEG only group had 1505. Adequate bowel preparation showed no significant difference between groups (OR: 1.23; 95% CI: 0.94, 1.61; I2 = 0%). Total Boston Bowel Preparation Scale (BBPS) scores were also similar (MD: 0.30; 95% CI: -0.02, 0.62; I2 = 93%). The left colon BBPS score showed significant improvement with linaclotide (MD: 0.09; 95% CI: 0.01, 0.17; I2 = 77%). Fewer adverse events were noted in the linaclotide group, including less abdominal discomfort (RR: 0.42; 95% CI: 0.21, 0.83; I2 = 87%), pain (RR: 0.47; 95% CI: 0.24, 0.91; I2 = 43%), bloating (RR: 0.46; 95% CI: 0.24, 0.90; I2 = 72%), nausea (RR: 0.66; 95% CI: 0.49, 0.89; I2 = 25%), and vomiting (RR: 0.55; 95% CI: 0.33, 0.92; I2 = 38%). Other outcomes, including cecal intubation rate, polyp detection rate, adenoma detection rate, sleep disturbance, and withdrawal time, showed no significant differences.
Discussion: This meta-analysis suggests that linaclotide plus PEG provides similar bowel cleansing efficacy to standard PEG with improved patient tolerability. Additionally, no substantial differences were observed in other procedural metrics, such as cecal intubation and detection rates. Further research is needed to standardize bowel preparation protocols, confirm these findings across diverse populations, and optimize colonoscopy outcomes.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Muhammad Shahzil indicated no relevant financial relationships.
Ali Akram Qureshi indicated no relevant financial relationships.
Fariha Hasan indicated no relevant financial relationships.
Zainab Jamil indicated no relevant financial relationships.
Talha Kashif indicated no relevant financial relationships.
Ammad Javaid Chaudhry indicated no relevant financial relationships.
Muhammad Saad Faisal indicated no relevant financial relationships.
Muhammad Ali Khaqan indicated no relevant financial relationships.
Umer Farooq indicated no relevant financial relationships.
Muhammad Shahzil, MD1, Ali Akram Qureshi, 2, Fariha Hasan, MD3, Zainab Jamil, 2, Talha Bin. Kashif, 2, Ammad Javaid Chaudhry, MD4, Muhammad Saad Faisal, MD4, Muhammad Ali Khaqan, MD5, Umer Farooq, DM6. P2160 - Efficacy and Tolerability of Linaclotide Combined with Polyethylene Glycol for Bowel Preparation: A Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
