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Systematic review: oral bowel preparation for colonoscopy
Author(s) -
BELSEY J.,
EPSTEIN O.,
HERESBACH D.
Publication year - 2007
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.03212.x
Subject(s) - tolerability , medicine , colonoscopy , bowel preparation , randomized controlled trial , meta analysis , systematic review , sodium phosphates , critical appraisal , medline , adverse effect , sodium , alternative medicine , colorectal cancer , pathology , cancer , political science , law , chemistry , organic chemistry
Summary Background There are many published trials of colon cleansing regimens for colonoscopy but no clear consensus regarding relative performance. Aim To identify high quality controlled trials comparing two or more bowel preparation regimens and to compare efficacy and tolerability. Methods A comprehensive systematic review was carried out to identify candidate studies. Quality appraisal was carried out on all identified studies. Results were meta‐analysed where possible and qualitatively compared if not. Results Eighty‐two studies qualified for analysis. Polyethylene glycol and sodium phosphate were the most frequently investigated preparations. There was no significant efficacy difference between the two, but sodium phosphate was better tolerated. Sodium picosulphate/magnesium citrate, a commonly prescribed preparation, was investigated in four studies, with no clear benefit over other regimens demonstrated. Safety was not recognized as a problem in the randomized controlled trials. Published case series demonstrate that sodium phosphate is associated with the highest risk of clinically significant electrolyte disturbances. Conclusion Shortcomings in study design limit the value of many of the studies. Based on these results, no single bowel preparation emerges as consistently superior. New preparations are required that combine better efficacy and tolerability, in addition to rigorous new validated study designs, allowing unequivocal comparisons to be made.