Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Dig Endosc. 2022 Jan;34(1):13-32. doi: 10.1111/den.14015. Epub 2021 Jun 24.
High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1 L or less (≤1 L).
We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1 L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety.
Bowel preparation with sodium picosulfate/magnesium citrate (SPMC; 19 trials, n = 10,287), 1L-polyethylene glycol with ascorbate (PEGA; 10 trials, n = 1717), sodium phosphate (NaP; 2 trials, n = 621), and oral sulfate solution (OSS; 3 trials, n = 597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I range: 86-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients.
Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.
高质量的肠道准备对于提高结肠镜检查的诊断准确性和安全性至关重要；然而，患者通常难以接受高容量的泻药，这可能导致肠道准备不佳。本综述旨在评估容量为 1L 或以下（≤1L）的肠道准备液的疗效。
我们系统地检索了自 2015 年以来发表的所有关于超低容量（≤1L）肠道准备液用于结肠镜检查的相关随机对照试验。主要终点是肠道准备充分的患者比例。次要终点包括腺瘤检出率（ADR）和安全性。
使用匹可硫酸钠/柠檬酸镁（SPMC；19 项试验，n=10287）、1L 聚乙二醇加维生素 C（PEGAC；10 项试验，n=1717）、磷酸钠（NaP；2 项试验，n=621）和口服硫酸盐溶液（OSS；3 项试验，n=597）进行肠道准备时，患者的肠道准备充分率分别为 75.2%、82.9%、81.9%和 92.1%；然而，研究之间存在很大的异质性（I 范围：86-98%）。SPMC 的 ADR 为 31.1%，1L-PEGAC 的 ADR 为 32.3%，NaP 的 ADR 为 30.4%，OSS 的 ADR 为 40.9%。所有超低容量肠道准备液均会引起短暂的电解质变化，但在大多数患者中没有持续的影响。
超低容量肠道准备液并不总是能满足当前指南中定义的 90%充分肠道准备质量标准。然而，对于不能耐受高容量泻药、无肠道准备不充分或与脱水相关并发症风险因素的患者，可考虑使用这些溶液。
