Pan Hui, Zheng Xiao-Ling, Fang Chao-Ying, Liu Lan-Zai, Chen Jian-Su, Wang Chao, Chen Yu-Dai, Huang Jian-Min, Zhou Yu-Shen, He Li-Ping
Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, The Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China.
Gastrointestinal Endoscopy Center, Fujian Provincial Hospital South Branch, Fuzhou 350001, Fujian Province, China.
World J Clin Cases. 2022 Aug 6;10(22):7844-7858. doi: 10.12998/wjcc.v10.i22.7844.
Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the "gold standard" for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate.
To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.
We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.
A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs ( < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms ( > 0.05).
Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.
4升聚乙二醇（PEG）的分剂量方案（SpDs）已被确立为肠道准备的“金标准”；然而，其应用受到所需大量液体以及与夜间剂量相关的睡眠干扰的限制。同时，PEG的同日单剂量方案（SSDs）已被推荐作为替代方案；然而，与其他方案相比其优越性仍存在争议。
比较SSD和大剂量SpDs PEG用于肠道准备的疗效和耐受性。
我们检索了MEDLINE/PubMed、Cochrane图书馆、RCA、EMBASE和科学引文索引扩展版，以查找比较（2升/4升）SSD与大剂量（4升/3升）基于SpDs PEG方案的随机试验，无论是否使用辅助泻药。计算肠道清洁度、睡眠干扰、使用相同准备方法重复该程序的意愿以及不良反应的相对风险比和平均差的汇总分析。根据研究间的异质性分析选择随机效应模型或固定效应模型。
共纳入18项研究。在（2升/4升）SSD与大剂量（4升/3升）SpDs之间，无论是否使用辅助泻药，肠道准备充分性（相对风险=0.97；95%CI：0.92 - 1.02）（14项试验）、右半结肠波士顿肠道准备量表（平均差=0.00；95%CI：-0.04，0.03）（9项试验）和右半结肠渥太华肠道准备量表（平均差=0.04；95%CI：-0.27，0.34）（5项试验）均无统计学显著差异。汇总分析支持使用SSD，其睡眠干扰较少（相对风险=0.52；95%CI：0.40，0.68）且腹痛发生率较低（相对风险=0.75；95%CI：0.62，0.90）。在亚组分析中，接受低剂量（2升）SSD的患者比SpDs更愿意使用相同的准备方法重复该程序（<0.05）。两组在包括恶心、呕吐和腹胀在内的不良反应方面无显著差异（>0.05）。
无论是否使用辅助泻药，基于（2升/4升）SSD PEG的方案在肠道清洁度和耐受性方面被认为与大剂量（≥3升）SpDs PEG方案相当或更好。由于液体需求量低且睡眠干扰少，接受低剂量（2升）SSD的患者更愿意使用相同的准备方法重复该程序。
