Elgendy Mohamed S, Rajab Islam, Najah Qasi, Faheem Mohamed A, Elsawy Omar K, Taha Hosam I, Elewidi Mariam, Shubietah Abdalhakim, Patel Dhruv, Farokhian Alisa, Abuelazm Mohamed, Baddoura Walid
Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Internal Medicine Department, St Joseph University Medical Center, Paterson, NJ, USA.
Int J Colorectal Dis. 2025 Jun 18;40(1):143. doi: 10.1007/s00384-025-04931-9.
Recent evidence supports linaclotide (Lin) for colonoscopy preparation. This network meta-analysis evaluates the combination of different pill numbers of Lin with polyethylene glycol (PEG) (high and low volumes in liters (L)) for bowel cleansing.
This systematic review and frequentist network meta-analysis, conducted in October 2024, assessed randomized controlled trials (RCTs) from Scopus, PubMed, Cochrane, WOS, and Embase. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated for categorical and continuous outcomes.
CRD42024618272.
Fourteen RCTs with 4,764 participants showed that total Boston Bowel Preparation Scale improved significantly with 2L PEG + 2Lin (MD = 2.03, 95%CI: [0.30:3.76], P = 0.0217), 3L-PEG + 3Lin (MD = 1.30, 95%CI: [0.42:2.18], P = 0.0038), and 4L-PEG (MD = 1.11, 95%CI: 0.23-1.98, P = 0.0129). Adenoma detection was highest with 3L-PEG + 3Lin (RR = 1.60, 95%CI: [1.05:2.43], P = 0.0280), while polyp detection improved with 2L PEG + 3Lin (RR = 1.72, 95%CI: [1.13:2.62], P = 0.0114) and 3L-PEG + 3Lin (RR = 1.33, 95%CI: [1.00:1.77], P = 0.0505). Procedure times were significantly reduced with 3L-PEG + 3Lin (MD = -4.6, 95%CI: [-6.24:-3.24], P < 0.0001), 3L-PEG + 1Lin (P = 0.035), and 4L-PEG (P < 0.01). Abdominal pain and abdominal bloating decreased with 2L PEG + 1Lin (P < 0.01) and 2L PEG + 2Lin (P = 0.021) but increased with 4L-PEG (P = 0.0178).
Combining PEG with Lin improves bowel cleanliness compared to 3L-PEG, with 2L PEG + 2Lin being the most effective and well-tolerated. Despite some heterogeneity, the findings suggest that adding Lin may enhance bowel preparation with comparable safety, warranting consideration of individual patient factors.
近期证据支持利那洛肽（Lin）用于结肠镜检查前准备。这项网状Meta分析评估了不同片数的利那洛肽与聚乙二醇（PEG）（高容量和低容量，单位为升（L））联合用于肠道清洁的效果。
这项系统评价和频率学派网状Meta分析于2024年10月进行，评估了来自Scopus、PubMed、Cochrane、WOS和Embase的随机对照试验（RCT）。针对分类和连续结局计算了风险比（RR）和平均差（MD）以及95%置信区间（CI）。
PROSPERO注册号：CRD42024618272。
14项随机对照试验共纳入4764名参与者，结果显示，2L PEG + 2Lin（MD = 2.03，95%CI：[0.30:3.76]，P = 0.0217）、3L - PEG + 3Lin（MD = 1.30，95%CI：[0.42:2.18]，P = 0.0038）和4L - PEG（MD = 1.11，95%CI：0.23 - 1.98，P = 0.0129）组的波士顿肠道准备量表总分显著改善。腺瘤检出率在3L - PEG + 3Lin组最高（RR = 1.60，95%CI：[1.05:2.43]，P = 0.0280），而息肉检出率在2L PEG + 3Lin组（RR = 1.72，95%CI：[1.13:2.62]，P = 0.0114）和3L - PEG + 3Lin组（RR = 1.33，95%CI：[1.00:1.77]，P = 0.0505）有所改善。3L - PEG + 3Lin组（MD = -4.6，95%CI：[-6.24:-3.24]，P < 0.0001）、3L - PEG + 1Lin组（P = 0.035）和4L - PEG组（P < 0.01）的操作时间显著缩短。腹痛和腹胀在2L PEG + 1Lin组（P < 0.01）和2L PEG + 2Lin组（P = 0.021）有所减轻，但在4L - PEG组有所增加（P = 0.0178）。
与3L - PEG相比，PEG与Lin联合使用可改善肠道清洁效果，其中2L PEG + 2Lin最为有效且耐受性良好。尽管存在一些异质性，但研究结果表明添加Lin可能在安全性相当的情况下增强肠道准备效果，值得考虑个体患者因素。
