Xia Hu-Bin, Ruan Wen-Li, Wu Min, Zhou Yi-Feng
The Fourth School of Clinical Medicine Zhejiang Chinese Medical University, Hangzhou First People's Hospital Hangzhou, Zhejiang China.
Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, School of Medicine Westlake University HangZhou, Zhejiang China.
JGH Open. 2025 Aug 30;9(9):e70262. doi: 10.1002/jgh3.70262. eCollection 2025 Sep.
To compare the efficacy of polyethylene glycol electrolyte (PEG) combined with lactulose versus PEG alone in bowel preparation quality for colonoscopy.
The protocol for this systematic review was registered with PROSPERO (CRD420251035139). Comprehensive literature searches were conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP. RevMan 5.4 software was employed to assess differences between the two groups regarding the rates of excellent bowel preparation, willingness to undergo repeat examination, incidence of adverse reactions, and adenoma detection rates.
Sixteen eligible studies, encompassing 2468 participants, were included in the analysis. Meta-analysis demonstrated that the combination of PEG and lactulose was significantly more effective than PEG alone in bowel cleansing (OR = 3.57, 95% CI: 2.75-4.63, < 0.001, = 0% for efficacy; SMD = 0.38, 95% CI: 0.26-0.50, < 0.001, = 45% for BBPS scores; SMD: Standard Mean Difference; BBPS: Boston Bowel Preparation Scale). This combination also led to a lower incidence of adverse events, including vomiting (OR = 0.54, 95% CI: 0.36-0.82, = 0.004), abdominal pain (OR = 0.54, 95% CI: 0.36-0.80, = 0.003), and abdominal bloating (OR = 0.53, 95% CI: 0.38-0.75, < 0.001), compared with PEG alone. Furthermore, PEG plus lactulose significantly improved the detection rate of intestinal adenomas (OR = 2.57, 95% CI: 1.74-3.79, < 0.001). However, no significant differences were observed in the incidence of nausea (OR = 0.69, 95% CI: 0.88-0.99, = 0.05) or willingness to repeat the examination (OR = 1.31, 95% CI: 0.51-3.36, = 0.58).
The combination of PEG and lactulose significantly enhances bowel cleansing efficacy, increases adenoma detection rates, and reduces the incidence of adverse reactions. This regimen is recommended for bowel preparation prior to colonoscopy.
比较聚乙二醇电解质（PEG）联合乳果糖与单用PEG在结肠镜检查肠道准备质量方面的疗效。
本系统评价方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD420251035139）登记。在多个数据库进行全面的文献检索，包括PubMed、Embase、Cochrane图书馆、Web of Science、中国知网（CNKI）、万方数据和维普资讯。采用RevMan 5.4软件评估两组在肠道准备优秀率、接受重复检查的意愿、不良反应发生率和腺瘤检出率方面的差异。
纳入16项符合条件的研究，共2468名参与者进行分析。荟萃分析表明，PEG联合乳果糖在肠道清洁方面显著优于单用PEG（优势比[OR]=3.57，95%置信区间[CI]：2.75 - 4.63，P<0.001，疗效方面I² = 0%；标准化均数差[SMD]=0.38，95% CI：0.26 - 0.50，P<0.001，波士顿肠道准备量表[BBPS]评分方面I² = 45%；SMD：标准化均数差；BBPS：波士顿肠道准备量表）。与单用PEG相比，这种联合用药还导致不良事件发生率较低，包括呕吐（OR = 0.54，95% CI：0.36 - 0.82，P = 0.004）、腹痛（OR = 0.54，95% CI：0.36 - 0.80，P = 0.003）和腹胀（OR = 0.53，95% CI：0.38 - 0.75，P<0.001）。此外，PEG加乳果糖显著提高了肠道腺瘤的检出率（OR = 2.57，95% CI：1.74 - 3.79，P<0.001）。然而，在恶心发生率（OR = 0.69，95% CI：0.88 - 0.99，P = 0.05）或接受重复检查的意愿（OR = 1.31，95% CI：0.51 - 3.36，P = 0.58）方面未观察到显著差异。
PEG联合乳果糖显著提高肠道清洁效果，增加腺瘤检出率，并降低不良反应发生率。推荐该方案用于结肠镜检查前的肠道准备。
