Hsu C W, Imperiale T F
Department of Medicine, Indiana University and Roudebush VA Medical Center, Indianapolis, USA.
Gastrointest Endosc. 1998 Sep;48(3):276-82. doi: 10.1016/s0016-5107(98)70191-9.
Although polyethylene glycol lavage solutions are widely used for colonoscopy preparation, evidence suggests that sodium phosphate is better tolerated and has similar efficacy. The purpose of this study was to compare compliance with and efficacy of polyethylene glycol and sodium phosphate using meta-analysis and to compare the cost of colonoscopy with both methods.
We used Medline to identify all randomized controlled trials comparing the two preparations. Study methods were evaluated, and quantitative data were abstracted independently, including inability to complete the preparation and preparation quality, rated as adequate or excellent. A random effects model was used to calculate the pooled relative risk. Direct costs and literature-based probability estimates were used to compare costs.
Among 1286 subjects from eight colonoscopist-blinded trials, the pooled relative risk of inability to complete the preparation was 0.23 (95% CI [0.18-0.28]) in favor of sodium phosphate. Although the best estimate of the relative risk for an adequate quality preparation revealed therapeutic equivalence (relative risk = 1.06: 95% CI [0.95-1.19]), an excellent quality preparation was more likely with sodium phosphate (relative risk = 1.72: 95% CI [1.16-2.53]). Assuming reexamination rates from published literature of 3% and 8% for sodium phosphate and polyethylene glycol, respectively, direct costs of colonic examination were $465 and $503. There were no clinically important adverse effects with either method.
The results suggest that sodium phosphate is as effective and less costly, with a more easily completed preparation, compared with polyethylene glycol and is the preferred method of preparation for colonoscopy for certain patient subgroups.
尽管聚乙二醇灌洗溶液广泛用于结肠镜检查前的肠道准备，但有证据表明磷酸钠的耐受性更好且疗效相似。本研究的目的是通过荟萃分析比较聚乙二醇和磷酸钠的依从性和疗效，并比较两种方法进行结肠镜检查的成本。
我们使用Medline检索所有比较这两种肠道准备方法的随机对照试验。对研究方法进行评估，并独立提取定量数据，包括无法完成肠道准备的情况以及肠道准备质量，质量分为足够或优秀。采用随机效应模型计算合并相对风险。使用直接成本和基于文献的概率估计来比较成本。
在八项结肠镜检查医师设盲试验的1286名受试者中，无法完成肠道准备的合并相对风险为0.23（95%可信区间[0.18 - 0.28]），磷酸钠更具优势。虽然高质量肠道准备的相对风险的最佳估计显示治疗等效性（相对风险 = 1.06：95%可信区间[0.95 - 1.19]），但磷酸钠更有可能实现优秀质量的肠道准备（相对风险 = 1.72：95%可信区间[1.16 - 2.53]）。假设根据已发表文献，磷酸钠和聚乙二醇的复查率分别为3%和8%，结肠检查的直接成本分别为465美元和503美元。两种方法均未出现具有临床意义的不良反应。
结果表明，与聚乙二醇相比，磷酸钠同样有效且成本更低，肠道准备更容易完成，是某些患者亚组结肠镜检查的首选肠道准备方法。
