Polyethylene glycol combined with lactulose has better efficacy than polyethylene glycol alone in bowel preparation before colonoscopy: A meta-analysis

Zhang, Xiaofen; Chen, Yishu; Chen, Ye; Zhu, Wei; Tang, Chenxi; Lamm, Shelby; Li, Lan

doi:10.1016/j.clinsp.2023.100172

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Review articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100172 copy

Polyethylene glycol combined with lactulose has better efficacy than polyethylene glycol alone in bowel preparation before colonoscopy: A meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The accuracy of diagnosis and the safety of treatment in colonoscopy depends largely on the quality of bowel cleansing. This study aimed to compare the efficacy and adverse reactions of Polyethylene Glycol (PEG) combined with lactulose with that of PEG alone in bowel preparation before colonoscopy.

Methods:

The authors searched a number of databases including EMBASE, MEDLINE, Cochrane Library, and China Academic Journals Full-text Database. The authors screened according to literature inclusion and exclusion criteria, assessed the quality of the included literature, and extracted the data. The meta-analysis of included literature used RevMan 5.3 and Stata 14.0 software.

Results:

A total of 18 studies, including 2274 patients, were enrolled. The meta-analysis showed that PEG combined with lactulose had a better efficacy (OR = 3.87, 95% CI 3.07‒4.87, p = 0.000, and I² = 36.2% in the efficiency group; WMD = 0.86, 95% CI 0.69‒1.03, p = 0.032 and I² = 0% in the BBPS score group) in bowel preparation for patients with or without constipation. Moreover, PEG combined with lactulose had fewer adverse reactions, including abdominal pain (OR = 1.42, 95% CI 0.94‒2.14, p = 0.094), nausea (OR = 1.60, 95% CI 1.13‒2.28, p = 0.009) and vomiting (OR = 1.77, 95% CI 1.14‒2.74, p = 0.011), than PEG alone. No significant reduction in the incidence of abdominal distention was observed.

Conclusion:

PEG combined with lactulose may be a better choice for bowel preparation before colonoscopy compared with PEG alone.

Keywords:
Bowel preparation; Colonoscopy; Polyethylene glycol; Lactulose; Meta-analysis

HIGHLIGHTS

High quality of bowel cleansing is important to the accuracy of diagnosis and the safety of treatment in colonoscopy.

PEG combined with lactulose has a better efficacy in bowel preparation than PEG alone.

PEG combined with lactulose has fewer adverse reactions than PEG alone in bowel preparation.

Study (year)	PEG-lactulose (n)	PEG (n)	Treatment	Design	Bowel assessment	With constipation
Hu et al. (2020)	180	180	PEG 2L+lactulose 100 mL PEG 2L	Double-blind, randomised	BBPS	No
Song WX et al. (2019)	149	151	PEG 2L+lactulose 90 mL PEG 2L	Randomised	BBPS	No
Liu FX et al. (2015)	61	60	PEG 2L+lactulose 50 mL PEG 2L	Randomised	BBPS	No
Zhang ZY et al. (2018)	16	16	PEG 2L+lactulose 90 mL PEG 2L	Randomised	BBPS	Yes
Zheng Y et al. (2018)	40	40	PEG 2L+lactulose 60 mL PEG 2L	Randomised	BBPS	Yes
Yu ZB et al. (2018)	36	36	PEG 2L+lactulose 120 mL PEG 2L	Single-blind, randomised	BBPS	Yes
Nong CS et al. (2015)	36	36	PEG 1L+lactulose 20 mL PEG 1L	Randomised	Non-validated scale	Yes
Wu J et al. (2018)	84	91	PEG 3L+lactulose 180 mL PEG 3L	Randomised	BBPS	Yes
Zhang XT et al. (2019)	45	45	PEG 4L+lactulose 60–180mL PEG 4L	Randomised	BBPS	Yes
Xu HR et al. (2015)	90	90	PEG 0.75L+lactulose 90 mL PEG 0.75L	Single-blind, Randomised	BBPS	Yes
Yang J et al. (2016)	50	50	PEG 2.5L+lactulose 20 mL PEG 3L	Randomised	Non-validated scale	No
Jiang XL et al (2017)	50	50	PEG 1-2L+lactulose 90 mL PEG 2–3L	Single-blind, randomised	BBPS	Yes
Wang Q et al. (2015)	74	74	PEG 2L+lactulose 120 mL PEG 2L	Randomised	Non-validated scale	Yes
Hu XB et al. (2020)	42	42	PEG 2L+lactulose 120 mL PEG 2L	Randomised	BBPS	No
Huang RW et al. (2015)	45	45	PEG 2L+lactulose 60 mL PEG 3L	Randomised	Non-validated scale	Yes
Wu Y et al. (2016)	53	53	PEG 2L+lactulose 30 mL PEG 2L	Randomised	OBPS	Yes
Lu et al. (2016)	45	45	PEG 2L+lactulose 30 mL PEG 2L	Single-blind, randomised	OBPS	Yes
Han LX et al. (2016)	35	35	PEG 3L+lactulose 45 mL PEG 3L	Randomised	Non-validated scale	Yes

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[1] *Corresponding author. E-mail address:nalil@zju.edu.cn (L. Li).