P4586 - Efficacy and Safety of Linaclotide-Enhanced Polyethylene Glycol Regimens for Bowel Preparation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Saksham Kohli, MBBS¹, Jhalak Agrohi, MBBS¹, Harendra Kumar, MBBS², Angad Tiwari, MBBS³, Ashish Sharma, MD⁴, Gedion Amdetsion, MD¹, Maria Grba, MD¹, Denise Nunez, DO¹, Abhin Sapkota, MBBS¹, Daniel Guifarro Rivera, MD⁵, Patricia Zarza Gulino, MD¹, Seema R. Gandhi, MD⁶, Sania Saleem, MD¹, Alejandro Nieto Dominguez, MD⁶, Bhanu Siva Mohan Pinnam, MD¹
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 2Dow University of Health Sciences, Karachi, Sindh, Pakistan; 3Maharani Laxmi Bai Medical College, Ghaziabad, Uttar Pradesh, India; 4University of Connecticut-Hartford, Hartford, CT; 5Cook County Health and Hospital Systems, Chicago, IL; 6Cook County Health, Chicago, IL

Introduction:

Adequate intestinal preparation is required for a high-quality colonoscopy. Linaclotide, a guanylate cyclase-C agonist, may improve bowel cleaning when combined with polyethylene glycol (PEG). However, its efficacy and tolerability in comparison to typical PEG-only regimens have yet to be explored at the population level. We aimed to compare the effectiveness and safety of linaclotide-assisted PEG regimens to standard PEG-only regimens in adult patients having elective colonoscopies.

Methods:

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Up to 2024, databases analyzed included PubMed, Cochrane, and Embase. Studies comparing linaclotide + PEG versus PEG-only regimens in individuals having screening, diagnostic, or surveillance colonoscopy were reviewed. The outcomes evaluated were appropriate bowel preparation (BBPS or OBPS), adenoma and polyp detection rates (ADR, PDR), cecal intubation rate, adverse events, desire to repeat colonoscopy, and sleep quality. Inverse variance approaches were used to create random effect models. A forest plot was created to represent the principal results, and sensitivity analysis validated the findings' resistance to dosage modifications.

Results: Six randomized controlled trials (RCTs), comprising 1,876 participants, met the inclusion criteria. Regimens combining linaclotide and polyethylene glycol (PEG) resulted in significantly higher rates of adequate bowel preparation compared to PEG alone (RR = 1.14, 95% CI: 1.06–1.22; p < 0.001; I² = moderate). The polyp detection rate was also higher in the linaclotide group (RR = 1.24, 95% CI: 1.08–1.43; p = 0.002). Data on adenoma detection rate (ADR), cecal intubation, and adverse events were limited and heterogeneous. Preliminary studies suggest that linaclotide-based regimens may enhance patient willingness to repeat colonoscopy and improve sleep quality; however, these findings require further validation.

Discussion: Linaclotide-assisted PEG regimens significantly improve stool preparation adequacy and polyp detection rates without compromising safety, supporting their use in routine colonoscopy preparation. These findings warrant further clinical trials and future studies on long-term outcomes and cost-effectiveness.


Figure: Linaclotide + PEG Significantly Improves Bowel Cleansing Efficacy Compared to PEG Alone


Figure: Enhanced Polyp Detection with Linaclotide-Enhanced PEG Regimens

Disclosures:
Saksham Kohli indicated no relevant financial relationships.
Jhalak Agrohi indicated no relevant financial relationships.
Harendra Kumar indicated no relevant financial relationships.
Angad Tiwari indicated no relevant financial relationships.
Ashish Sharma indicated no relevant financial relationships.
Gedion Amdetsion indicated no relevant financial relationships.
Maria Grba indicated no relevant financial relationships.
Denise Nunez indicated no relevant financial relationships.
Abhin Sapkota indicated no relevant financial relationships.
Daniel Guifarro Rivera indicated no relevant financial relationships.
Patricia Zarza Gulino indicated no relevant financial relationships.
Seema Gandhi indicated no relevant financial relationships.
Sania Saleem indicated no relevant financial relationships.
Alejandro Nieto Dominguez indicated no relevant financial relationships.
Bhanu Siva Mohan Pinnam indicated no relevant financial relationships.

Saksham Kohli, MBBS¹, Jhalak Agrohi, MBBS¹, Harendra Kumar, MBBS², Angad Tiwari, MBBS³, Ashish Sharma, MD⁴, Gedion Amdetsion, MD¹, Maria Grba, MD¹, Denise Nunez, DO¹, Abhin Sapkota, MBBS¹, Daniel Guifarro Rivera, MD⁵, Patricia Zarza Gulino, MD¹, Seema R. Gandhi, MD⁶, Sania Saleem, MD¹, Alejandro Nieto Dominguez, MD⁶, Bhanu Siva Mohan Pinnam, MD¹. P4586 - Efficacy and Safety of Linaclotide-Enhanced Polyethylene Glycol Regimens for Bowel Preparation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.