P0276 - Comparative Effectiveness of Bowel Preparation Agents in Colonoscopy: A Network Meta-Analysis

Omer Farooq Mohammed, MBBS¹, Aasim Akthar Ahmed, MD², Suchith Boodegere Suresh, ³, Ayman Nadeem, MBBS⁴, Adi Prasad Bodapati, MD⁵, Ramsha Khan, MBBS¹, Yeshika Thapa, MD⁶, Sai Charan Kotha, MBBS⁷, Binay Panjiyar, MD⁸, Bhavani Gangineni, MD⁹
1Osmania General Hospital and Medical College, Hyderabad, Telangana, India; 2St. Francis Medical Center, Monroe, LA; 3Montefiore St Luke's Cornwall Hospital, Newburgh, NY; 4Osmania Medical College, Hyderabad, Telangana, India; 5Texas Tech University Health Sciences Center, Odessa, TX; 6University of Central Florida, Gainesville, FL; 7Government Medical College and Hospital Nalgonda, Hyderabad, Telangana, India; 8NorthShore University Hospital, Manhasset, NY; 9Guntur Medical College, Harlingen, TX

Introduction: Colonoscopy is a widely preferred procedure for screening and diagnosing colonic diseases. It allows for reasonable diagnostic sensitivity and specificity, which often becomes limited due to low-quality bowel preparation. Polyethylene glycol(PEG) is the standard regimen. However, it has high volume requirements, leading to poor patient compliance. This study aims to comparatively assess available regimens and draw an appropriate conclusion.

Methods: The electronic databases, PubMed, Google Scholar, PLOS One, Cochrane Library, Biomedcentral, and ScienceDirect were searched from January 2020 to May 2025 using robust search strategies. Randomised Controlled Trials(RCTs) comparing bowel-cleansing regimens in adults (≥ 18 years) undergoing elective colonoscopy were included. Outcomes analysed were cleansing success, adenoma detection rate (ADR) and nausea. Pairwise Network meta-analysis was performed on R programming.

Results: Among 13,192 pooled patients from 35 RCTs, 3L PEG+3D-LINACLOTIDE (3-litre PEG with 3-day linaclotide) showed comparatively superior cleansing success (Relative Risk (RR) 1.27, 95% Confidence Interval (CI) [1.13, 1.43]) with P-score= 0.98 and I²= 58.3%, followed by 4L PEG+1D-LINACLOTIDE (4-litre PEG with 1-day linaclotide) with RR: 1.24; [CI 1.05, 1.45], P-score= 0.95 and SENNA with RR: 1.13; [CI 1.01, 1.27], P-score= 0.87, with all the three regimens being statistically significant. Regarding ADR, magnesium sulfate solution had the highest rate with RR: 1.41; [CI 0.88, 2.27], P-score= 0.79 and I²= 29.3%, followed by 4L PEG+1D-LINACLOTIDE with RR: 1.42; [CI 0.85, 2.3], P-score= 0.79.

In respect to nausea, the lowest incidence rate of nausea was seen in 1L PEG+LINACLOTIDE with RR: 0.19; [CI 0.06, 0.59], P-score= 0.97 and I²= 73.5%, followed by 2L PEG with RR: 0.42; [CI 0.21, 0.86], P-score= 0.81, and 2L PEG+LINACLOTIDE with RR: 0.45; [CI 0.21, 0.93], P-score= 0.78. However, 4L PEG+1D-LINACLOTIDE with RR: 0.44; [CI 0.17, 1.13], P-score= 0.77 also showed one of the lowest incidence rates, suggesting better tolerability.

Discussion: Overall analysis shows that 4L PEG+1D-LINACLOTIDE has the most favourable profile, with superior cleansing success, ADR and lower incidence of nausea. SENNA remains the second most favourable, suggesting its role as a better alternative for bowel preparation prior to colonoscopy. More well-designed trials are needed to strengthen the evidence and clinical decision-making.


Figure: Network Meta Analysis Plots:
1. Cleansing success network map and forest plot.
2. Adenoma detection rate network map and forest plot.
3. Nausea network map and forest plot.

Disclosures:
Omer Farooq Mohammed indicated no relevant financial relationships.
Aasim Akthar Ahmed indicated no relevant financial relationships.
Suchith Boodegere Suresh indicated no relevant financial relationships.
Ayman Nadeem indicated no relevant financial relationships.
Adi Prasad Bodapati indicated no relevant financial relationships.
Ramsha Khan indicated no relevant financial relationships.
Yeshika Thapa indicated no relevant financial relationships.
Sai Charan Kotha indicated no relevant financial relationships.
Binay Panjiyar indicated no relevant financial relationships.
Bhavani Gangineni indicated no relevant financial relationships.

Omer Farooq Mohammed, MBBS¹, Aasim Akthar Ahmed, MD², Suchith Boodegere Suresh, ³, Ayman Nadeem, MBBS⁴, Adi Prasad Bodapati, MD⁵, Ramsha Khan, MBBS¹, Yeshika Thapa, MD⁶, Sai Charan Kotha, MBBS⁷, Binay Panjiyar, MD⁸, Bhavani Gangineni, MD⁹. P0276 - Comparative Effectiveness of Bowel Preparation Agents in Colonoscopy: A Network Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.