P2419 - Oral Sulfate-Based Versus Low Volume Polyethylene Glycol Ascorbate Regimens for Colonoscopy Preparation in the Geriatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ali Emre Bardak, MD¹, Gizem Teker, MD², Yusuf Yalcin, MD³, Stefan Mitev, MD⁴, Zulal Istemihan, MD², Sandeep Krishnan, MBBS, PhD¹
1St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA; 2Istanbul University, Istanbul, Istanbul, Turkey; 3Boston Medical Center - South, Boston, MA; 4University Hospital St Ivan Rilski, Sofiya, Sofiya, Bulgaria

Introduction: One of the main causes of inadequate bowel preparation in elderly patients is poor compliance due to the large volume of the preparation solutions. This has made low-volume colonoscopy preparation regimens particularly appealing in this population. In this study, we compared oral sulfate-based (OS) and low-volume polyethylene glycol-ascorbate (PEG/Asc) regimens for efficacy and safety in elderly patients undergoing colonoscopy.

Methods: We conducted a systematic literature search of PubMed, Embase, and the Cochrane Library through May 2025 to identify randomized controlled trials (RCTs) comparing OS and low-volume PEG/Asc regimens for bowel preparation before colonoscopy in adults aged ≥ 65 years. Eligible studies reported at least one prespecified outcome. The primary outcome was the efficacy of the bowel cleansing; secondary outcomes included polyp and adenoma detection rates, patient satisfaction, and adverse events. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. Data were pooled using random-effects models.

Results: Four RCTs encompassing 610 participants (304 OS, 306 low-volume PEG/Asc) were included. All included studies reported similar baseline characteristics between the two regimens. Successful bowel preparation rates did not differ between OS and PEG/Asc (RR 1.00; 95% CI 0.96–1.03). There were also no significant differences in total Boston Bowel Preparation Scale (BBPS) (MD 0.11; 95% CI -0.11–0.34) or segmental scores in the right colon (MD 0.21; 95% CI -0.01–0.42), transverse colon (MD 0.10; 95% CI -0.04–0.25), or left colon (MD 0.11; 95% CI -0.04–0.25). OS increased polyp detection rates (RR 1.21; 95% CI 1.02–1.43), and adenoma detection rates (RR 1.28; 95% CI 1.10–1.49). Although OS was associated with greater overall satisfaction on the visual-analogue scale (MD 0.75; 95% CI 0.04–1.46), there was no significant difference in willingness to reuse the same preparation (RR 1.08; 95% CI 0.92–1.26). Adverse events including nausea (RR 1.16; 95% CI 0.78–1.73), vomiting (RR 1.35; 95% CI 0.39–4.69), abdominal distention (RR 0.79; 95% CI 0.33–1.90), or abdominal pain (RR 0.55; 95% CI 0.13–2.37) were comparable.

Discussion: Our study suggests that OS and low‐volume PEG/Asc are equally effective in cleansing the colon, but OS offers higher patient satisfaction and may enhance polyp and adenoma detection without increasing adverse events.


Figure: Meta-analysis included four randomized controlled trials (Nam 2022, Kim 2022, Lim 2023, and Kang 2024). (A) Continuous outcomes with mean differences, (B) Dichotomous outcomes with risk ratios. OS: oral sulfate-based; LV PEG-Asc: low-volume polyethylene glycol-ascorbate; BBPS: Boston Bowel Preparation Scale; VAS: visual analogue scale

Disclosures:
Ali Emre Bardak indicated no relevant financial relationships.
Gizem Teker indicated no relevant financial relationships.
Yusuf Yalcin indicated no relevant financial relationships.
Stefan Mitev indicated no relevant financial relationships.
Zulal Istemihan indicated no relevant financial relationships.
Sandeep Krishnan indicated no relevant financial relationships.

Ali Emre Bardak, MD¹, Gizem Teker, MD², Yusuf Yalcin, MD³, Stefan Mitev, MD⁴, Zulal Istemihan, MD², Sandeep Krishnan, MBBS, PhD¹. P2419 - Oral Sulfate-Based Versus Low Volume Polyethylene Glycol Ascorbate Regimens for Colonoscopy Preparation in the Geriatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.