S908 Polyethylene Glycol versus Oral Sulfate Solution for Colonoscopy: An Updated Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: Colonoscopy is vital for detecting colorectal cancer, but inadequate bowel preparation can hinder its effectiveness, leading to longer procedures and increased risks. Traditional polyethylene glycol (PEG) solutions are often challenging for patients to consume due to volume and taste. Low-volume alternatives like PEG with ascorbic acid and oral sulfate solution (OSS) have emerged, showing promising efficacy and patient tolerance. Our study aims to evaluate the efficacy and safety of PEG solutions compared to OSS in colonoscopy. Methods: A comprehensive literature search was carried out from inception till June 2024 on PubMed, Embase, Cochrane CENTRAL, and clinicaltrials.gov. Only randomised controlled trials comparing OSS with PEG in patients undergoing colonoscopy were included. Statistical analyses were performed using R version 4.3.3. The random effects model was used and odds ratios (ORs) and mean differences (MDs) were calculated with their 95% confidence intervals (CIs). Publication bias was assessed by Luis Furuya-Kanamori (LFK) index, funnel and doi plots. Results: A total of 20 studies with 6,458 participants were included in the meta-analysis. Out of them, 2,594 received PEG, while 3,864 received OSS. The use of OSS significantly increased adenoma detection rate (OR = 0.82, 95% CI 0.70-0.95, P = 0.01) and polyp detection rate (OR = 0.73, 95% CI 0.60-0.88, P < 0.01), and was associated with a significantly higher score on Boston Bowel Preparation Scale (BBPS) (MD = -0.33, 95% CI -0.53 - -0.14, P < 0.01). The differences between scores on Ottawa Bowel Preparation Scale (MD = 0.98, 95% CI -0.59-2.55, P = 0.11), cecal insertion time (MD = 0.13, 95% CI -0.21-0.48, P = 0.40), and cecal intubation rate (OR = 0.91, 95% CI 0.65-1.27, P = 0.53) were not significant. Sleep disturbances were significantly increased with the use of OSS (OR = 2.24, 95% CI 1.24-4.06, P = 0.03), however, other adverse effects, including nausea, headache, thirst, dizziness, paresthesias, and abdominal pain, discomfort and distention were not significantly associated with the use of either solution. Conclusion: Our analysis revealed OSS to be significantly more effective for increased adenoma and polyp detection rate and higher scores on BBPS. Neither solution was significantly associated with any adverse effect, except sleep disturbances due to OSS use. Thus, our results support that OSS is both an efficacious and safe solution as compared to PEG for use in colonoscopy (see Table 1). Table 1. - Clinical outcomes and adverse events reported in the included studies Clinical Efficacy Outcome No. of Studies Events/Total Pooled Effect Size CI (P-value) I2 LFK Index PEG OSS CIR 15 2278/2316 2340/2376 OR=0.91 0.65 to 1.27 (0.53) 0% - BBPS* 13 -/1920 -/1922 MD= -0.33 -0.53 to -0.14 (< 0.01) 81% - ADR 12 768/2080 864/2086 OR= 0.82 0.70 to 0.95 (0.01) 7% - PDR 9 467/1169 539/1124 OR=0.73 0.60 to 0.88 (< 0.01) 0% -0.83 CIT* 8 -/1392 -/1346 MD= 0.13 -0.21 to 0.48 (0.40) 34% -1.17 OBPS* 3 -/370 -/572 MD= 0.98 -0.59 to 2.55 (0.11) 69% 0.72 Adverse Events Adverse Event No. of Studies Events/Total Pooled Proportions CI (P-value) I 2 LFK Index PEG OSS Nausea 17 562/2806 574/2989 0.92 0.69 to 1.23 (0.56) 64% - Vomiting 17 124/2806 155/3990 0.77 0.49 to 1.20 (0.23) 57% - Abdominal distention 14 368/1777 360/1748 1.03 0.86 to 1.25 (0.70) 0% - Abdominal Pain 13 127/1725 134/1693 0.92 0.62 to 1.35 (0.64) 19% - Headache 4 9/666 14/627 0.72 0.14 to 3.75 (0.57) 16% 1.28 Thirst 5 79/377 70/382 1.23 0.40 to 3.83 (0.64) 71% 0.43 Dizziness 3 43/273 45/275 0.93 0.14 to 6.28 (0.88) 72% 0.85 Mucosal Change 4 17/383 22/383 0.76 0.25 to 2.30 (0.40) 0% 0.29 Paresthesia 4 7/373 5/374 1.39 0.28 to 6.97 (0.56) 0% -3.13 Numbness 3 4/231 4/232 1.03 0.16 to 6.86 (0.95) 0% -0.95 Sleep disturbances 3 5/204 2/206 2.24 1.24 to 4.06 (0.03) 0% 2.07 Abdominal Discomfort 2 36/651 15/657 1.33 0.00 to 1911088.90 (0.84) 83% -3.57 ADR=Adenoma detection rate, PDR=Polyp detection rate, CIR= Cecal intubation rate, BBPS= Boston bowel preparation score, CIT= Cecal insertion time, OBPS= Ottawa bowel preparation scale, I2=Heterogeneity, CI=Confidence interval, LFK=Luis Furuya-Kanamori, PEG=Polyethylene glycol, OSS=Oral sulfate solution.*Continuous outcomes.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,018 | 0,035 |
| Bibliométrie | 0,008 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».