S908 Polyethylene Glycol versus Oral Sulfate Solution for Colonoscopy: An Updated Systematic Review and Meta-Analysis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.035 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".