S326 Comparative Effectiveness of Bowel Preparation Agents in Colonoscopy: A Network Meta-Analysis
Bibliographic record
Abstract
Introduction: Colorectal cancer screening is routinely performed in solid organ transplant candidates, and although not obligatory per guidelines, is an important consideration during a pre-transplant workup given increased post-transplant immunosuppression. A comprehensive review of risks versus benefits in heart, liver, and lung transplant candidates has not yet been performed. We sought to evaluate colorectal cancer screening in heart, liver, and lung transplant candidates. Methods: We performed searches of Ovid MEDLINE, Embase, Cochrane, and Web of Science to March 22, 2024 for observational studies or clinical trials. The search was conducted using the MeSH headings as well as equivalent key words and phrases. Studies were extracted using Covidence and independently classified by 2 reviewers, with disagreements resolved by a third reviewer. The median Newcastle-Ottawa Scale to assess the quality of studies was 7, reflecting adequate quality. Pooled data using adenoma detection rate was possible, but a meta-analysis of other variables was not possible due to the heterogeneity of the data. Results: Of a total of 5,483 studies screened, 20 studies met inclusion criteria. All 20 studies reported adenoma detection rates (ADR) of 4.2%-42.9% (1,764 patients). Ten studies reported advanced ADRs of 1.6%-13.9% (281 patients). Twelve studies reported cancer detection rates of 0%-4.5% (62 patients). Ten studies reported complication rates of 0%-56.5%, with 127 patients experiencing some sort of procedure-related complication. The most common complication was acute kidney injury in 73 patients. A procedure-related gastrointestinal bleed occurred in 31 patients. De-listing due to colonoscopy-related colonic perforation occurred with 1 patient, and this patient later died due to sepsis. Conclusion: A systematic review evaluating the risks versus benefits of colon cancer screening in solid organ transplant candidates is needed in clinical practice to guide screening decisions, and although preliminary work has been done in this area, no systematic review to date has examined the types and rates of complications due to candidate colonoscopies. Our review revealed numerous complications, and overall, the literature does not demonstrate a significant difference in advanced adenoma and cancer detection rates in the pre-transplant population as compared to the general population. This data will be helpful to clinicians in weighing the risks and benefits of colorectal cancer screening in this population.
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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 | 0.028 | 0.058 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.059 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
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".