Combined linaclotide and polyethylene glycol electrolyte for colonoscopy preparation: A network meta-analysis of 14 randomized controlled trials

Authors

Mohamed S. Elgendy, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt. dr.elgendy.mo@gmail.com.
Islam Rajab, Internal Medicine Department, St Joseph University Medical Center, Paterson, NJ, USA.
Qasi Najah, Faculty of Medicine, Al Margeb University, Al Khums, Murqub, Libya.
Mohamed A. Faheem, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Omar K. Elsawy, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Hosam I. Taha, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Mariam Elewidi, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Abdalhakim Shubietah, Advocate Health - MidwestFollow
Dhruv Patel, Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, NJ, USA.
Alisa Farokhian, Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, NJ, USA.
Mohamed Abuelazm, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Walid Baddoura, Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, NJ, USA.

Recommended Citation

Elgendy MS, Rajab I, Najah Q, et al. Combined linaclotide and polyethylene glycol electrolyte for colonoscopy preparation: a network meta-analysis of 14 randomized controlled trials. Int J Colorectal Dis. 2025;40(1):143. Published 2025 Jun 18. doi:10.1007/s00384-025-04931-9

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Purpose:Recent evidence supports linaclotide (Lin) for colonoscopy preparation. This network meta-analysis evaluates the combination of different pill numbers of Lin with polyethylene glycol (PEG) (high and low volumes in liters (L)) for bowel cleansing.

Methods:This systematic review and frequentist network meta-analysis, conducted in October 2024, assessed randomized controlled trials (RCTs) from Scopus, PubMed, Cochrane, WOS, and Embase. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated for categorical and continuous outcomes.

Prospero id:CRD42024618272.

Results:Fourteen RCTs with 4,764 participants showed that total Boston Bowel Preparation Scale improved significantly with 2L PEG + 2Lin (MD = 2.03, 95%CI: [0.30:3.76], P = 0.0217), 3L-PEG + 3Lin (MD = 1.30, 95%CI: [0.42:2.18], P = 0.0038), and 4L-PEG (MD = 1.11, 95%CI: 0.23-1.98, P = 0.0129). Adenoma detection was highest with 3L-PEG + 3Lin (RR = 1.60, 95%CI: [1.05:2.43], P = 0.0280), while polyp detection improved with 2L PEG + 3Lin (RR = 1.72, 95%CI: [1.13:2.62], P = 0.0114) and 3L-PEG + 3Lin (RR = 1.33, 95%CI: [1.00:1.77], P = 0.0505). Procedure times were significantly reduced with 3L-PEG + 3Lin (MD = -4.6, 95%CI: [-6.24:-3.24], P < 0.0001), 3L-PEG + 1Lin (P = 0.035), and 4L-PEG (P < 0.01). Abdominal pain and abdominal bloating decreased with 2L PEG + 1Lin (P < 0.01) and 2L PEG + 2Lin (P = 0.021) but increased with 4L-PEG (P = 0.0178).

Conclusions:Combining PEG with Lin improves bowel cleanliness compared to 3L-PEG, with 2L PEG + 2Lin being the most effective and well-tolerated. Despite some heterogeneity, the findings suggest that adding Lin may enhance bowel preparation with comparable safety, warranting consideration of individual patient factors.

Type

Article

PubMed ID

40528061