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CC BY-NC-ND 4.0 · Endosc Int Open
DOI: 10.1055/a-2778-9563
Original article

Efficacy and acceptability of bowel preparation strategies for inflammatory bowel disease colonoscopy: Systematic review and meta-analysis

Authors

  • Gaurav Bhaskar Nigam 

    1   Translational Gastroenterology and Liver Unit, University of Oxford Nuffield Department of Medicine, Oxford, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN105596)

  • Morris Gordon

    2   School of Medicine, University of Central Lancashire, Preston, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN6723)

  • Vassiliki Sinopoulou 

    2   School of Medicine, University of Central Lancashire, Preston, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN6723)

  • Anukriti Tomar

    2   School of Medicine, University of Central Lancashire, Preston, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN6723)

  • Shahida Din

    3   Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN59892)
    4   Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN59892)

  • Margaret Vance

    5   Wolfson Unit for Endoscopy, St. Mark's Hospital, London, United Kingdom of Great Britain and Northern Ireland

  • Ana Wilson

    6   Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, United Kingdom of Great Britain and Northern Ireland

  • James East

    7   Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN11269)
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Background: Patients with inflammatory bowel disease (IBD) frequently undergo colonoscopy, each requiring bowel preparation. ESGE 2019 guidelines recommended high or low volume polyethylene glycol (PEG)-based bowel prep for IBD patients; however other non-PEG-based preparations (sulphate and picosulphate-based) have now been studied in IBD. Methods: We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and WHO ICTPR for randomised controlled trials (RCTs) up to December 2024. Primary outcome was bowel prep success; secondary outcomes included tolerability, acceptability, caecal intubation rates (CIR) and safety. Pooled estimates used risk ratio (RR) and GRADE to assess evidence certainty. Results: Ten RCTs (1479 IBD patients) were included. There was no difference in prep success (RR 0.98, 95%CI 0.88-1.09; I2=33%, 2 RCTs; moderate certainty evidence) between 2L vs. 4L PEG, but higher acceptability for 2L (RR 0.69, 95%CI 0.59-0.80; I2=18%,2 RCTs; high certainty evidence). Low-volume non-PEG vs. PEG, are probably similar for prep success (RR 0.96,95%CI:0.90-1.01; I2=6%,3 RCTs; moderate certainty evidence). The evidence on tolerability and acceptability was very uncertain. Sub-group analysis revealed comparable effectiveness of picosulphate-based (RR 0.89, 95%CI 0.78-1.01; I2=0%,1 RCT) and sulphate-based preps (RR 0.98, 95% CI: 0.91-1.05; I2=28%, 2 RCTs) compared to low-volume PEG. Safety data were inconsistently reported. Conclusion: High-certainty evidence supports low-volume PEG as comparably successful to high-volume PEG, with higher acceptability. Moderate-certainty evidence indicates similar success between non-PEG and PEG-based preps. Both low-volume PEG and non-PEG-based preps are supported for use in IBD, broadening options beyond current ESGE guidelines.



Publication History

Received: 04 February 2025

Accepted after revision: 23 December 2025

Accepted Manuscript online:
24 December 2025

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Bibliographical Record
Gaurav Bhaskar Nigam, Morris Gordon, Vassiliki Sinopoulou, Anukriti Tomar, Shahida Din, Margaret Vance, Ana Wilson, James East. Efficacy and acceptability of bowel preparation strategies for inflammatory bowel disease colonoscopy: Systematic review and meta-analysis. Endosc Int Open ; 0: a27789563.
DOI: 10.1055/a-2778-9563