Journal article
Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta‐analysis
United European gastroenterology journal, Vol.8(10), pp.1217-1227
12/2020
DOI: 10.1177/2050640620953224
PMCID: PMC7724533
PMID: 32838693
Abstract
Background
Bowel preparation for colonoscopy is often poorly tolerated due to poor palatability and adverse effects. This can negatively impact on the patient experience and on the quality of bowel preparation. This systematic review and meta‐analysis was carried out to assess whether adjuncts to bowel preparation affected palatability, tolerability and quality of bowel preparation (bowel cleanliness).
Methods
A systematic search strategy was conducted on PubMed, MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to identify studies evaluating adjunct use for colonoscopic bowel preparation. Studies comparing different regimens and volumes were excluded. Specific outcomes studied included palatability (taste), willingness to repeat bowel preparation, gastrointestinal adverse events and the quality of bowel preparation. Data across studies were pooled using a random‐effects model and heterogeneity assessed using I 2 ‐statistics.
Results
Of 467 studies screened, six were included for analysis (all single‐blind randomised trials; n = 1187 patients). Adjuncts comprised citrus reticulata peel, orange juice, menthol candy drops, simethicone, Coke Zero and sugar‐free chewing gum. Overall, adjunct use was associated with improved palatability (mean difference 0.62, 95% confidence interval 0.29–0.96, p < 0.001) on a scale of 0–5, acceptability of taste (odds ratio 2.75, 95% confidence interval: 1.52–4.95, p < 0.001) and willingness to repeat bowel preparation (odds ratio 2.92, 95% confidence interval: 1.97–4.35, p < 0.001). Patients in the adjunct group reported lower rates of bloating (odds ratio 0.48, 95% confidence interval: 0.29–0.77, p = 0.003) and vomiting (odds ratio 0.47, 95% confidence interval 0.27–0.81, p = 0.007), but no difference in nausea (p = 0.10) or abdominal pain (p = 0.62). Adjunct use resulted in superior bowel cleanliness (odds ratio 2.52, 95% confidence interval: 1.31–4.85, p = 0.006). Heterogeneity varied across outcomes, ranging from 0% (vomiting) to 81% (palatability), without evidence of publication bias. The overall quality of evidence was rated moderate.
Conclusion
In this meta‐analysis, the use of adjuncts was associated with better palatability, less vomiting and bloating, willingness to repeat bowel preparation and superior quality of bowel preparation. The addition of adjuncts to bowel preparation may improve outcomes of colonoscopy and the overall patient experience.
Details
- Title: Subtitle
- Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta‐analysis
- Creators
- Umair Kamran - University Hospitals Birmingham NHS Foundation TrustAbdullah Abbasi - Shrewsbury and Telford Hospital NHS TrustImran Tahir - Worcestershire Acute Hospitals NHS TrustJames Hodson - University of BirminghamKeith Siau - University Hospitals Birmingham NHS Foundation Trust
- Resource Type
- Journal article
- Publication Details
- United European gastroenterology journal, Vol.8(10), pp.1217-1227
- DOI
- 10.1177/2050640620953224
- PMID
- 32838693
- PMCID
- PMC7724533
- NLM abbreviation
- United European Gastroenterol J
- ISSN
- 2050-6406
- eISSN
- 2050-6414
- Publisher
- SAGE Publications
- Language
- English
- Date published
- 12/2020
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984843435202771
Metrics
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