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Improving the view during flexible sigmoidoscopy: a systematic review of published randomized, controlled trials comparing the use of oral bowel preparation versus enema bowel preparation

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Abstract

To systematically analyse the published randomized, controlled trials (RCTs) comparing the use of oral bowel preparation (OBP) versus enema bowel preparation (EBP) for diagnostic or screening flexible sigmoidoscopy. Published RCTs, comparing the use of OBP versus EBP, were analysed using RevMan®, and the combined outcomes were expressed as odds ratios (OR). Eight RCTs evaluating 2457 patients were retrieved from the standard electronic databases. There was significant heterogeneity among included trials. The compliance of the patients (p = 0.32) and the acceptability of both bowel preparation regimens (OR, 1.42; 95 % CI, 0.67, 2.99; z = 0.92; p = 0.36) were similar in both groups. In addition, the incidence of adverse reactions (OR, 0.87; 95 % CI, 0.54, 1.41; z = 0.57; p = 0.57), the risk of incomplete procedure due to poor bowel preparation (p = 0.18) and the incidence of poor bowel preparation (OR, 1.21; 95 % CI, 0.63, 2.33; z = 0.59; p = 0.56) were also similar in both groups. EBP and OBP were equally effective for bowel preparation in patients undergoing flexible sigmoidoscopy. Although this study failed to demonstrate the superiority of EBP, at least equivalent efficacy for bowel cleansing may be extrapolated.

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Conflict of interest

None to declare.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or/and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable standards.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in published trials used for this review.

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Authors and Affiliations

  1. Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK

    Muhammad Shafique Sajid, Jennifer F. Caswell, Mustafa A. Q. Abbas, Mirza K. Baig & Malcolm R. McFall

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  1. Muhammad Shafique Sajid
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  2. Jennifer F. Caswell
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Correspondence to Muhammad Shafique Sajid.

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Sajid, M.S., Caswell, J.F., Abbas, M.A.Q. et al. Improving the view during flexible sigmoidoscopy: a systematic review of published randomized, controlled trials comparing the use of oral bowel preparation versus enema bowel preparation. Updates Surg 67, 247–256 (2015). https://doi.org/10.1007/s13304-015-0295-2

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