Skip to main content
Log in

Efficacy and Tolerability of Prucalopride in Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript



Adequate bowel preparation is a vital determinant for the success of colonoscopy. However, individuals who undergo bowel preparation for colonoscopy can experience major discomfort. To solve this problem, adding prucalopride to the prepared solution may reduce intake volume, decreasing discomfort and side effects. We performed meta-analyses and systematic review of available randomized controlled trials.


Meta-analyses were conducted to evaluate the overall relative risk and 95% confidence intervals in the combined studies for the assessment of primary outcome, which is the efficacy of bowel preparation with the addition of prucalopride.


Four randomized controlled trials involving 581 patients were included. When data were pooled for all patients in two non-inferiority studies, no significant difference in the quality of bowel preparation was observed between patients receiving prucalopride plus bowel preparation solution at a lower volume and those receiving the existing solution (relative risk: 0.94; 95% confidence interval: 0.86–1.03). The effects of prucalopride on acceptability, adverse events, adenoma detection rate, and polyp detection rate did not significantly differ from those of traditional solutions.


The combination of prucalopride and bowel preparation solution at a lower volume has similar effects on bowel preparation, and its use did not increase the occurrence of adverse effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Belsey J, Crosta C, Epstein O, et al. Meta-analysis: the relative efficacy of oral bowel preparations for colonoscopy 1985–2010. Aliment Pharmacol Ther. 2012;35:222–37.

    Article  CAS  PubMed  Google Scholar 

  2. Kim HW. Inadequate bowel preparation increases missed polyps. Clin Endosc. 2012;45:345.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Froehlich F, Wietlisbach V, Gonvers J-J, Burnand B, Vader J-P. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005;61:378–84.

    Article  PubMed  Google Scholar 

  4. Brahmania M, Park J, Svarta S, et al. Incomplete colonoscopy: maximizing completion rates of gastroenterologists. Can J Gastroenterol. 2012;26:589–92.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Valiante F, Bellumat A, De Bona M, De Boni M. Bisacodyl plus split 2-L polyethylene glycol-citrate-simethicone improves quality of bowel preparation before screening colonoscopy. World J Gastroenterol. 2013;19:5493.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Saltzman JR, Cash BD, Pasha SF, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81:781–94.

    Article  PubMed  Google Scholar 

  7. Sim JS, Koo JS. Predictors of inadequate bowel preparation and salvage options on colonoscopy. Clin Endosc. 2016;49:346.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hsu CW, Imperiale TF. Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. Gastroinest Endosc. 1998;48(3):276–82.

    Article  CAS  Google Scholar 

  9. Zwas FR, Cirillo NW, El-Serag HB, et al. Colonic mucosal abnormalities associated with oral sodium phosphate solution. Gastroinest Endosc. 1996;43(5):463–6.

    Article  CAS  Google Scholar 

  10. Wong N, et al. Microscopic focal cryptitis associated with sodium phosphate bowel preparation. Histopathology. 2000;36(5):476–8.

    CAS  PubMed  Google Scholar 

  11. Markowitz GS, Nasr SH, Klein P, et al. Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Hum Pathol. 2004;35:675–84.

    Article  PubMed  Google Scholar 

  12. Tan H, Liew Q, Loo S, Hawkins RJA. Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation. Anaesthesia. 2002;57:478–83.

    Article  CAS  PubMed  Google Scholar 

  13. Marshall JB, Pineda JJ, Barthel JS, King PD. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol–electrolyte lavage for colonoscopy preparation. Gastrointest Endosc. 1993;39:631–4.

    Article  CAS  PubMed  Google Scholar 

  14. Kim ES, Lee WJ, Jeen YT, et al. A randomized, endoscopist-blinded, prospective trial to compare the preference and efficacy of four bowel-cleansing regimens for colonoscopy. Scand J Gastroenterol. 2014;49:871–7.

    Article  PubMed  Google Scholar 

  15. Yoo IK, Lee JS, Chun HJ, et al. A randomized, prospective trial on efficacy and tolerability of low-volume bowel preparation methods for colonoscopy. Dig Liver Dis. 2015;47:131–7.

    Article  PubMed  Google Scholar 

  16. Kim SH, Kim JW. Low volume polyethylene glycol (peg) plus ascorbic acid, a valid alternative to standard PEG. Gut Liver. 2016;10:160.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sharma VK, Chockalingham SK, Ugheoke EA, et al. Prospective, randomized, controlled comparison of the use of polyethylene glycol electrolyte lavage solution in four-liter versus two-liter volumes and pretreatment with either magnesium citrate or bisacodyl for colonoscopy preparation. Gastrointest Endosc. 1998;47:167–71.

    Article  CAS  PubMed  Google Scholar 

  18. Adams WJ, Meagher AP, Lubowski DZ, King DW. Bisacodyl reduces the volume of polyethylene glycol solution required for bowel preparation. Dis Colon Rectum. 1994;37:229–34.

    Article  CAS  PubMed  Google Scholar 

  19. Clark RE, Godfrey JD, Choudhary A, Ashraf I, Matteson ML, Bechtold ML. Low-volume polyethylene glycol and bisacodyl for bowel preparation prior to colonoscopy: a meta-analysis. Ann Gastroenterol. 2013;26:319.

    PubMed  PubMed Central  Google Scholar 

  20. Kang SH, Jeen YT, Lee JH, et al. Comparison of a split-dose bowel preparation with 2 liters of polyethylene glycol plus ascorbic acid and 1 liter of polyethylene glycol plus ascorbic acid and bisacodyl before colonoscopy. Gastrointest Endosc. 2017;86:343–8.

    Article  PubMed  Google Scholar 

  21. Giglio MC, Luglio G, Tarquini R, Cerbone D, Bucci P, Bucci L. Role of prucalopride in treatment of chronic constipation and recurrent functional obstruction in a patient with steinert myotonic dystrophy. J Clin Gastroenterol. 2015;49:85–6.

    Article  PubMed  Google Scholar 

  22. Wong BS, Manabe N, Camilleri MJC. Role of prucalopride, a serotonin (5-HT4) receptor agonist, for the treatment of chronic constipation. Gastroenterology. 2010;3:49.

    CAS  Google Scholar 

  23. Quigley E, Vandeplassche L, Kerstens R, Ausma J. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation–a 12-week, randomized, double-blind, placebo-controlled study. Aliment Pharm Ther. 2009;29:315–28.

    Article  CAS  Google Scholar 

  24. Emmanuel A, Cools M, Vandeplassche L, Kerstens R. Prucalopride improves bowel function and colonic transit time in patients with chronic constipation: an integrated analysis. Am J Gastroenterol. 2014;109:887.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Sun Z, Dong X, Zhao J, et al. Can prucalopride improve the efficacy and tolerability of colonoscopy preparation? Int J Clin Exp Med. 2017;10:9387–96.

    Google Scholar 

  26. Hung JS, Yi CH, Liu TT, Lei WY, Wong MW, Chen CL. Does prucalopride reduce the dose of sodium phosphate in bowel preparation? A single-blind, randomized, and prospective study. Dig Dis Sci. 2019;20:294–300.

    Article  CAS  Google Scholar 

  27. Kerdsin S, Sutthivana C. Sa1073 quality of bowel preparation for colonoscopy with prucalopride plus polyethylene glycol solution: a double blind prospective randomized controlled trial. Gastrointest Endosc. 2019;89:AB164.

    Article  Google Scholar 

  28. Choi SJ, Kim ES, Choi BK, et al. A randomized controlled trial comparing the efficacy of 1-L polyethylene glycol solution with ascorbic acid plus prucalopride versus 2-L polyethylene glycol solution with ascorbic acid for bowel preparation. Scand J Gastroenterol. 2018;53:1619–24.

    Article  CAS  PubMed  Google Scholar 

  29. Corleto VD, Antonelli G, Coluccio C, D'Alba L, di Giulio E. Efficacy of prucalopride in bowel cleansing before colonoscopy: results of a pilot study. World J Gastrointest Endosc. 2017;9:558–60.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rostom A, Jolicoeur EJ. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc. 2004;59:482–6.

    Article  PubMed  Google Scholar 

  31. Calderwood AH, Schroy PC III, Lieberman DA, Logan JR, Zurfluh M, Jacobson BC. Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc. 2014;80:269–76.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. Endoscopy. 2017;49:378–97.

    Article  PubMed  Google Scholar 

  33. Williams JE, Holub JL, Faigel DO. Polypectomy rate is a valid quality measure for colonoscopy: results from a national endoscopy database. Gastrointest Endosc. 2012;75:576–82.

    Article  PubMed  Google Scholar 

  34. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  35. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  36. Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002.

    Article  PubMed  Google Scholar 

  37. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;151:264–9.

    Google Scholar 

  38. Briejer MR, Bosmans J-P, Van Daele P, et al. The in vitro pharmacological profile of prucalopride, a novel enterokinetic compound. Eur J Pharmacol. 2001;423:71–83.

    Article  CAS  PubMed  Google Scholar 

  39. De Schryver A, Andriesse G, Samsom M, et al. The effects of the specific 5HT4 receptor agonist, prucalopride, on colonic motility in healthy volunteers. Aliment Pharmacol Ther. 2002;16:603–12.

    Article  PubMed  Google Scholar 

  40. Camilleri M, Deiteren A. Prucalopride for constipation. Expert Opin Pharmacother. 2010;11:451–61.

    Article  CAS  PubMed  Google Scholar 

  41. Camilleri M, Beyens G, Kerstens R, Robinson P, Vandeplassche L. Safety assessment of prucalopride in elderly patients with constipation: a double-blind, placebo-controlled study. Neurogastroenterol Motil. 2009;21:1256–e117117.

    Article  CAS  PubMed  Google Scholar 

  42. The prep is worse than the procedure Split dosing and some new liquids may make bowel cleansing needed for colonoscopy a bit easier and perhaps more palatable. Harv Health Lett. 2010;35:6–7.

Download references



No funding or sponsorship was received for this study or publication of this article. The Rapid Service Fee was funded by the authors.


All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Design and supervision: Ji Taek Hong. Data extraction and study review: Ji Taek Hong, Sung-Wook Park, and Seok-Pyo Shin. Data analysis: Sung-Wook Park and Ji Taek Hong. Visualization: Ji Taek Hong. Writing-original draft: Ji Taek Hong and Sung-Wook Park Approval of the final manuscript: all authors. Corresponding author: Ji Taek Hong.


The authors Sung-Wook Park, Seok-Pyo Shin, and Ji Taek Hong have nothing to disclose. Ji Taek Hong’s current affiliation is the Department of Internal Medicine, College of Medicine, Mokdong Hospital, Ewha Womans University, Seoul, Korea.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

All data and materials used in this study are freely available. References have been provided.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ji Taek Hong.

Additional information

Digital Features

To view digital features for this article go to

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 320 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, SW., Shin, SP. & Hong, J.T. Efficacy and Tolerability of Prucalopride in Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis. Adv Ther 37, 2507–2519 (2020).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: