Skip to main content

Advertisement

SpringerLink
Log in

Sodium phosphate is superior to polyethylene glycol in constipated patients undergoing colonoscopy: a systematic review and meta-analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Constipation is an important and highly prevalent predictor of inadequate bowel preparation during colonoscopy. In North America, between 2 and 28% of the general population suffer from constipation. Despite the high prevalence of constipation, to our knowledge, no meta-analysis on the optimal bowel preparation for constipated patients has been performed. We aimed to systematically review the literature to determine the ideal bowel preparation regiment for patients with chronic constipation.

Methods

A comprehensive search of electronic databases (MEDLINE, EMBASE, SCOPUS, and Web of Science) was performed. We included studies that assessed the quality of bowel preparation in constipated patients receiving different agents prior to colonoscopy. The primary outcome was colon cleanliness. Secondary outcomes included tolerability of the bowel preparation and serious adverse events.

Results

Preliminary database search yielded 1581 articles after duplicates were removed. After screening of the titles and abstracts using the exclusion criteria, 358 full-text articles were retained. Full-text articles were reviewed and eight studies meeting the inclusion criteria were included for qualitative synthesis. Three randomized controlled trials identified a total of 1636 constipated patients, of whom 225 were eligible for meta-analysis. Of those, 107 (47.6%) received NaP and 118 (52.4%) received PEG. Patients receiving NaP before colonoscopy had a higher chance of a successful bowel preparation than patients receiving PEG (OR 1.87, CI 1.06 to 3.32, P = 0.003). In the studies comparing PEG to NaP, two found that NaP resulted in greater tolerability of the bowel preparation and one study found that PEG resulted in superior tolerability.

Conclusions

In chronically constipated patients undergoing colonoscopy, the use of NaP may result in superior colonic cleanliness when compared to PEG, however, quality of evidence was low. Further high-quality studies are required to delineate the optimal bowel preparation in patients with constipation.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rex D, Petrini J, Baron T, Chak A, Cohen J, Deal S (2006) Quality indicators for colonoscopy. Am J Gastroenterol 101:1200–1208. https://doi.org/10.1111/j.1572-0241.2006.00673.x

    Article  Google Scholar 

  2. Saltzman JR, Cash BD, Pasha SF, Early DS, Raman Muthusamy V, Khashab MA, Chathadi KV, Fanelli RD, Chandrasekhara V, Lightdale JR, Fonkalsrud L, Shergill AK, Hwang JH, Decker GA, Jue TL, Sharaf R, Fisher DA, Evans JA, Foley K, Shaukat A, Eloubeidi MA, Faulx AL, Wang A, Acosta RD (2015) Bowel preparation before colonoscopy. Gastrointest Endosc 81:781–794. https://doi.org/10.1016/j.gie.2014.09.048

    Article  PubMed  Google Scholar 

  3. Calderwood AH, Thompson KD, Schroy PC, Lieberman DA, Jacobson BC (2015) Good is better than excellent: bowel preparation quality and adenoma detection rates. Gastrointest Endosc 81:691–699. https://doi.org/10.1016/j.gie.2014.10.032

    Article  PubMed  PubMed Central  Google Scholar 

  4. Levenstein S, Li Z, Almer S, Barbosa A, Marquis P, Moser G, Sperber A, Toner B, Drossman DA (2001) Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol 96:1797–1802. https://doi.org/10.1016/S0002-9270(01)02437-6

    Article  Google Scholar 

  5. Parente F, Vailati C, Bargiggia S, Manes G, Fontana P, Masci E, Arena M, Spinzi G, Baccarin A, Mazzoleni G, Testoni PA (2015) 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-litre polyethylene glycol as preparation for colonoscopy in chronic constipation. Dig Liver Dis 47:857–863. https://doi.org/10.1016/j.dld.2015.06.008

    Article  CAS  PubMed  Google Scholar 

  6. McCrea GL, Miaskowski C, Stotts NA, Macera L, Varma MG (2009) A Review of the literature on gender and age differences in the prevalence and characteristics of constipation in North America. J Pain Symptom Manag 37:737–745. https://doi.org/10.1016/j.jpainsymman.2008.04.016

    Article  Google Scholar 

  7. Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, Coman E, Polito J (2001) Factors predictive of difficult colonoscopy. Gastrointest Endosc 54:558–562. https://doi.org/10.1067/mge.2001.118950

    Article  CAS  PubMed  Google Scholar 

  8. Bernstein C, Thorn M, Monsees K, Spell R, O’Connor JB (2005) A prospective study of factors that determine cecal intubation time at colonoscopy. Gastrointest Endosc 61:72–75. https://doi.org/10.1016/S0016-5107(04)02461-7

    Article  PubMed  Google Scholar 

  9. Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions. Wiley, Chichester

    Google Scholar 

  10. GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015 (developed by Evidence Prime, Inc.). Available from gradepro.org

  11. Collaboration C (2014) Review manager (Version 5.3) [Computer Software]. Copenhagen, Denmark Nord Cochrane Cent

  12. Higgins JPT, Thompson SG, Deeks JJ, Altman DG Measuring inconsistency in meta-analyses. BMJ 327:557–560.

  13. Arezzo A (2000) Prospective randomized trial comparing bowel cleaning preparations for colonoscopy. Surg Laparosc Endosc Percutan Tech 10:215–217

    Article  CAS  Google Scholar 

  14. Chen H, Li X, Ge Z (2009) Comparative study on two colonic bowel preparations for patients with chronic constipation. Scand J Gastroenterol 44:375–379. https://doi.org/10.1080/00365520802538211

    Article  PubMed  Google Scholar 

  15. De Salvo L, Borgonovo G, Ansaldo GL, Varaldo E, Floris F, Assalino M, Gianiorio F (2006) The bowel cleansing for colonoscopy A randomized trial comparing three methods. Ann Ital Chir 77:143–146

    PubMed  Google Scholar 

  16. Pereyra L, Cimmino D, Malla CG, Laporte M, Rotholtz N, Peczan C, Lencinas S, Pedreira S, Catalano H, Boerr L, Pereyra L, Cimmino D, Laporte M, Peczan C, Lencinas S, Pedreira S (2013) Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study. World J Gastroenterol 19:5103–5110. https://doi.org/10.3748/wjg.v19.i31.5103

    Article  PubMed  PubMed Central  Google Scholar 

  17. Li Y, Jia X, Liu B, Qi Y, Zhang X, Ji R, Yu Y, Zuo X, Li Y (2017) Randomized controlled trial: standard versus supplemental bowel preparation in patients with Bristol stool form 1 and 2. PLoS ONE 12:1–12. https://doi.org/10.1371/journal.pone.0171563

    Article  CAS  Google Scholar 

  18. Lu J, Cao Q, Wang X, Pu J, Peng X (2016) Application of oral lactulose in combination with polyethylene glycol electrolyte powder for colonoscopy bowel preparation in patients with constipation. Am J Ther 1024:1020–1024

    Article  Google Scholar 

  19. Tajika M, Niwa Y, Bhatia V, Kawai H, Kondo S, Sawaki A, Mizuno N (2012) Efficacy of mosapride citrate with polyethylene glycol solution for colonoscopy preparation. Am J Ther 18:2517–2525. https://doi.org/10.3748/wjg.v18.i20.2517

    Article  CAS  Google Scholar 

  20. Toledo TK, Dipalma JA (2001) Review article: colon cleansing preparation for gastrointestinal procedures. Aliment Pharmacol Ther 15:605–611. https://doi.org/10.1046/j.1365-2036.2001.00966.x

    Article  CAS  PubMed  Google Scholar 

  21. Mamula P, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Rodriguez SA, Tierney WM (2009) Colonoscopy preparation. Gastrointest Endosc 69:1201–1209. https://doi.org/10.1016/j.gie.2009.01.035

    Article  PubMed  Google Scholar 

  22. Derrick MR, Burgess HD, Baker MT, Binnie NE, Baker MT, Binnie NE (2014) A review of its use as a fumigant. J Am Inst Conserv 29:77–90

    Article  Google Scholar 

Download references

Acknowledgements

A $6000 Department of Surgery Summer Studentship from the Department of Surgery, University of Alberta, Edmonton, Alberta, Canada

Author information

Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Jerry T. Dang, Ashley Shaw, Chunhong Tian & Shahzeer Karmali

  2. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Muhammad Moolla

  3. Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada

    ThucNhi Tran Dang & Richard Sultanian

  4. Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Jerry T. Dang

Authors
  1. Jerry T. Dang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad Moolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. ThucNhi Tran Dang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chunhong Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shahzeer Karmali
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Richard Sultanian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jerry T. Dang.

Ethics declarations

Disclosure

Dr. Sultanian serves as a consultant for Boston Scientific. Muhammad Moolla and Drs. Dang, Shaw, Dang, Tian, and Karmali have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 12 kb)

Supplementary file2 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dang, J.T., Moolla, M., Dang, T.T. et al. Sodium phosphate is superior to polyethylene glycol in constipated patients undergoing colonoscopy: a systematic review and meta-analysis. Surg Endosc 35, 900–909 (2021). https://doi.org/10.1007/s00464-020-07464-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07464-0

Keywords

Search

Navigation