Efficacy of ultra-low volume (≤1L) bowel preparation fluids - systematic review and meta-analysis

Background and aims High-quality bowel preparation is paramount for the diagnostic accuracy and safety of colonoscopy; however, it is often difficult for patients to adhere to high-volume laxatives, which may contribute to poor bowel preparation. This review aims to assess the efficacy of bowel preparation fluids of 1L or less (≤1L). Methods We performed a systematic review including all relevant randomized controlled trials on ultra-low volume (≤1L) bowel preparation fluids for colonoscopy published since 2015. Primary endpoint was the percentage of adequately prepared patients. Secondary endpoints included adenoma detection rate (ADR) and safety. Results Bowel preparation with sodium picosulfate/magnesium citrate (SPMC) (19 trials, n=10,287), 1L-polyethylene glycol with ascorbate (PEGA) (10 trials, n=1,717), sodium phosphate (NaP) (2 trials, n=621), and oral sulfate solution (OSS) (3 trials, n=597) was adequate in 75.2%, 82.9%, 81.9%, and 92.1%, respectively, of patients; however, heterogeneity between studies was considerable (I2 range: 86%-98%). Pooled ADRs were 31.1% with SPMC, 32.3% with 1L-PEGA, 30.4% with NaP, and 40.9% with OSS. Temporary electrolyte changes were seen with all ultra-low volume bowel preparation fluid solutions but without sustained effects in most patients. Conclusion Ultra-low volume bowel preparation fluids do not always meet the 90% quality standard for adequate bowel preparation as defined by current guidelines. Nonetheless, they may be considered in patients intolerant for higher-volume laxatives and without risk factors for inadequate bowel preparation or dehydration-related complications.