S493 Efficacy and Safety of Linaclotide-Enhanced Polyethylene Glycol Regimens for Bowel Preparation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Adequate intestinal preparation is required for a high-quality colonoscopy. Linaclotide, a guanylate cyclase-C agonist, may improve bowel cleaning when combined with polyethylene glycol (PEG). However, its efficacy and tolerability in comparison to typical PEG-only regimens have yet to be explored at the population level. We aimed to compare the effectiveness and safety of linaclotide-assisted PEG regimens to standard PEG-only regimens in adult patients having elective colonoscopies. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Up to 2024, databases analyzed included PubMed, Cochrane, and Embase. Studies comparing linaclotide + PEG versus PEG-only regimens in individuals having screening, diagnostic, or surveillance colonoscopy were reviewed. The outcomes evaluated were appropriate bowel preparation (BBPS or OBPS), adenoma and polyp detection rates (ADR, PDR), cecal intubation rate, adverse events, desire to repeat colonoscopy, and sleep quality. Inverse variance approaches were used to create random effect models. A forest plot was created to represent the principal results, and sensitivity analysis validated the findings' resistance to dosage modifications. Results: Six RCTs, comprising 1,876 participants, met the inclusion criteria. Regimens combining linaclotide and polyethylene glycol (PEG) resulted in significantly higher rates of adequate bowel preparation compared to PEG alone (RR = 1.14, 95% confidence interval [CI]: 1.06–1.22; P < 0.001; I² = moderate). The polyp detection rate was also higher in the linaclotide group (RR = 1.24, 95% CI: 1.08–1.43; P = 0.002). Data on adenoma detection rate (ADR), cecal intubation, and adverse events were limited and heterogeneous. Preliminary studies suggest that linaclotide-based regimens may enhance patient willingness to repeat colonoscopy and improve sleep quality; however, these findings require further validation. Conclusion: Linaclotide-assisted PEG regimens significantly improve stool preparation adequacy and polyp detection rates without compromising safety, supporting their use in routine colonoscopy preparation. These findings warrant further clinical trials and future studies on long-term outcomes and cost-effectiveness.