S396 Oral Sulfate-Based Versus Low Volume Polyethylene Glycol Ascorbate Regimens for Colonoscopy Preparation in the Geriatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: One of the main causes of inadequate bowel preparation in elderly patients is poor compliance due to the large volume of the preparation solutions. This has made low-volume colonoscopy preparation regimens particularly appealing in this population. In this study, we compared oral sulfate-based (OS) and low-volume polyethylene glycol-ascorbate (PEG/Asc) regimens for efficacy and safety in elderly patients undergoing colonoscopy. Methods: We conducted a systematic literature search of PubMed, Embase, and the Cochrane Library through May 2025 to identify randomized controlled trials (RCTs) comparing OS and low-volume PEG/Asc regimens for bowel preparation before colonoscopy in adults aged ≥65 years. Eligible studies reported at least one prespecified outcome. The primary outcome was the efficacy of the bowel cleansing; secondary outcomes included polyp and adenoma detection rates, patient satisfaction, and adverse events. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. Data were pooled using random-effects models. Results: Four RCTs encompassing 610 participants (304 OS, 306 low-volume PEG/Asc) were included. All included studies reported similar baseline characteristics between the 2 regimens. Successful bowel preparation rates did not differ between OS and PEG/Asc (RR 1.00; 95% CI 0.96–1.03). There were also no significant differences in total Boston Bowel Preparation Scale (BBPS) (MD 0.11; 95% CI -0.11–0.34) or segmental scores in the right colon (MD 0.21; 95% CI -0.01–0.42), transverse colon (MD 0.10; 95% CI -0.04–0.25), or left colon (MD 0.11; 95% CI -0.04–0.25). OS increased polyp detection rates (RR 1.21; 95% CI 1.02–1.43), and adenoma detection rates (RR 1.28; 95% CI 1.10–1.49). Although OS was associated with greater overall satisfaction on the visual-analogue scale (MD 0.75; 95% CI 0.04–1.46), there was no significant difference in willingness to reuse the same preparation (RR 1.08; 95% CI 0.92–1.26). Adverse events including nausea (RR 1.16; 95% CI 0.78–1.73), vomiting (RR 1.35; 95% CI 0.39–4.69), abdominal distention (RR 0.79; 95% CI 0.33–1.90), or abdominal pain (RR 0.55; 95% CI 0.13–2.37) were comparable. Conclusion: Our study suggests that OS and low‐volume PEG/Asc are equally effective in cleansing the colon, but OS offers higher patient satisfaction and may enhance polyp and adenoma detection without increasing adverse events.