S449 Safety and Efficacy of Polyethylene Glycol and Linaclotide in Improving Bowel Preparation During Colonoscopy in Constipated Patients: A Systematic Review and Meta-Analysis

Introduction: Colonoscopy, a diagnostic and therapeutic procedure for gastrointestinal issues, requires adequate bowel preparation for optimal results. Polyethylene glycol solutions (PEG) are the standard for bowel preparation but its combination with linaclotide may enhance its efficacy and safety. We conducted a systematic review and meta-analysis to compare PEG plus linaclotide with PEG alone for bowel preparation during colonoscopy. Methods: A systematic literature search was conducted on PubMed, Scopus, Cochrane Library and clinicaltrials.gov until November 2024 for randomized controlled trials (RCTs) comparing PEG plus Linaclotide with PEG for colonoscopy preparation. The meta-analysis was performed using the R software (version 4.1.2). The relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were considered for assessing dichotomous and continuous outcomes. Forest plots were drawn to visualize effect size, and funnel plots assessed publication bias. Heterogeneity was assessed using I2 statistics. Cochrane’s ROB2 scale was used to assess the quality of studies. Results: Seven RCTs including 4,851 patients were included in our study. Three studies used the Ottawa scale for bowel preparation with results favoring PEG plus Linaclotide group (WMD = 0.35; 95% CI = 0.01 - 0.69; P = 0.04; I2 = 48%) and 5 studies used the Boston score showing similar results (WMD = 0.38; 95% CI = 0.09-0.67; P = 0.01; I2 = 77%). Comparable results were found between both groups for adenoma detection rate (RR = 1.09; 95% CI = 0.98 to 1.22; P = 0.11; I2 = 0%) and polyp detection rate (RR = 1.06; 95% CI = 0.97-1.15; P = 0.16, I2 = 32%). However, PEG plus Linaclotide showed statistically significant reduction in vomiting (RR = 0.43, 95% CI = 0.31-0.60, P < 0.01, I2 = 0%), nausea (RR = 0.57; 95% CI = 0.43–0.77; P < 0.01), bloating (RR = 0.77, 95% CI = 0.68-0.88, P < 0.01), and abdominal pain (RR = 0.64; 95% CI = 0.47–0.86; P = 0.01) as compared to PEG alone. Conclusion: PEG plus Linaclotide showed better bowel preparation and fewer side effects than PEG alone, without compromising lesion detection rates. With a larger pooled sample size than previous studies, this meta-analysis supports PEG plus linaclotide as a preferred regimen for colonoscopy preparation.