S326 Comparative Effectiveness of Bowel Preparation Agents in Colonoscopy: A Network Meta-Analysis

Introduction: Colonoscopy is a widely preferred procedure for screening and diagnosing colonic diseases. It allows for reasonable diagnostic sensitivity and specificity, which often becomes limited due to low-quality bowel preparation. Polyethylene glycol (PEG) is the standard regimen. However, it has high volume requirements, leading to poor patient compliance. This study aims to comparatively assess available regimens and draw an appropriate conclusion. Methods: The electronic databases, PubMed, Google Scholar, PLOS One, Cochrane Library, Biomedcentral, and ScienceDirect were searched from January 2020 to May 2025 using robust search strategies. Randomized Controlled Trials (RCTs) comparing bowel-cleansing regimens in adults (≥18 years) undergoing elective colonoscopy were included. Outcomes analyzed were cleansing success, adenoma detection rate (ADR) and nausea. Pairwise Network meta-analysis was performed on R programming. Results: Among 13,192 pooled patients from 35 RCTs, 3L PEG+3D-LINACLOTIDE (3-litre PEG with 3-day linaclotide) showed comparatively superior cleansing success (relative risk [RR] 1.27, 95% confidence interval [CI] 1.13, 1.43) with P-score = 0.98 and I2 = 58.3%, followed by 4L PEG+1D-LINACLOTIDE (4-liter PEG with 1-day linaclotide) with RR: 1.24; (CI 1.05, 1.45), P-score = 0.95 and SENNA with RR: 1.13; [CI 1.01, 1.27], P-score = 0.87, with all the 3 regimens being statistically significant. Regarding ADR, magnesium sulfate solution had the highest rate with RR: 1.41; [CI 0.88, 2.27], P-score = 0.79 and I2 = 29.3%, followed by 4L PEG+1D-LINACLOTIDE with RR: 1.42; [CI 0.85, 2.3], P-score = 0.79. In respect to nausea, the lowest incidence rate of nausea was seen in 1L PEG+LINACLOTIDE with RR: 0.19; [CI 0.06, 0.59], P-score = 0.97 and I2 = 73.5%, followed by 2L PEG with RR: 0.42; [CI 0.21, 0.86], P-score = 0.81, and 2L PEG+LINACLOTIDE with RR: 0.45; [CI 0.21, 0.93], P-score = 0.78. However, 4L PEG+1D-LINACLOTIDE with RR: 0.44; [CI 0.17, 1.13], P-score = 0.77 also showed one of the lowest incidence rates, suggesting better tolerability. Conclusion: Overall analysis shows that 4L PEG+1D-LINACLOTIDE has the most favorable profile, with superior cleansing success, ADR and lower incidence of nausea. SENNA remains the second most favorable, suggesting its role as a better alternative for bowel preparation prior to colonoscopy. More well-designed trials are needed to strengthen the evidence and clinical decision-making.