Linaclotide combined with polyethylene glycol in bowel preparation for overweight individuals: a prospective randomized controlled study

To explore the effect of 580 μg linaclotide combined with 2 L polyethylene glycol (PEG) in bowel preparation for overweight individuals and compare it with the 3 L PEG split-dose regimen. Patients aged 18–70 years who were overweight were randomly assigned to two groups: 2 L PEG + 580 μg linaclotide (2 L PEG + 2 L) and 3 L PEG split-dose. The primary outcome was adequate bowel preparation, as assessed by the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included cecal intubation rate, terminal ileum intubation rate, adverse events (AEs), willingness to repeat the preparation next time, and patient satisfaction score. A total of 240 patients were included in the analysis: 121 in the 2 L PEG + 2 L group and 119 in the 3 L PEG group. Adequate bowel preparation did not differ significantly between the two groups ( p > 0.05). The incidence of nausea, vomiting, and abdominal discomfort was significantly lower in the 2 L PEG + 2 L group than in the 3 L PEG group ( p < 0.05). The patient satisfaction score was significantly higher in the 2 L PEG + 2 L group than in the 3 L PEG group ( p < 0.05). The 2 L PEG +2 L group had a significantly higher willingness to repeat bowel preparation than the 3 L PEG group ( p < 0.05). Binary logistic regression revealed a significant increase in inadequate bowel preparation with increased BMI. Among overweight individuals, the 2 L PEG + 2 L regimen provides equally effective bowel cleansing quality compared with the 3 L PEG regimen, while offering superior tolerability and patient satisfaction. It represents a preferable modified bowel preparation strategy for this population.