Lactulose Combined With PEG for Effective and Safe Bowel Preparation Before Colonoscopy: A Meta-Analysis

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open Pub Date : 2025-08-30 DOI:10.1002/jgh3.70262

Hu-Bin Xia, Wen-Li Ruan, Min Wu, Yi-Feng Zhou

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Abstract

Objective

To compare the efficacy of polyethylene glycol electrolyte (PEG) combined with lactulose versus PEG alone in bowel preparation quality for colonoscopy.

Methods

The protocol for this systematic review was registered with PROSPERO (CRD420251035139). Comprehensive literature searches were conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP. RevMan 5.4 software was employed to assess differences between the two groups regarding the rates of excellent bowel preparation, willingness to undergo repeat examination, incidence of adverse reactions, and adenoma detection rates.

Results

Sixteen eligible studies, encompassing 2468 participants, were included in the analysis. Meta-analysis demonstrated that the combination of PEG and lactulose was significantly more effective than PEG alone in bowel cleansing (OR = 3.57, 95% CI: 2.75–4.63, p < 0.001, I² = 0% for efficacy; SMD = 0.38, 95% CI: 0.26–0.50, p < 0.001, I² = 45% for BBPS scores; SMD: Standard Mean Difference; BBPS: Boston Bowel Preparation Scale). This combination also led to a lower incidence of adverse events, including vomiting (OR = 0.54, 95% CI: 0.36–0.82, p = 0.004), abdominal pain (OR = 0.54, 95% CI: 0.36–0.80, p = 0.003), and abdominal bloating (OR = 0.53, 95% CI: 0.38–0.75, p < 0.001), compared with PEG alone. Furthermore, PEG plus lactulose significantly improved the detection rate of intestinal adenomas (OR = 2.57, 95% CI: 1.74–3.79, p < 0.001). However, no significant differences were observed in the incidence of nausea (OR = 0.69, 95% CI: 0.88–0.99, p = 0.05) or willingness to repeat the examination (OR = 1.31, 95% CI: 0.51–3.36, p = 0.58).

Conclusion

The combination of PEG and lactulose significantly enhances bowel cleansing efficacy, increases adenoma detection rates, and reduces the incidence of adverse reactions. This regimen is recommended for bowel preparation prior to colonoscopy.

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乳果糖联合聚乙二醇用于结肠镜检查前有效和安全的肠道准备：一项荟萃分析

目的比较聚乙二醇电解质（PEG）联合乳果糖与单独应用聚乙二醇对结肠镜下肠准备质量的影响。方法本系统评价的方案在PROSPERO注册（CRD420251035139）。在PubMed、Embase、Cochrane Library、Web of Science、中国知网（CNKI）、万方数据、VIP等多个数据库进行综合文献检索。采用RevMan 5.4软件评估两组在肠准备优良率、重复检查意愿、不良反应发生率和腺瘤检出率方面的差异。结果16项符合条件的研究包括2468名受试者纳入分析。荟萃分析显示，PEG和乳果糖联合使用在肠道清洁方面明显比单独使用PEG更有效（OR = 3.57, 95% CI: 2.75-4.63, p < 0.001, I2 = 0%的疗效；SMD = 0.38, 95% CI: 0.26-0.50, p < 0.001, I2 = 45%的BBPS评分；SMD：标准平均差；BBPS：波士顿肠道准备量表）。与单独使用PEG相比，这种组合还导致较低的不良事件发生率，包括呕吐（OR = 0.54, 95% CI: 0.36-0.82, p = 0.004）、腹痛（OR = 0.54, 95% CI: 0.36-0.80, p = 0.003）和腹胀（OR = 0.53, 95% CI: 0.38-0.75, p < 0.001）。此外，聚乙二醇加乳果糖显著提高了肠腺瘤的检出率（OR = 2.57, 95% CI: 1.74 ~ 3.79, p < 0.001）。然而，在恶心发生率（OR = 0.69, 95% CI: 0.88-0.99, p = 0.05）或重复检查意愿（OR = 1.31, 95% CI: 0.51-3.36, p = 0.58）方面没有观察到显著差异。结论聚乙二醇联合乳果糖可显著提高肠道清洁效果，提高腺瘤检出率，降低不良反应发生率。该方案推荐用于结肠镜检查前的肠道准备。

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