Assessment of Lubiprostone as an Adjunct Therapy for Bowel Preparation in Colonoscopy: A Meta-Analysis of Randomized Controlled Trials

Introduction

The quality of bowel preparation has a significant impact on the success of colonoscopy. Currently, osmotically balanced polyethylene glycol electrolyte (PEG-E) solutions are most commonly used for bowel preparation. Recently, lubiprostone (LBP) has been considered a potentially effective adjunct to PEG. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the safety and efficacy of LBP in bowel preparation for colonoscopy.

Methods

Following PRISMA guidelines, we systematically screened PubMed, Embase, Web of Science, and Cochrane Library for RCTs on LBP as an adjunct to PEG-E for improving bowel preparation quality for colonoscopy. Statistical analysis was performed on RevMan, using a random-effects model with the generic inverse variance method to address clinical heterogeneity; results were significant at p < 0.05. Outcomes were reported as relative risks and standard errors.

Results

This meta-analysis included seven RCTs with 1206 patients. Adding LBP did not increase the likelihood of an excellent bowel preparation [RR = 1.28, 95% CI: 0.94–1.74, p = 0.12] or contribute to poor preparation [RR = 0.61, 95% CI: 0.36–1.04; p = 0.07]. It also did not affect procedure time [MD = −0.74, 95% CI: −2.91–1.43; p = 0.50], polyp detection rate [RR = 1.07, 95% CI: 0.90–1.26; p = 0.45], or adenoma detection rate [RR = 1.09, 95% CI: 0.75–1.57; p = 0.66].

Conclusion

Our meta-analysis found that LBP, explored as an adjunct to PEG-E solutions for bowel preparation, offers no significant additive effect on preparation quality before colonoscopy.