Performance, Efficacy, and Safety of Lubiprostone in Bowel Preparation Regimens: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Introduction: Bowel preparation is an essential part of the colonoscopy process, with inadequate or poor bowel preparation associated with decreased polyp detection. We performed a systematic review and meta-analysis to investigate the effects of adjunct lubiprostone bowel prep on colonoscopies performance.

Methods: We conducted a comprehensive search in PubMed, Embase, Cochrane, and Web of Science from inception until February 2025 for RCTs comparing lubiprostone adjunct therapy, bowel prep and control. Our data was analyzed for polyp detection rates, bowel prep quality, colonoscopy duration, adverse events, and side effects. A random effects model was used, and the data were presented using pooled odds ratios (OR) and mean differences (MD) with 95% CI.

Results: Eight RCT manuscripts were included with 1322 patients (657 in the lubiprostone group and 665 in the control group). There was no significant difference in polyp detection rate between groups (OR: 1.27, 95% CI: 0.92-1.76, P=0.15, I2: 0%). The lubiprostone group had significantly higher odds of excellent bowel prep compared with control (OR: 2.25, 95% CI: 1.52-3.33, P<0.0001, I2: 41%) and significantly lower odds of poor bowel prep (P=0.009). Colonoscopy duration in minutes was similar (P=0.17). Adverse event odds were similar between groups (P=0.22).

Conclusion: Lubiprostone as an adjunct agent for bowel prep improves the odds of excellent quality prep while mitigating the odds of poor prep. Lubiprostone adjunct bowel prep is similar to control in adverse effects.