Safety and efficacy of linaclotide as an adjuvant for bowel preparation: A systematic review and meta-analysis

Abstract

Introduction: High-volume polyethylene glycol (PEG) is widely used for bowel preparation, but its large volume and unpleasant taste are common drawbacks. These factors frequently lead to reduced patient adherence. Linaclotide, an FDA-approved drug for constipation, appears to offer a potential solution by lowering the amount of PEG needed. Methods: Our search included MEDLINE through PubMed, Scopus, Web of Science (WOS), and Cochrane databases. Subgroup analysis was employed for additional stratification. Results: The overall effect estimates regarding total BBPS score indicated no significant difference between the two groups [MD 0.19, 95 % CI (−0.37, 0.74), P = 0.51]. Further stratification showed linaclotide superiority over the control group with equal PEG dosage [MD 0.99, 95 % CI (0.69, 1.30), P < 0.00001] and no difference compared to the group with double the PEG dosage [MD −0.27, 95 % CI (−0.59, 0.05], P = 0.10]. No statistically significant difference between the two groups was detected in adenoma detection, polyp detection, or cecal intubation time. Also, Linaclotide showed statistical superiority against all subgroups regarding withdrawal time. Moreover, linaclotide group showed a favoring statistically significant difference regarding nausea, vomiting, abdominal pain, bloating, and willingness to repeat the colonoscopy. Conclusion: Linaclotide demonstrates superior efficacy compared to the control group with equal PEG doses and shows no statistically significant difference when compared to the group with double the PEG dosage, all while resulting in fewer adverse events.