Abstract：
OBJECTIVE: Colonoscopy has a vital role in the diagnosis of inflammatory bowel disease (IBD), as well as in the estimation of disease severity, monitoring response to therapy, and surveillance for neoplasia. We performed a systematic review of randomised trials of various bowel preparations for colonoscopy in IBD.
METHODS: We searched various electronic databases (PubMed, Embase, and CENTRAL) for studies reporting about the use of various strategies to improve colonoscopy preparation in IBD. We included only randomized clinical trials (RCTs). A network meta-analysis was done using a frequentist approach to compare the effectiveness of various bowel preparations. The risk of bias was assessed using Cochrane risk of bias tool 2.0. Other outcome parameters like compliance, tolerance, acceptance, and adverse effects were assessed qualitatively.
RESULTS: Seven RCTs reporting about 960 patients were included. On comparison with 4 liter (L) of poliethylen glycol (PEG), oral sulfate solution (OR=1.1, 95%CI: 0.65-1.86); PEG2L/Ascorbate (OR=0.98, 95%CI: 0.65-1.48); PEG1L (OR=1, 95%CI: 0.55-1.81); PEG2L plus bisacodyl (OR=1.08, 95%CI: 0.71-1.65); PEG4L plus simethicone (OR=1, 95%CI: 0.67-1.50); PEG/ sodium picosulfate and magnesium citrate (SPMC) 1.5L (OR=0.99, 95%CI: 0.55-1.78); SPMC 2L (OR=1.09, 95%CI: 0.61-1.97) had similar effectiveness. Three RCTs reported compliance, five RCTs reported tolerance, two studies reported patient acceptance and five RCTs reported data on the willingness of patients to repeat the procedure in the future. Low-volume preparations had better compliance, tolerance, acceptance, and willingness to repeat. No difference in additional outcomes like change in disease activity after colonoscopy, procedure-related outcomes after colonoscopy like cecal intubation rate, and change in electrolyte levels were found.
CONCLUSIONS: Various bowel preparations had similar effectiveness in respect to colonoscopy preparation in IBD patients. Low-volume preparations have better compliance, tolerance, and acceptance. The systematic review was limited by a small number of included RCTs.
METHODS: We searched various electronic databases (PubMed, Embase, and CENTRAL) for studies reporting about the use of various strategies to improve colonoscopy preparation in IBD. We included only randomized clinical trials (RCTs). A network meta-analysis was done using a frequentist approach to compare the effectiveness of various bowel preparations. The risk of bias was assessed using Cochrane risk of bias tool 2.0. Other outcome parameters like compliance, tolerance, acceptance, and adverse effects were assessed qualitatively.
RESULTS: Seven RCTs reporting about 960 patients were included. On comparison with 4 liter (L) of poliethylen glycol (PEG), oral sulfate solution (OR=1.1, 95%CI: 0.65-1.86); PEG2L/Ascorbate (OR=0.98, 95%CI: 0.65-1.48); PEG1L (OR=1, 95%CI: 0.55-1.81); PEG2L plus bisacodyl (OR=1.08, 95%CI: 0.71-1.65); PEG4L plus simethicone (OR=1, 95%CI: 0.67-1.50); PEG/ sodium picosulfate and magnesium citrate (SPMC) 1.5L (OR=0.99, 95%CI: 0.55-1.78); SPMC 2L (OR=1.09, 95%CI: 0.61-1.97) had similar effectiveness. Three RCTs reported compliance, five RCTs reported tolerance, two studies reported patient acceptance and five RCTs reported data on the willingness of patients to repeat the procedure in the future. Low-volume preparations had better compliance, tolerance, acceptance, and willingness to repeat. No difference in additional outcomes like change in disease activity after colonoscopy, procedure-related outcomes after colonoscopy like cecal intubation rate, and change in electrolyte levels were found.
CONCLUSIONS: Various bowel preparations had similar effectiveness in respect to colonoscopy preparation in IBD patients. Low-volume preparations have better compliance, tolerance, and acceptance. The systematic review was limited by a small number of included RCTs.
摘要：
目的：结肠镜检查在炎症性肠病（IBD）的诊断中具有至关重要的作用，以及疾病严重程度的估计，监测对治疗的反应，和瘤形成的监测。我们对IBD结肠镜检查的各种肠道准备的随机试验进行了系统评价。
方法：我们搜索了各种电子数据库(PubMed，Embase,和CENTRAL）用于报告使用各种策略改善IBD结肠镜检查准备的研究。我们仅纳入随机临床试验（RCTs）。使用频率统计方法进行了网络荟萃分析，以比较各种肠道准备的有效性。使用Cochrane偏倚风险工具2.0评估偏倚风险。其他结果参数，如合规性，容忍度,接受,对不良反应进行了定性评估.
结果：纳入了7个报告960例患者的RCTs。与4升（L）的聚乙二醇（PEG）相比，口服硫酸盐溶液（OR=1.1，95CI：0.65-1.86）；PEG2L/抗坏血酸酯（OR=0.98，95CI：0.65-1.48）；PEG1L（OR=1，95CI：0.55-1.81）；PEG2L加bisacodyl（OR=1.08，95CI：0.71-1.65）；PEG4L加硫酸酯（OR=1，95o三个RCT报告了合规性，五个RCT报告了耐受性，两项研究报告了患者的接受度,5项RCT报告了患者将来重复该手术的意愿数据.低容量制剂的依从性较好,容忍度,接受,愿意重复。结肠镜检查后疾病活动的变化等其他结果没有差异，结肠镜检查后与手术相关的结局，如盲肠插管率，并发现电解质水平的变化。
结论：在IBD患者中，各种肠道准备与结肠镜检查准备具有相似的有效性。低容量制剂具有更好的依从性，容忍度,和接受。系统评价受到纳入RCT数量少的限制。
方法：我们搜索了各种电子数据库(PubMed，Embase,和CENTRAL）用于报告使用各种策略改善IBD结肠镜检查准备的研究。我们仅纳入随机临床试验（RCTs）。使用频率统计方法进行了网络荟萃分析，以比较各种肠道准备的有效性。使用Cochrane偏倚风险工具2.0评估偏倚风险。其他结果参数，如合规性，容忍度,接受,对不良反应进行了定性评估.
结果：纳入了7个报告960例患者的RCTs。与4升（L）的聚乙二醇（PEG）相比，口服硫酸盐溶液（OR=1.1，95CI：0.65-1.86）；PEG2L/抗坏血酸酯（OR=0.98，95CI：0.65-1.48）；PEG1L（OR=1，95CI：0.55-1.81）；PEG2L加bisacodyl（OR=1.08，95CI：0.71-1.65）；PEG4L加硫酸酯（OR=1，95o三个RCT报告了合规性，五个RCT报告了耐受性，两项研究报告了患者的接受度,5项RCT报告了患者将来重复该手术的意愿数据.低容量制剂的依从性较好,容忍度,接受,愿意重复。结肠镜检查后疾病活动的变化等其他结果没有差异，结肠镜检查后与手术相关的结局，如盲肠插管率，并发现电解质水平的变化。
结论：在IBD患者中，各种肠道准备与结肠镜检查准备具有相似的有效性。低容量制剂具有更好的依从性，容忍度,和接受。系统评价受到纳入RCT数量少的限制。
