Abstract：
BACKGROUND: This study aimed to compare oral sulfate solution (OSS) with polyethylene glycol (PEG) for bowel preparation before colonoscopy.
METHODS: A literature search was performed on PubMed, Ovid, and Cochrane Databases for randomized clinical trials (RCT) comparing OSS with PEG for bowel preparation before colonoscopy. The last search was performed on 22 August 2023. The primary outcome was the quality of bowel preparation. The outcomes were compared by meta-analysis and trial sequential analysis (TSA).
RESULTS: A total of 14 RCTs with 4526 patients were included. OSS was comparable with PEG regarding adequate bowel preparation [P = 0.16, odds ratio (OR) = 1.19, 95% confidence interval (CI) [0.93, 1.51], I2 = 0%]. However, OSS showed obvious priority in excellent bowel preparation (P < 0.001, OR = 1.62, 95% CI [1.27, 2.05], I2 = 0%) and total Boston bowel preparation scale (BBPS) [P = 0.02, weighted mean difference (WMD) = 0.27, 95% CI [0.05, 0.50], I2 = 84%]. Additionally, the detection rate of polyps (P = 0.001, OR = 1.44, 95% CI [1.15, 1.80], I2 = 0%) and adenoma (P = 0.007, OR = 1.22, 95% CI [1.06, 1.42], I2 = 0%) was significantly higher in the OSS group. The two groups showed comparable incidence of adverse events except for a higher incidence of dizziness (P = 0.02, OR = 1.74, 95% CI [1.08, 2.83], I2 = 11%) was indicated in the OSS group. Moreover, OSS was associated with a higher satisfaction score (P = 0.02, WMD = 0.62, 95% CI [0.09, 1.15], I2 = 70%). In the TSA, the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary and the required information size has been reached for excellent bowel preparation and total BBPS.
CONCLUSIONS: The current data demonstrated that OSS was associated with better quality of bowel preparation. More clinical trials are still needed to confirm other outcomes.
METHODS: A literature search was performed on PubMed, Ovid, and Cochrane Databases for randomized clinical trials (RCT) comparing OSS with PEG for bowel preparation before colonoscopy. The last search was performed on 22 August 2023. The primary outcome was the quality of bowel preparation. The outcomes were compared by meta-analysis and trial sequential analysis (TSA).
RESULTS: A total of 14 RCTs with 4526 patients were included. OSS was comparable with PEG regarding adequate bowel preparation [P = 0.16, odds ratio (OR) = 1.19, 95% confidence interval (CI) [0.93, 1.51], I2 = 0%]. However, OSS showed obvious priority in excellent bowel preparation (P < 0.001, OR = 1.62, 95% CI [1.27, 2.05], I2 = 0%) and total Boston bowel preparation scale (BBPS) [P = 0.02, weighted mean difference (WMD) = 0.27, 95% CI [0.05, 0.50], I2 = 84%]. Additionally, the detection rate of polyps (P = 0.001, OR = 1.44, 95% CI [1.15, 1.80], I2 = 0%) and adenoma (P = 0.007, OR = 1.22, 95% CI [1.06, 1.42], I2 = 0%) was significantly higher in the OSS group. The two groups showed comparable incidence of adverse events except for a higher incidence of dizziness (P = 0.02, OR = 1.74, 95% CI [1.08, 2.83], I2 = 11%) was indicated in the OSS group. Moreover, OSS was associated with a higher satisfaction score (P = 0.02, WMD = 0.62, 95% CI [0.09, 1.15], I2 = 70%). In the TSA, the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary and the required information size has been reached for excellent bowel preparation and total BBPS.
CONCLUSIONS: The current data demonstrated that OSS was associated with better quality of bowel preparation. More clinical trials are still needed to confirm other outcomes.
摘要：
背景：本研究旨在比较口服硫酸溶液（OSS）与聚乙二醇（PEG）在结肠镜检查前的肠道准备。
方法：在PubMed上进行了文献检索，奥维德,和Cochrane数据库用于比较OSS和PEG在结肠镜检查前的肠道准备的随机临床试验（RCT）。最后一次搜索是在2023年8月22日进行的。主要结果是肠道准备的质量。通过荟萃分析和试验序贯分析（TSA）比较结果。
结果：共纳入14个RCTs，4526例患者。OSS在充分的肠道准备方面与PEG相当[P=0.16,比值比(OR)=1.19,95%置信区间(CI)[0.93,1.51],I2=0%]。然而,OSS在良好的肠道准备中显示出明显的优先权（P<0.001，OR=1.62，95％CI[1.27，2.05]，I2=0％）和波士顿总肠道准备量表（BBPS）[P=0.02，加权平均差（WMD）=0.27，95％CI[0.05，0.50]，I2=84%]。此外,息肉检出率(P=0.001,OR=1.44,95%CI[1.15,1.80],I2=0%)和腺瘤(P=0.007,OR=1.22,95%CI[1.06,1.42],I2=0%)显著高于OSS组。除头晕发生率较高以外，两组不良事件发生率相当(P=0.02,OR=1.74,95%CI[1.08,2.83],I2=11%）在OSS组中表示。此外，OSS与较高的满意度评分相关(P=0.02,WMD=0.62,95%CI[0.09,1.15],I2=70%)。在TSA中，累积Z曲线跨越了常规边界和试验序贯监测边界,并且达到了良好的肠道准备和总BBPS所需的信息大小.
结论：目前的数据表明OSS与更好的肠道准备质量相关。仍需要更多的临床试验来确认其他结果。
方法：在PubMed上进行了文献检索，奥维德,和Cochrane数据库用于比较OSS和PEG在结肠镜检查前的肠道准备的随机临床试验（RCT）。最后一次搜索是在2023年8月22日进行的。主要结果是肠道准备的质量。通过荟萃分析和试验序贯分析（TSA）比较结果。
结果：共纳入14个RCTs，4526例患者。OSS在充分的肠道准备方面与PEG相当[P=0.16,比值比(OR)=1.19,95%置信区间(CI)[0.93,1.51],I2=0%]。然而,OSS在良好的肠道准备中显示出明显的优先权（P<0.001，OR=1.62，95％CI[1.27，2.05]，I2=0％）和波士顿总肠道准备量表（BBPS）[P=0.02，加权平均差（WMD）=0.27，95％CI[0.05，0.50]，I2=84%]。此外,息肉检出率(P=0.001,OR=1.44,95%CI[1.15,1.80],I2=0%)和腺瘤(P=0.007,OR=1.22,95%CI[1.06,1.42],I2=0%)显著高于OSS组。除头晕发生率较高以外，两组不良事件发生率相当(P=0.02,OR=1.74,95%CI[1.08,2.83],I2=11%）在OSS组中表示。此外，OSS与较高的满意度评分相关(P=0.02,WMD=0.62,95%CI[0.09,1.15],I2=70%)。在TSA中，累积Z曲线跨越了常规边界和试验序贯监测边界,并且达到了良好的肠道准备和总BBPS所需的信息大小.
结论：目前的数据表明OSS与更好的肠道准备质量相关。仍需要更多的临床试验来确认其他结果。
