Comparing various bowel preparation regimens in constipated patients undergoing colonoscopy: A systematic review and network meta-analysis of randomised controlled trials.

Probiotic 14d + NaP showed the greatest improvement in adequate bowel preparation rate compared to 4L PEG.

• RR = 3.59; 95% CI: [1.83, 7.04] compared with 4L PEG
• Probiotic 14d + NaP was ranked best regarding adequate bowel preparation with a P-score of 0.99
• 15 randomised controlled trials were included in the network meta-analysis
• Analysis performed using frequentist network meta-analysis with 'meta' and 'netmeta' packages on R version 4.3.3

3L PEG + 3d-linaclotide significantly improved adequate bowel preparation rate and was ranked best for abdominal pain and vomiting.

• RR = 1.29; 95% CI: [1.12, 1.47] for adequate bowel preparation compared with 4L PEG
• Showed a significant reduction in abdominal pain: RR = 0.18; 95% CI: [0.04, 0.88] compared with 4L PEG
• Ranked best for abdominal pain with P-score = 0.89
• Ranked best for vomiting with P-score = 0.80

4L PEG + 1d-linaclotide improved adequate bowel preparation rate compared to 4L PEG and was ranked best for nausea.

• RR = 1.25; 95% CI: [1.04, 1.51] for adequate bowel preparation compared with 4L PEG
• Ranked best regarding nausea with P-score = 0.77

Sodium phosphate + bisacodyl improved adequate bowel preparation rate compared to 4L PEG.

• RR = 1.52; 95% CI: [1.09, 2.10] compared with 4L PEG
• PubMed, Cochrane Central, and ScienceDirect were searched until April 2025
• Ranking was performed using P-scores within the frequentist network meta-analysis framework

Probiotic 14d + NaP was ranked best for bloating among the bowel preparation regimens assessed.

• P-score = 0.84 for bloating
• This regimen was also ranked best for adequate bowel preparation (P-score = 0.99)
• Adverse events were described as similar across regimens overall

The network meta-analysis included 15 randomised controlled trials comparing various bowel preparation regimens in constipated patients undergoing colonoscopy.

• Databases searched included PubMed, Cochrane Central, and ScienceDirect up to April 2025
• The reference comparator for most outcomes was 4L polyethylene glycol (PEG)
• Regimens evaluated included various PEG combinations with linaclotide, sodium phosphate with bisacodyl, and probiotics with sodium phosphate
• Outcomes assessed included adequate bowel preparation rate, abdominal pain, bloating, nausea, and vomiting