title: Systematic review and meta-analysis: sodium picosulfate/magnesium citrate vs. polyethylene glycol for colonoscopy preparation.
abstract: OBJECTIVE
  Previous studies comparing sodium picosulfate/magnesium citrate (SPMC) with polyethylene glycol (PEG) drew inconsistent conclusions. We conducted a meta-analysis to compare the performance of the two agents for colonoscopy preparation.
  
  
  METHODS
  A search of randomized controlled trials (RCTs) up to July 2015 was acquired, using MEDLINE, EMBASE, the Cochrane Library, and Google Scholar. We calculated the pooled estimates of bowel cleanliness, polyp/adenoma detection rate (PDR/ADR), completion of preparation, willingness to repeat identical bowel preparation, and adverse events by using relative risk (RR) with random-effects models. A non-inferiority analysis was performed, comparing SPMC to PEG for bowel cleaning efficacy.
  
  
  RESULTS
  A total of 25 RCTs were qualified for analysis. There was no statistically significant difference between the two agents in bowel cleanliness, but the effect direction showed a trend in favor of PEG (RR 0.93; 95 % CI 0.86-1.01, P = 0.07). The non-inferiority analysis demonstrated the non-inferiority of SPMC by retaining at least 90 % of the effect of PEG. Similarly, there was no significant difference between the two agents in PDR (RR 0.94; 95 % CI 0.82-1.08, P = 0.37) and ADR (RR 0.88; 95 % CI 0.74-1.05, P = 0.16). However, a higher proportion of patients were likely to complete SPMC preparation (RR 1.08; 95 % CI 1.04-1.13, P < 0.001) and were willing to repeat SPMC preparation (RR 1.44; 95 % CI 1.25-1.67, P < 0.001). The total number of adverse events was significantly lower in the SPMC group (RR 0.78; 95 % CI 0.66-0.93, P = 0.004).
  
  
  CONCLUSIONS
  SPMC, with better tolerability and less frequent adverse events, demonstrated non-inferior bowel cleaning efficacy than that of the PEG. Large-scale, well-organized, head-to-head studies are warranted.
authors.affiliation: Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Digestive Endoscopy Center, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. gbercp616@163.com.
authors.forename: Biao
authors.initials: B
authors.lastname: Gong
mesh_terms: D002400:Cathartics / Q000627:therapeutic use*; D002951:Citrates / Q000627:therapeutic use*; D019343:Citric Acid / Q000627:therapeutic use*; D003113:Colonoscopy; D006801:Humans; D009942:Organometallic Compounds / Q000627:therapeutic use*; D010847:Picolines / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000627:therapeutic use*
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C110422:magnesium citrate
keywords: Adenoma detection rate; Bowel preparation; Sodium picosulphate; Tolerability
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