Efficacy and safety of polyethylene glycol in combination with linaclotide versus polyethylene glycol alone for colonoscopy: a grade-assessed systematic review and meta-analysis

The effectiveness of colonoscopy largely depends on the quality of bowel preparation. Polyethylene glycol (PEG) is commonly used but has certain limitations. This review evaluates whether combining PEG with linaclotide improves preparation efficacy and safety compared with PEG alone. A search was conducted in Medline, Embase, and ClinicalTrials.gov up to October 2024. Only randomized controlled trials comparing PEG combined with linaclotide versus PEG alone and reporting adenoma detection rates (ADR) or polyp detection rates (PDR) were included. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were reported. A total of eight studies, including 3,071 participants, were included. Pooled analysis indicated that PEG combined with linaclotide was significantly associated with a higher ADR (RR, 1.15; 95% CI, 1.03-1.28), higher Boston bowel preparation scale score (MD, 0.31; 95% CI, 0.02-0.61), and greater willingness to repeat colonoscopy (RR, 1.16; 95% CI, 1.08-1.24). Although PDR (RR, 1.05; 95% CI, 0.89-1.24) was numerically higher in the intervention group, the difference was not statistically significant. Additionally, the intervention significantly reduced the incidence of nausea, vomiting, bloating, and abdominal pain. PEG combined with linaclotide is a safe alternative to PEG alone, improving ADR, bowel preparation quality, and patient comfort.