A meta-analysis of randomized controlled trials of the addition of lubiprostone to bowel preparation before colonoscopy

AIM: Adequate bowel preparation is essential to the quality of colonoscopy. We performed a meta-analysis to determine the efficacy and safety of the addition of lubiprostone to the bowel preparation process prior to colonoscopy. METHODS: Online databases, namely, PubMed, MEDLINE and Cochrane Library, were searched for randomized controlled trials that assessed the additive effect of lubiprostone on the quality of colon preparation in patients undergoing colonoscopy. Each included study was evaluated by the Jadad score to assess the quality of the study. The primary outcome was bowel preparation efficacy, defined as the proportion of patients with an excellent or poor preparation. The secondary outcomes included the length of the colonoscopy, polyp detection, and any adverse effects. RESULTS: In total, 5 articles published between 2008 and 2016 fulfilled the selection criteria. The addition of lubiprostone to the bowel cleansing process significantly increased the proportion of patients with an excellent preparation (risk ratio [RR] = 1.68, 95% confidence interval (CI): 1.40–2.02, P < .00001) but did not decrease the procedural time or increase the polyp detection rate (mean difference = -0.52, 95% CI: -3.74–2.69, P = .75; RR = 1.16, 95% CI: 0.96–1.42, P = .13, respectively). There was no significant difference in the proportion of patients with any adverse events. CONCLUSION: The addition of lubiprostone to the bowel preparation regimen prior to colonoscopy is effective and safe.