Abstract

Background: Patients with inflammatory bowel disease (IBD) frequently undergo colonoscopy, each requiring bowel preparation. ESGE 2019 guidelines recommended high or low volume polyethylene glycol (PEG)-based bowel prep for IBD patients; however other non-PEG-based preparations (sulphate and picosulphate-based) have now been studied in IBD. Methods: We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and WHO ICTPR for randomised controlled trials (RCTs) up to December 2024. Primary outcome was bowel prep success; secondary outcomes included tolerability, acceptability, caecal intubation rates (CIR) and safety. Pooled estimates used risk ratio (RR) and GRADE to assess evidence certainty. Results: Ten RCTs (1479 IBD patients) were included. There was no difference in prep success (RR 0.98, 95%CI 0.88-1.09; I2=33%, 2 RCTs; moderate certainty evidence) between 2L vs. 4L PEG, but higher acceptability for 2L (RR 0.69, 95%CI 0.59-0.80; I2=18%,2 RCTs; high certainty evidence). Low-volume non-PEG vs. PEG, are probably similar for prep success (RR 0.96,95%CI:0.90-1.01; I2=6%,3 RCTs; moderate certainty evidence). The evidence on tolerability and acceptability was very uncertain. Sub-group analysis revealed comparable effectiveness of picosulphate-based (RR 0.89, 95%CI 0.78-1.01; I2=0%,1 RCT) and sulphate-based preps (RR 0.98, 95% CI: 0.91-1.05; I2=28%, 2 RCTs) compared to low-volume PEG. Safety data were inconsistently reported. Conclusion: High-certainty evidence supports low-volume PEG as comparably successful to high-volume PEG, with higher acceptability. Moderate-certainty evidence indicates similar success between non-PEG and PEG-based preps. Both low-volume PEG and non-PEG-based preps are supported for use in IBD, broadening options beyond current ESGE guidelines.