Efficacy and safety of linaclotide plus polyethylene glycol for bowel preparation before colonoscopy in elderly Chinese patients: a systematic review and meta-analysis.

BACKGROUND

Elderly adults often have inadequate bowel preparation and poor tolerance to high-volume polyethylene glycol (PEG). Linaclotide may enhance intestinal secretion and transit. We compared linaclotide plus PEG (Lin + PEG) with PEG alone in elderly adults.

METHODS

We searched CBM, CNKI, VIP, Chinese Medical Journals Full-text Database, Wanfang, PubMed, Embase, and Web of Science from inception to April 23, 2026, for randomized controlled trials comparing Lin + PEG with PEG alone in Chinese adults aged ≥60 years, or trials reporting extractable elderly subgroup data. Two authors independently screened studies and extracted data. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). Meta-analysis was performed using Review Manager and Stata. Prespecified subgroup analyses were conducted according to constipation status, linaclotide dose, and PEG-volume comparability.

RESULTS

Twelve RCTs conducted in China, involving 1,334 participants, were included. Lin + PEG improved total bowel cleansing quality [MD = 0.93, 95% CI (0.66-1.20), p < 0.00001; I2 = 86%] and segmental BBPS scores. Lin + PEG was also associated with lower risks of vomiting [RR = 0.60, 95% CI (0.41-0.86), p = 0.006; I2 = 0%], abdominal pain [RR = 0.57, 95% CI (0.34-0.94), p = 0.03; I2 = 10%], abdominal distension [RR = 0.61, 95% CI (0.38-0.98), p = 0.04; I2 = 50%], and nausea [RR = 0.59, 95% CI (0.38-0.92), p = 0.02; I2 = 32%]. No significant difference was observed for total adverse events [RR = 0.76, 95% CI (0.57-1.01), p = 0.06; I2 = 60%]. Lin + PEG also reduced total procedure time [MD = -2.35 min, 95% CI (-3.11 to -1.60), p < 0.00001; I2 = 68%]. The polyp detection rate (PDR) was higher in the Lin + PEG group [RR = 1.25, 95% CI (1.01-1.55), p = 0.04; I2 = 47%].

CONCLUSION

In elderly Chinese adults, Lin + PEG may improve bowel cleansing and reduce total procedure time. No clear increase in reported adverse events was observed, although the certainty of the safety evidence remains limited.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251183002, identifier (CRD420251183002).