Oral sulfate-based versus low-volume polyethylene glycol-ascorbate regimens for colonoscopy preparation in the geriatric population: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Adequate bowel preparation is essential for high-quality colonoscopy; however, older adults often struggle with large-volume regimens. Low-volume oral sulfate (OS)-based and polyethylene glycol-ascorbate (PEG-Asc) may improve tolerability without compromising efficacy. This study compared the efficacy, tolerability, and safety of these regimens in older adults.

METHODS

We searched the PubMed, Embase, and Cochrane databases from inception until May 2025 for randomized controlled trials comparing OS with low-volume PEG-Asc in adults aged ≥65 years. Outcomes were pooled using random-effects models as risk ratios (RRs) or mean differences (MDs).

RESULTS

Six trials (n=682; OS, 340; PEG-Asc, 342) were included. The overall cleansing success rates were comparable (RR, 1.00; 95% confidence interval [CI], 0.96-1.03). Total Boston bowel preparation scale and segmental scores did not significantly differ between the groups (MD, 0.08; 95% CI, -0.10 to 0.27). OS improved lesion detection in terms of polyp detection (RR, 1.21; 95% CI, 1.01-1.45) and adenoma detection rates (RR, 1.28; 95% CI, 1.10-1.49). Patient-reported satisfaction modestly favored OS compared with PEG-Asc (MD, 0.69; 95% CI, 0.10-1.29), whereas willingness to reuse was similar between the two groups (RR, 1.09; 95% CI, 0.97-1.23). Adverse events and procedural metrics did not significantly differ between the groups.

CONCLUSIONS

In adults aged ≥65 years, OS and low-volume PEG-Asc achieved similar cleansing quality and safety. OS may confer higher polyp and adenoma detection rates than PEG-Asc and may be a reasonable option for maximizing lesion detection.