BACKGROUND Constipation is an important and highly prevalent predictor of inadequate bowel preparation during colonoscopy. In North America, between 2 and 28% of the general population suffer from constipation. Despite the high prevalence of constipation, to our knowledge, no meta-analysis on the optimal bowel preparation for constipated patients has been performed. We aimed to systematically review the literature to determine the ideal bowel preparation regiment for patients with chronic constipation. METHODS A comprehensive search of electronic databases (MEDLINE, EMBASE, SCOPUS, and Web of Science) was performed. We included studies that assessed the quality of bowel preparation in constipated patients receiving different agents prior to colonoscopy. The primary outcome was colon cleanliness. Secondary outcomes included tolerability of the bowel preparation and serious adverse events. RESULTS Preliminary database search yielded 1581 articles after duplicates were removed. After screening of the titles and abstracts using the exclusion criteria, 358 full-text articles were retained. Full-text articles were reviewed and eight studies meeting the inclusion criteria were included for qualitative synthesis. Three randomized controlled trials identified a total of 1636 constipated patients, of whom 225 were eligible for meta-analysis. Of those, 107 (47.6%) received NaP and 118 (52.4%) received PEG. Patients receiving NaP before colonoscopy had a higher chance of a successful bowel preparation than patients receiving PEG (OR 1.87, CI 1.06 to 3.32, P = 0.003). In the studies comparing PEG to NaP, two found that NaP resulted in greater tolerability of the bowel preparation and one study found that PEG resulted in superior tolerability. CONCLUSIONS In chronically constipated patients undergoing colonoscopy, the use of NaP may result in superior colonic cleanliness when compared to PEG, however, quality of evidence was low. Further high-quality studies are required to delineate the optimal bowel preparation in patients with constipation.

中文翻译：

---

在进行结肠镜检查的便秘患者中，磷酸钠优于聚乙二醇：系统评价和荟萃分析。

背景技术便秘是结肠镜检查期间肠道准备不足的重要且高度普遍的预测因素。在北美，便秘人群占总人口的2％至28％。尽管便秘的患病率很高，据我们所知，尚未进行针对便秘患者最佳肠准备的荟萃分析。我们旨在系统地回顾文献，以确定慢性便秘患者的理想肠道准备方案。方法对电子数据库（MEDLINE，EMBASE，SCOPUS和Web of Science）进行了全面搜索。我们纳入了评估结肠镜检查之前接受不同药物治疗的便秘患者肠道准备质量的研究。主要结果是结肠清洁度。次要结果包括肠准备的耐受性和严重不良事件。结果去除重复项后，初步数据库搜索产生了1581篇文章。在使用排除标准筛选标题和摘要后，保留了358条全文文章。本文对全文进行了审查，并对八项符合纳入标准的研究进行了定性综合。三项随机对照试验共鉴定出1636名便秘患者，其中225名符合条件进行荟萃分析。其中，有107（47.6％）人接受NaP，有118（52.4％）人接受PEG。结肠镜检查前接受NaP的患者比接受PEG的患者有更高的成功肠道准备的机会（OR 1.87，CI 1.06至3.32，P = 0.003）。在比较PEG和NaP的研究中，两项研究发现NaP可以提高肠道准备的耐受性，一项研究发现PEG可以提高肠耐受性。结论在接受结肠镜检查的慢性便秘患者中，与PEG相比，NaP的使用可能导致优越的结肠清洁度，但是证据质量很低。需要进一步的高质量研究来确定便秘患者的最佳肠准备。