Linaclotide combined with polyethylene glycol significantly improves bowel preparation quality in patients with constipationCombining two medications improves bowel prep for patients with constipation

BackgroundIn patients with chronic constipation, standard bowel preparation using polyethylene glycol (PEG) often results in inadequate intestinal cleansing, complicating colonoscopy. This study systematically assessed the efficacy and safety of linaclotide combined with PEG (linaclotide-PEG) compared to PEG alone.MethodsA systematic search was conducted in PubMed, EMBASE, Web of Science, CENTRAL, CNKI, VIP, and Wanfang databases up to February 1, 2025, to identify randomized controlled trials (RCTs) comparing linaclotide-PEG with PEG monotherapy in constipated patients. Study quality was assessed using the Cochrane Risk of Bias (RoB 2) tool. Data analyses were performed using Stata 16.0.ResultsEleven RCTs (2022-2024) involving 1,525 participants were included. Compared to PEG alone, linaclotide-PEG significantly improved overall bowel preparation quality [mean difference (MD)=0.82; 95% confidence interval (CI): 0.58-1.05; P < 0.05] and segment-specific cleansing scores (left colon: MD = 0.28; right colon: MD = 0.34; transverse colon: MD = 0.35; all P < 0.05). Additionally, polyp detection rate increased, procedural duration and cecal intubation times decreased, and patients’ willingness to repeat colonoscopy improved significantly (all P < 0.05). The linaclotide-PEG regimen also reduced adverse reaction (nausea and vomiting events) (P < 0.05). No significant publication bias was detected (Egger’s and Begg’s tests: P > 0.05).ConclusionLinaclotide-PEG is superior to PEG alone, enhancing bowel cleansing effectiveness, increasing lesion detection rates, shortening procedure times, and reducing adverse events, thus offering clear clinical advantages.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420250652929.