# Safety and Efficacy of Polyethylene Glycol Versus Placebo in the Bowel Preparation for Elective Colorectal Surgeries: A Systemic Review and Meta-Analysis

## TL;DR

This study finds that polyethylene glycol offers no significant benefits over placebo for bowel preparation before colorectal surgeries.

## Contribution

A meta-analysis comparing PEG and placebo for bowel preparation in elective colorectal surgeries, revealing no significant efficacy differences.

## Key findings

- PEG showed no significant improvement in bowel preparation quality compared to placebo.
- No significant differences were found in surgical site infections or other postoperative complications between PEG and placebo groups.
- The study highlights the need for further research into alternative bowel preparation methods.

## Abstract

The most suitable type of preoperative colonic preparation for colorectal surgery is controversial. Polyethylene glycol (PEG) has been widely used and some regard it as more suitable for bowel cleansing. However, it also has some limitations, such as nausea and vomiting. These problems have caused surgeons to question whether bowel cleansing offers any benefit at all.

This study aims to assess the safety and efficacy of PEG, compare it with other available bowel preparations, conduct a detailed analysis of the available evidence, and inform clinical practice guidelines for bowel preparation before elective colorectal surgeries.

MeSH terms and keywords, including "colorectal surgeries", "polyethylene glycol", and "placebo", were used to run a literature search on PubMed, Embase, Cochrane, and Clinicaltrials.gov from inception to January 2025. Randomized controlled trials (RCTs) comparing PEG with placebo for patients undergoing colorectal surgeries were included. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method in RevMan (Cochrane Collaboration, London, UK). Random effects meta-analysis was undertaken.

Ten RCTs with a total of 2613 patients were included. Polyethylene showed no significant benefits over placebo regarding quality of bowel preparation (RR = 1.03, 95% CI: 0.91-1.17, p = 0.64) and incidence of surgical site infections (SSIs) (RR = 1.29, 95% CI: 0.95-1.75; p = 0.11). Both groups were comparable in terms of anastomotic leak (RR = 1.14, 95% CI: 0.70-1.85, p = 0.60), intra-abdominal abscess (RR = 0.77, 95% CI: 0.36-1.65, p = 0.50), ileus (RR = 1.16, 95% CI: 0.44-3.05, p = 0.76), anastomotic dehiscence (RR = 0.79, 95% CI: 0.39-1.59, p = 0.51), vomiting (RR = 0.54, 95% CI: 0.27-1.09, p = 0.09), and repeated operations (RR = 0.66, 95% CI: 0.20-2.24, p = 0.51).

PEG has no significant benefits over placebo for bowel preparation before colorectal surgeries. Further research and RCTs are necessary to identify and explore other therapeutic options for patients undergoing colorectal surgeries.