High-volume polyethene glycol (PEG) solutions remain a major barrier to successful colonoscopy bowel preparation because of poor tolerability. Linaclotide, a guanylate cyclase-C agonist that increases intestinal secretion and transit, has been explored as an adjunct to bowel preparation, but the optimal dose and timing have been uncertain.
High-volume polyethene glycol (PEG) solutions remain a major barrier to successful colonoscopy bowel preparation because of poor tolerability. Linaclotide, a guanylate cyclase-C agonist that increases intestinal secretion and transit, has been explored as an adjunct to bowel preparation, but the optimal dose and timing have been uncertain.
This large, multicenter randomised trial evaluated whether short-term linaclotide pretreatment could safely allow a reduction in PEG volume without compromising bowel cleanliness. Adults undergoing screening or diagnostic colonoscopy were assigned to one of three strategies: standard high-volume PEG alone, linaclotide combined with high-volume PEG, or linaclotide combined with reduced-volume PEG.
The key finding was that three days of linaclotide combined with a lower PEG volume achieved bowel preparation quality comparable to standard regimens. Importantly, this lower-volume strategy did not negatively affect clinically relevant colonoscopy outcomes, including polyp detection, adenoma detection, or completion of bowel preparation.
From a tolerability standpoint, the reduced-volume PEG plus linaclotide regimen was associated with fewer adverse gastrointestinal symptoms compared with the higher-volume combination regimen. This suggests a potential patient-centred advantage, particularly for individuals who struggle with large-volume preparations.
Overall, this study supports a practical and patient-friendly bowel preparation strategy in average-risk individuals: short-term linaclotide pretreatment allows PEG volume reduction while maintaining preparation effectiveness and safety. If confirmed in broader populations, this approach could improve patient adherence, comfort, and willingness to undergo colonoscopy without sacrificing diagnostic quality.
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