Colonoscopy has gained significant importance in recent years due to its crucial role in diagnosing, screening, and treating a wide range of gastrointestinal diseases [1,2]. It plays a crucial role in the early detection of conditions such as colorectal cancer and polyps, making it an essential procedure for preventive healthcare [3]. Regular colonoscopy screenings are vital for many individuals in the population, contributing to its widespread use and emphasizing the need for convenience and patient compliance [[4], [5], [6], [7]].

Bowel preparation is a crucial step for colonoscopy and plays a key role in determining the quality of the examination [3]. The standard regimen, as recommended by clinical guidelines, typically involves a high-volume 4 L dose of polyethylene glycol (PEG) [8,9]. Although this dose is effective in achieving high-quality bowel cleansing, the large volume of fluid is often difficult to tolerate due to adverse reactions such as nausea, vomiting, and the unpleasant taste of the solution. This results in poor tolerance and acceptance, driving the need to explore alternative options.

Lower-volume PEG solutions combined with additional bowel laxatives, such as mosapride [10], lactulose [11], and bisacodyl [12,13], have been proposed as alternatives. However, each of these combinations has limitations, including potential dangerous side effects and limited efficacy.

Linaclotide, a guanylate cyclase-C receptor agonist, is approved for use as a treatment option for adults with constipation-related conditions, including constipation-predominant irritable bowel syndrome (IBS-C) and chronic idiopathic constipation (CIC) [14]. It works by activating GC-C and increasing secretion of fluid into the intestinal lumen [15]. This action softens feces, enhances gastrointestinal motility, and promotes more frequent bowel movements. Conversely, linaclotide also reduces intestinal discomfort by inhibiting pain-sensing nerves [16].

The proven efficacy of linaclotide as a prosecretory agent has led to interest in its use for bowel preparation. Multiple studies have explored the combination of linaclotide with PEG, assessing both its safety and efficacy in comparison to PEG alone. This systematic review and meta-analysis aims to provide comprehensive evidence on the new regimen of Linaclotide as an Adjuvant for Bowel Preparation.