Bowel preparation for elective procedures in children: a systematic review and meta-analysis

Abstract

ObjectiveReviews have investigated preparation for colonoscopy, but not for surgery, They are also often limited to patients up to 16 years, despite many paediatric gastroenterologists caring for older patients. We carried out a systematic review investigating the optimum bowel preparation agents for all indications in children and young people.DesignA Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool.PatientsYoung people requiring bowel preparation for any elective procedure, as defined by the primary studies.InterventionsRCTs comparing bowel preparation with placebo or other interventions.Main outcome measuresAdequacy of bowel preparation, tolerability and adverse events.ResultsThe search yielded 2124 results and 15 randomised controlled studies (n=1435)but heterogeneity limited synthesis. Meta-analysis of two studies comparing polyethylene glycol (PEG) with sodium phosphate showed no difference in the quality of bowel preparation (risk ratio (RR) 1.27(95% CI 0.66 to 2.44)). Two studies comparing sodium picosulfate/magnesium citrate with PEG found no difference in bowel preparation but significantly higher number of patients needing nasogastric tube insertion in the polyethylene glycol-electrolyte lavage solution (RR 0.04(95% CI 0.01 to 0.18), 45 of 117 in PEG group vs 2 of 121 in sodium picosulfate group). Meta-analysis of three studies (n=241) found no difference between PEG and sennasoids (RR 0.73(95% CI 0.31 to 1.71)).ConclusionsThe evidence base is clinically heterogeneous and methodologically at risk of bias. There is evidence that all regimens are equally effective. However, sodium picosulfate was better tolerated than PEG. Future research is needed with all agents and should seek to consider safety and tolerability as well as efficacy.

The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy

“…As a result, the rate of children from the PEG-ELS group being unable to successfully complete the bowel preparation was higher than that in the sodium picosulphate/magnesium citrate group and the willingness to repeat the preparation if needed was lower when compared with the two other groups. Our results, in terms of efficacy, tolerability, and safety, are comparable with the data presented in a recently published meta-analysis on bowel preparation in children that included two studies comparing PEG and sodium picosulphate/magnesium citrate [2].…”

“…Overall, the best bowel regimen in children before the elective colonoscopy with regard to the preparation's palatability, volume of the solution, ease at taking, and willingness to repeat was the NaPico+MgCit group. The results are in line with previous studies confirming that bowel cleansing with picosulphate/magnesium citrate was better tolerated and accepted than protocols with polyethylene glycol among children between 10 and 18 years of age [2,9,[12][13][14].…”

“…There is no one standardized bowel cleansing schedule before colonoscopy in children. A recently published systematic review and meta-analysis on bowel preparation for elective procedures in children called for new randomized trials assessing efficacy, safety, and tolerability of bowel preparation in the pediatric population [2].…”

Çocuklarda İki Bağırsak Hazırlık İlacının Etkinlik ve Kullanılabilirliğinin Karşılaştırılması: Polietilen Glikol ve Sodyum Fosfat

“…The studies that compare the efficacy of PEG and NP in children are limited. A metaanalysis including two studies that compare PEG and NP in 63 participants found no difference in adequacy of bowel preparation (6)(7)(8). Similarly, colonoscopy time and amount of suctioned fluid were not different between two groups in our study.…”

“…The tolerability of PEG was usually reported as poor, because it requires consumption of large amount of fluid and necessitates the use of nasogastric (NG) tube (6). One disadvantage of our study is that we did not evaluate the use of NG tube in our patients.…”