Bowel Preparation for Pediatric Colonoscopy

Abstract

Pediatric bowel preparation protocols used before colonoscopy vary greatly, with no identified standard practice. The present clinical report reviews the evidence for several bowel preparations in children and reports on their use among North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members. Publications in the pediatric literature for bowel preparation regimens are described, including mechanisms of action, efficacy and ease of use, and pediatric studies. A survey distributed to pediatric gastroenterology programs across the country reviews present national practice, and cleanout recommendations are provided. Finally, further areas for research are identified.

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

“… 4 Reduced tolerance can result in poor outcomes due to inadequate preparation, increased rate of complications, extended procedural time and missed lesions. 3 Additionally, side effects have previously been noted, such as hyperphosphataemia, in children who receive sodium phosphate. 4 …”

“… 2 Several regimens have been tried with the aim of identifying the safest, efficacious and tolerable combination, with varying success. 3 …”

“…While previous reviews have considered preparation for colonoscopy, 3 they do not always consider surgical interventions and often limit their populations at the age of 16 years, despite it being normal practice for paediatric gastroenterologists to look after such patients for a number of years before transition to adult services. 5 …”

One-day oral polyethylene glycol based cleanout is effective for pre-colonoscopy preparation in children

“…Although the dominant alternative that has emerged to high-volume PEG monotherapy is low-dose PEG with stimulant laxative dual therapy, our observations suggest that high volume PEG limited to one day pre-procedure is effective and well tolerated. Further research is required to compare one day monotherapy with dual therapy in terms of safety, outcome based quality of prep, adherence and tolerability [ 5 ].…”

“…A common alternative to PEG monotherapy for bowel prep is dual therapy with a stimulant (bisacodyl, senna) or combined stimulant–osmotic (Magnesium Citrate) laxative, which directly affects nerve, smooth muscle, and epithelial cells in the intestine to alter mucosal electrolyte transport [ 4 ]. A 2014 review by NASPHGHAN found that while PEG was the regimen of choice for monotherapy, dual therapy with PEG and stimulant laxative was used by between 36% (age 2–5 cohort) and 61% (age 12+ cohort) of physicians [ 5 ].…”