Bowel preparation in pediatric colonoscopy: results of an open observational study

Abstract

Background and study aims: The goal of this study was to analyze the bowel cleansing methods currently used for pediatric colonoscopy in terms of effectiveness, tolerance and safety. Patients and methods: Data from 768 colonoscopies reported by 28 centers were registered in an online database for further analysis. Binary logistic regression was used to determine how preparation methods affected the cleaning effect (Aronchick score) and the rate of adverse events (Aes) and complications. Results: The most frequently reported cleansing agents were sodium picosulphate (54.2?%) and polyethylene-glycol (41.3?%) in various combinations. The cleaning effect was good to excellent in 72.6?% of patients. AEs during the preparation period occurred in 21.5?% of patients. Complications during endoscopy were reported in 12.1?% and were mostly mild. The different agents had no influence on the cleaning effect. In contrast the risk of AEs during preparation was significantly increased when polyethylene-glycol was used (odds ratio (OR) 2.112, P?=?0.002) but reduced with the use of sodium picosulphate (OR 0.380, P?<?0.001). In particular, the risk of needing a nasogastric tube to complete clean-out was about 10-fold higher when polyethylene-glycol was used. Conclusions: A large variety of regimens are used for bowel preparation in children. We found a good overall cleaning result independent of the agents used. Cleansing agents, on the other hand, had a significant influence on tolerance and safety.

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

“…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].…”

“…No child needed to undergo lavage via a nasogastric tube. However, the rate of pediatric patients that are unable to ingest the prescribed amount of preparation varies from study to study [4,8,10,11,14]. Several factors may explain the high compliance rate with bowel cleansing protocols in our study.…”

“…Only a limited number of studies have evaluated the efficacy and safety of polyethylene glycol (PEG) 3350 powder in a 1-day bowel preparation regimen for pediatric colonoscopy [3][4][5][6][7][8][9][10][11][12]. Little is also known about the effectiveness and tolerability of sodium picosulphate/magnesium citrate before colonoscopy in children [9,[12][13][14].…”

Bowel Preparation for Pediatric Colonoscopy

“…In a small study of 35 patients receiving PEG-ELS, up to 77.1% of patients rated the taste as “very bad” and 57.1% of patients rated the bowel preparation as “very difficult” ( 11 ). Similar results were shown in other studies ( 9 , 10 , 12 ). Newer PEG-ELS preparations now contain ascorbic acid; this is more palatable and has a higher osmotic effect, allowing for half the required volume.…”

Single versus split dose polyethylene glycol for bowel preparation in children undergoing colonoscopy: a systematic review and meta-analysis

“…Besides, it can lead to colonic mucosal changes that mimic inflammatory bowel disease (31). Another bowel preparation therapies combining different drugs (such as magnesium citrate, bisacodyl, relaxants et al) have shown variable efficacy and adverse effects (32,33). Previous study (34) has reported the efficacy and safety of a 1-day PEG bowel preparation protocol for colonoscopy in children, but they have not use standard scoring systems to assess outcomes such as tolerance and adequacy of the bowel preparation.…”