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

Abstract

BackgroundThe adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.MethodsThe standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively abstracted relevant indices including patient demographics, prep quality, procedure impairment, duration and completion from an institutional quality monitoring survey tool between 2015 and 2016 and similarly abstracted prospectively recorded indices that included the dataset above as well as additional fields for procedure deviations and additional laxative use.ResultsA total of 642 procedures (mean age 12.2 years; F: 380) were accrued, nonadherence to the cleanout regimen (7.3%) and additional laxative use (3.1%) were observed in a small proportion of the prospective dataset subjects, adequate cleanout defined as thin or thick liquid but no solids present was reported in 79.5% and 15.8% of cases and impaired study from inadequate cleanout was reported in 11.8% of studies albeit the cecum was reached and the terminal ileum was intubated in 97.8 and 93.6% of studies. The duration of the study was significantly longer with the presence of a fellow trainee assisting in the procedure. Patient age and gender did not correlate with prep adequacy or cecal and ileal intubation rates, inadequate cleanout was significantly associated with impairment and incomplete studies.ConclusionA one day, single agent, osmotic laxative (Polyethylene glycol) based cleanout regimen is effective in routine pre-procedure cleanout for standard colonoscopy in pediatric age range patients.

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

“…Newer low-volume preparation alone (e.g., sodium picosulphate/magnesium citrate) or with combination with bisacodyl (e.g. PEG-bisacodyl) allows for preparation with only 2 L of solution instead of 4 L. Some of these preparations are officially approved for treatment of chronic constipation, and they have recently started to be used for bowel cleanout in children (PEG-3350) [3][4][5][6][7][8][9][10][11][12], whereas others are primarily used for colonoscopy cleansing but have no pediatric registration in Poland. The aim of this prospective, randomized, 3-arm study was to compare the efficacy, safety, and tolerability of three different 1-day regimens of bowel preparation for the pediatric colonoscopy: high-volume PEG-ELS versus low-volume PEG-3350 without electrolytes combined with bisacodyl versus sodium picosulphate/magnesium citrate.…”

“…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].…”

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

“…Both senna and sodium phosphate can cause side effects, such as dehydration, which lead extra fluids intake to the patients. Furthermore, previous studies (9,28) have shown that PEG can be used as a safe and effective formulation for children at a dose of 1.5 g/kg for 4 days. However, it has been reported that bowel preparation should be ideally completed in a shorter period of time (12).…”

Bowel Preparation for Pediatric Colonoscopy

“…Phatak et al showed that 92–93% of 111 pediatric patients receiving 2 days of PEG with bisacodyl achieved “good” or “excellent” bowel preparation ( 18 ). A large two-part retrospective and prospective study of 656 patients on 1 day of oral PEG-3350 monotherapy reported adequate clean out (defined as thin or thick liquids) in 79.5 and 15.8% of cases, respectively ( 19 ). While the safety of PEG without electrolytes has been questioned, two studies reviewing electrolytes pre and post PEG-3350 did not show clinically significant changes in potassium or bicarbonate ( 17 , 20 ).…”