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

Abstract

Background. Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children. Aim. The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability. Material and Methods. The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained. Results. One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p=0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p=0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient’s grade for palatability, low volume of the solution, and willingness to repeat the same protocol. Conclusion. All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.

Sodium Picosulphate with Magnesium Citrate versus Polyethylene Glycol for Bowel Preparation in Children: A Systematic Review

“…There was no disagreement between authors on inclusion and exclusion of studies. Finally, four RCTs that randomized 380 participants (190 in the PS/Mg and 190 in PEG group) with age from 2 to 18 years were identified [ 11 12 13 14 ]. The sample size of trials ranged from 71 to 144 participants.…”

“…3 ). In both groups, successful colon cleansing (BPPS≥6) was observed in approximately 90% of patients (PS/Mg: 89%, PEG: 90%) [ 12 14 ].…”

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

“…However, hitherto these scales are rarely used to evaluate bowel cleansing regimes in children. There are several studies that evaluate different bowel preparations by using mainly Boston Bowel Preparation Scale, recently, however none of them compared PEG vs NP (11)(12)(13)(14). Ottawa Bowel Preparation Quality Scale, which was developed and published in 2004, evaluates the colon in three segments and also separately rates the fluid quantity (4).…”

The unmet needs for identifying the ideal bowel preparation

“…Different dosing regimens, timing, and preparations have been investigated for improving patient acceptance of BP. 46 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 Low volume PEG ( vs high volume PEG) and split‐dose or same‐day regimens ( vs day‐before regimens) have been usually shown to achieve higher acceptance rate and willing to repeat the endoscopic procedure. 15 However, the ideal regimen has not yet been defined.…”