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A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA.
Insights
Golytely offered the best colon cleansing but had lower tolerance. Magnesium citrate with X-prep provided good cleansing and was acceptable. Dulcolax without dietary restriction resulted in poor colon cleansing.
Area of Science:
- Pediatric Gastroenterology
- Clinical Trial Methodology
Background:
- Effective bowel preparation is crucial for pediatric colonoscopy.
- Evaluating different bowel preparation regimens in children is essential for optimizing procedure success and patient experience.
Purpose of the Study:
- To compare the acceptance and efficacy of three distinct bowel preparation regimens in pediatric patients undergoing colonoscopy.
Main Methods:
- A prospective, randomized, single-blind study involving 70 pediatric patients (ages 3-20).
- Three preparations were evaluated: Magnesium citrate/X-prep (Group A), Dulcolax/Fleet enema (Group B), and Golytely (Group C).
- Colon cleansing was graded by blinded endoscopists; patient-reported outcomes included tolerance, willingness to retake, adverse effects, and compliance.
Main Results:
- Colon cleansing was superior in Groups A and C compared to Group B (p < 0.0001).
- Group C (Golytely) demonstrated the best cleansing, though with significantly more adverse effects and lower tolerance/compliance compared to Groups A and B (p < 0.01).
- Groups A and B showed comparable tolerance and compliance, with Group B patients more willing to retake the preparation than Group C (p < 0.002).
Conclusions:
- Golytely provides the most effective colon cleansing in pediatric patients but is less well-tolerated.
- Magnesium citrate with X-prep is an acceptable option offering good colon cleansing.
- Dulcolax without dietary restriction leads to inadequate colon cleansing in this pediatric population.
Objective:
We performed a prospective, randomized, single-blind study in children undergoing colonoscopy to evaluate the acceptance and efficacy of three different bowel preparations.
Methods:
Seventy patients (ages 3-20 yr, 38 males) were randomly assigned to one of the three study preparations: Magnesium citrate with X-prep and clear liquid diet for 2 days (group A); Dulcolax for 2 days and Fleet enema without dietary restriction (group B); and Golytely 20 ml/kg (up to 1 L) per hour for 4 h with clear liquid diet for 1 day (group C). Endoscopists blinded to bowel preparation graded the adequacy of colon cleansing. The preparations were rated by patients for tolerance, willingness to retake them, adverse effects, and compliance.
Results:
Data analysis using Fisher exact test and trend test showed that colon cleansing in groups A and C was superior to that in group B (p < 0.0001) and better in group C than A (p < 0.075). Overall tolerance and compliance were significantly better for groups A and B than group C (p < 0.003), but not different between A and B. More of group B patients were willing to retake the preparation than in group C (p < 0.002) and group A (p < 0.05), but this was not different between groups A and C. Adverse effects were reported more frequently by patients in group C than in groups A and B (p < 0.01).
Conclusions:
Although the least well tolerated, Golytely provided the best cleansing. Dulcolax without dietary restriction provided unsatisfactory colon cleansing. Magnesium citrate with X-prep was acceptable and provided good cleansing.