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Colon cleansing with oral sodium phosphate in adolescents: dose, efficacy, acceptability, and safety
Mahmoud Sabri1, Carlo Di Lorenzo, Wendy Henderson
1Division of Pediatric Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA.
Insights
A 1-day oral sodium phosphate solution (NaP solution) bowel preparation was more acceptable for children undergoing colonoscopy than a 3-day magnesium citrate regimen. Both bowel preparations were safe and effective for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy
- Clinical Trials
Background:
- Standardized bowel preparation protocols for pediatric colonoscopy are lacking.
- This study addresses the need for effective and well-tolerated bowel cleansing methods in children and adolescents.
Purpose of the Study:
- To compare the efficacy, acceptability, and safety of a 1-day oral sodium phosphate solution (NaP solution) regimen versus a standard 3-day magnesium citrate regimen for pediatric colonoscopy.
- To determine the preferred bowel preparation method for children and adolescents.
Main Methods:
- A randomized controlled trial involving 48 children and adolescents.
- Comparison of a 1-day NaP solution regimen (regimen A) against a 3-day magnesium citrate regimen with an enema (regimen B).
- Assessment of bowel cleansing quality, patient/parent acceptability via questionnaires, and safety through electrolyte monitoring and adverse event reporting.
Main Results:
- Bowel cleansing quality was similar between the two groups, with 71% achieving excellent or good preparation.
- Regimen A (1-day NaP solution) was significantly more acceptable, with 77% willing to repeat compared to 32% for regimen B.
- Higher nausea intensity was reported in regimen A, but overall adverse events and electrolyte levels were comparable and deemed safe.
- Pediatric patients who had experienced both regimens overwhelmingly preferred regimen A.
Conclusions:
- The 1-day oral NaP solution regimen is a safe, effective, and more acceptable alternative to the 3-day magnesium citrate regimen for bowel preparation in selected healthy children and adolescents (over 10.5 years and 34 kg).
- This finding provides valuable evidence for optimizing pediatric colonoscopy preparation.
Background And Aims:
Standardized bowel preparation in children and adolescents has not been established. Our aim was to compare two bowel preparation regimens and determine which was more effective, acceptable, and safer for children undergoing colonoscopy.
Methods:
We compared the efficacy and acceptability of a 1-day regimen with oral sodium phosphate solution (NaP solution) (1 mL/kg/day, maximum 90 mL in two divided doses; regimen A) to our standard 3-day regimen magnesium citrate (4 mL/kg/day x 3 days, maximum 237 mL, followed by an enema the morning of colonoscopy; regimen B). After informed consent was obtained, 48 children were randomized (N = 25, 23, respectively). Weight, electrolytes, calcium, phosphorus, and magnesium were measured at screening and the day of the colonoscopy. Questionnaires were given to assess acceptability and adverse events. Endoscopists rated the quality of bowel preparation on a 4-level scale from excellent to poor.
Results:
Median age and weight at screening were 14 yr, 53 kg, and 15 yr, 51 kg in regimen A and B, respectively. No statistical significance was observed in electrolytes, phosphorus, or adverse events apart from higher nausea intensity in regimen A (P= 0.012). Bowel cleansing was similar between groups (71% excellent or good). Subjects were more willing to repeat regimen A than B (77%vs 32%, respectively, P < 0.006). All 10 subjects who received regimen A and had prior colonoscopies using regimen B, preferred regimen A.
Conclusions:
In a selected group of otherwise healthy children and adolescents over 10.5 yr and above 34 kg, 1-day oral NaP solution was more acceptable than 3-day magnesium citrate with an enema, and both regimens were found to be safe and efficacious.
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