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Polyethylene glycol powder solution versus senna for bowel preparation for colonoscopy in children
Natalie A Terry1, Mei Lin Chen-Lim, Elizabeth Ely
1Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Small-volume polyethylene glycol-preparation (PEG-P) is an effective and safe colonoscopy preparation for pediatric patients compared to senna. This study found PEG-P yielded significantly better results with good tolerability.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Pharmacology
Background:
- Large-volume polyethylene glycol-based solutions (PEG-ES) are effective for colonoscopy but have drawbacks like taste and volume.
- Small-volume electrolyte-free polyethylene glycol-preparation (PEG-P) is used in pediatric centers, but its efficacy and safety are not well-documented compared to other agents.
- Senna is another option for colonoscopy preparation, but its effectiveness needs comparison with newer agents.
Purpose of the Study:
- To compare the efficacy and safety of small-volume electrolyte-free polyethylene glycol-preparation (PEG-P) against senna for colonoscopy preparation in pediatric patients.
- To evaluate if PEG-P offers a superior colonoscopy preparation quality compared to senna.
- To assess the tolerability and safety profiles of both PEG-P and senna preparations.
Main Methods:
- A prospective, randomized, single-blinded study involving pediatric patients aged 6 to 21 years.
- Patients were randomized to receive either PEG-P (1.5 g/kg divided twice daily for 2 days) or senna (15-30 mL daily for 2 days).
- Colonoscopy preparation quality was assessed by a blinded endoscopist using the Aronchick scale; patient-reported symptoms and ease of preparation were also recorded. Serum chemistry panels were obtained.
Main Results:
- PEG-P resulted in significantly higher excellent/good preparation scores (88%) compared to senna (29%) (P = 0.0022).
- Both PEG-P and senna preparations were well-tolerated by patients in terms of ease of use.
- No significant differences in demographics or laboratory values were observed between the groups, and no serious adverse events were reported.
Conclusions:
- Small-volume polyethylene glycol-preparation (PEG-P) is an effective colonoscopy preparation in the pediatric population.
- Senna preparation was found to be insufficient for adequate colonoscopy preparation in this study.
- Both PEG-P and senna appear safe and well-tolerated in pediatric patients, but PEG-P demonstrates superior efficacy.
Objectives:
Safety and effectiveness of large-volume polyethylene glycol-based solution (PEG-ES) have been documented, but the taste and volume can be barriers to successful colonoscopy preparation. Efficacy and safety of small-volume electrolyte-free (PEG-P) preparation (Miralax) for colonoscopy preparation have been rarely studied, although presently used at many pediatric centers. The primary objective of the present study was to determine whether PEG-P results in a more efficacious and safe colonoscopy preparation as compared with senna.
Methods:
The study design was prospective, randomized, and single-blinded. Patients ages 6 to 21 years were randomized to a 2-day clean-out regimen of PEG-P at a dose of 1.5 g/kg divided twice per day for 2 days versus senna 15 mL daily (ages 6-12) or 30 mL daily (ages 12-21) for 2 days. Both preparations required 1 day of clear liquids whereas senna preparation required an additional day of full liquid diet. A blinded endoscopist graded the quality of preparation with a standardized cleanliness tool (Aronchick scale). Serum chemistry panels were obtained. Patients or parents rated symptoms and ease of preparation. The anticipated number of subjects was 166; however, the interim analysis demonstrated inferiority of senna preparation.
Results:
Thirty patients were evaluated in the present study. Of the patients in the PEG-P arm, 88% (14/16) received an excellent/good score compared with 29% (4/14), with the senna preparation (P = 0.0022). Both preparations were well-tolerated by patient-graded ease of preparation. Demographics and laboratory values did not differ significantly across the 2 groups. No serious adverse events were noted.
Conclusions:
PEG-P is an effective colonoscopy preparation whereas senna preparation was insufficient. Both were well-tolerated and appear safe in a pediatric population.
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