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Published on: August 1, 2019
Bowel preparations for colonoscopy: an RCT
Giovanni Di Nardo1, Marina Aloi2, Salvatore Cucchiara2
1Departments of Pediatrics, Pediatric Gastroenterology Unit, and giovanni.dinardo@uniroma1.it.
Insights
Four pediatric colonoscopy bowel preparations were compared. Low-volume polyethylene glycol (PEG) and sodium picosulfate/magnesium citrate regimens were as effective as standard PEG-ELS, with better tolerability and acceptance.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Endoscopy
Background:
- Pediatric colonoscopy preparation is challenging.
- Current bowel cleansing agents have limitations for children.
Purpose of the Study:
- Compare efficacy, safety, tolerability, and acceptance of four pediatric bowel preparation methods.
- Identify optimal bowel cleansing regimens for pediatric colonoscopy.
Main Methods:
- Randomized, investigator-blinded, noninferiority trial.
- Children (2-18 years) received PEG 4000 with simethicon (PEG-ELS), PEG-4000 with citrates/simethicone/bisacodyl (PEG-CS+Bisacodyl), PEG 3350 with ascorbic acid (PEG-Asc), or sodium picosulfate/magnesium citrate (NaPico+MgCit).
- Bowel cleansing assessed by Boston Bowel Preparation Scale; tolerability, acceptability, and compliance evaluated.
Main Results:
- Three hundred patients randomized.
- PEG-CS+Bisacodyl, PEG-Asc, and NaPico+MgCit were noninferior to PEG-ELS for overall colon cleansing.
- No serious adverse events; NaPico+MgCit showed significantly higher tolerability, acceptability, and compliance.
Conclusions:
- Low-volume PEG and NaPico+MgCit preparations are effective alternatives to high-volume PEG-ELS in children.
- NaPico+MgCit is the most suitable regimen due to superior tolerability and acceptance.
Background:
The ideal preparation regimen for pediatric colonoscopy remains elusive, and available preparations continue to represent a challenge for children. The aim of this study was to compare the efficacy, safety, tolerability, and acceptance of 4 methods of bowel cleansing before colonoscopy in children.
Methods:
This randomized, investigator-blinded, noninferiority trial enrolled all children aged 2 to 18 years undergoing elective colonoscopy in a referral center for pediatric gastroenterology. Patients were randomly assigned to receive polyethylene glycol (PEG) 4000 with simethicon (PEG-ELS group) or PEG-4000 with citrates and simethicone plus bisacodyl (PEG-CS+Bisacodyl group), or PEG 3350 with ascorbic acid (PEG-Asc group), or sodium picosulfate plus magnesium oxide and citric acid (NaPico+MgCit group). Bowel cleansing was evaluated according to the Boston Bowel Preparation Scale. The primary end point was overall colon cleansing. Tolerability, acceptability, and compliance were also evaluated.
Results:
Two hundred ninety-nine patients were randomly allocated to the 4 groups. In the per-protocol analysis, PEG-CS+Bisacodyl, PEG-Asc, and NaPico+MgCit were noninferior to PEG-ELS in bowel-cleansing efficacy of both the whole colon (P = .910) and colonic segments. No serious adverse events occurred in any group. Rates of tolerability, acceptability, and compliance were significantly higher in the NaPico+MgCit group.
Conclusions:
Low-volume PEG preparations (PEG-CS+Bisacodyl, PEG-Asc) and NaPico+MgCit are noninferior to PEG-ELS in children, representing an attractive alternative to high-volume regimens in clinical practice. Because of the higher tolerability and acceptability profile, NaPico+MgCit would appear as the most suitable regimen for bowel preparation in children.
