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Bowel preparation for elective procedures in children: a systematic review and meta-analysis

Morris Gordon1,2, Fiona Karlsen2, Sahira Isaji2

  • 1School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.

BMJ Paediatrics Open
|April 12, 2018
PubMed

Insights

This systematic review found that various bowel preparation agents are equally effective for children and young people undergoing surgery. Sodium picosulfate was better tolerated than polyethylene glycol (PEG).

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Preparation
  • Evidence-Based Medicine

Background:

  • Existing reviews on bowel preparation primarily focus on colonoscopy and often exclude older pediatric patients.
  • There is a need to evaluate optimal bowel preparation agents for surgical procedures in a broader pediatric population.
  • Paediatric gastroenterologists frequently manage older patients requiring surgical bowel preparation.

Purpose of the Study:

  • To systematically review randomized controlled trials (RCTs) on the optimal bowel preparation agents for all indications in children and young people.
  • To assess the adequacy of bowel preparation, tolerability, and adverse events associated with different agents.

Main Methods:

  • A systematic review adhering to Cochrane guidelines was conducted.
  • Data extraction and quality assessment were performed independently by two reviewers using the Cochrane risk of bias tool.
  • Included studies were RCTs comparing bowel preparation agents with placebo or other interventions in young people undergoing elective procedures.

Main Results:

  • Fifteen RCTs involving 1435 participants were analyzed, though heterogeneity limited extensive synthesis.
  • No significant difference in bowel preparation quality was found between polyethylene glycol (PEG) and sodium phosphate, or between sodium picosulfate/magnesium citrate and PEG.
  • Sodium picosulfate/magnesium citrate resulted in significantly fewer patients requiring nasogastric tube insertion compared to PEG.

Conclusions:

  • The current evidence base for pediatric bowel preparation is heterogeneous and carries a risk of bias.
  • All evaluated bowel preparation regimens appear to be equally effective in terms of adequacy.
  • Sodium picosulfate demonstrated better tolerability compared to PEG, highlighting the need for further research on safety and tolerability.
Abstract

Keywords:
bowel clearancebowel preparationcolonoscopysystematic review

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