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One-day oral polyethylene glycol based cleanout is effective for pre-colonoscopy preparation in children
Ashwath S Kumar1, Brooke L Beutler2, Thomas M Attard3,4
1University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Insights
A one-day Polyethylene glycol (PEG) bowel preparation regimen is effective for pediatric colonoscopies. This age-categorized dosing approach ensures adequate cleanout in most children, facilitating successful procedures.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Gastrointestinal Motility
Background:
- Colonoscopy quality heavily relies on pre-procedure bowel preparation adequacy.
- A standardized pre-procedure regimen for pediatric colonoscopy is lacking.
- Polyethylene glycol (PEG) is recommended by professional guidelines.
Purpose of the Study:
- To assess the provider-assessed adequacy of a one-day, age-categorized Polyethylene glycol (PEG) based cleanout regimen in pediatric patients.
- To evaluate the effectiveness of the PEG regimen in achieving adequate bowel preparation for colonoscopy in children.
Main Methods:
- Retrospective and prospective abstraction of data from 642 pediatric colonoscopies (2015-2016).
- Utilized an institutional quality monitoring survey tool to collect data on demographics, prep quality, and procedure outcomes.
- Employed an age-dependent minimum PEG dosing regimen with clear liquids the day prior to the procedure.
Main Results:
- Adequate cleanout (thin or thick liquid, no solids) was achieved in 79.5% of cases.
- Inadequate cleanout occurred in 11.8% of studies, significantly associated with impaired and incomplete procedures.
- Cecal intubation and terminal ileum intubation rates were high (97.8% and 93.6%, respectively), with no correlation to patient age or gender.
Conclusions:
- A one-day, single-agent Polyethylene glycol (PEG) based cleanout regimen is effective for routine pediatric colonoscopy preparation.
- The regimen demonstrates efficacy in achieving adequate bowel preparation, supporting its use in pediatric patients.
Background:
The adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.
Methods:
The standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively abstracted relevant indices including patient demographics, prep quality, procedure impairment, duration and completion from an institutional quality monitoring survey tool between 2015 and 2016 and similarly abstracted prospectively recorded indices that included the dataset above as well as additional fields for procedure deviations and additional laxative use.
Results:
A total of 642 procedures (mean age 12.2 years; F: 380) were accrued, nonadherence to the cleanout regimen (7.3%) and additional laxative use (3.1%) were observed in a small proportion of the prospective dataset subjects, adequate cleanout defined as thin or thick liquid but no solids present was reported in 79.5% and 15.8% of cases and impaired study from inadequate cleanout was reported in 11.8% of studies albeit the cecum was reached and the terminal ileum was intubated in 97.8 and 93.6% of studies. The duration of the study was significantly longer with the presence of a fellow trainee assisting in the procedure. Patient age and gender did not correlate with prep adequacy or cecal and ileal intubation rates, inadequate cleanout was significantly associated with impairment and incomplete studies.
Conclusion:
A one day, single agent, osmotic laxative (Polyethylene glycol) based cleanout regimen is effective in routine pre-procedure cleanout for standard colonoscopy in pediatric age range patients.
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