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Split dose versus full single-dose regimen of polyethylene glycol for bowel preparation in pediatric colonoscopy: a
Hansa Sriphongphankul1,2, Pornthep Tanpowpong1, Chatmanee Lertudomphonwanit1
1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok.
Insights
The split-dose regimen of polyethylene glycol with electrolyte solution significantly improves bowel preparation success in children undergoing colonoscopy. This method also enhances patient willingness to repeat the procedure and shows a trend towards better tolerability.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy Procedures
- Gastrointestinal Motility
Background:
- Previous meta-analyses in adults indicate split-dose polyethylene glycol with electrolyte solution (PEG-ES) is superior for bowel preparation compared to a single full dose.
- No comparable studies have been conducted in pediatric populations to evaluate PEG-ES dosing regimens.
Purpose of the Study:
- To compare the efficacy of split-dose versus full single-dose PEG-ES for bowel preparation in children undergoing colonoscopy.
- To assess secondary outcomes including tolerability, acceptability, and compliance with the PEG-ES regimens.
Main Methods:
- An investigator-blinded randomized controlled trial enrolled 45 children aged 2-18 years undergoing elective colonoscopy.
- Patients were randomized to receive either a full single dose or two split doses of PEG-ES.
- Bowel preparation success was assessed using the Boston Bowel Preparation Scale (score ≥ 6), with secondary outcomes evaluated via questionnaire.
Main Results:
- The split-dose PEG-ES group demonstrated a significantly higher rate of successful bowel preparation (95%) compared to the full single-dose group (72%, P = 0.047).
- Patients in the split-dose group showed a significantly higher willingness to repeat the same protocol (83% vs. 36%, P = 0.002).
- A trend towards lower rates of nausea and vomiting was observed in the split-dose group (39% vs. 68%, P = 0.051).
Conclusions:
- The split-dose regimen of PEG-ES for bowel preparation is superior in efficacy for pediatric colonoscopy compared to the traditional full single-dose regimen.
- The split-dose approach suggests improved tolerability and acceptability in pediatric patients.
- These findings support the adoption of split-dose PEG-ES for enhanced pediatric bowel preparation.
Objectives:
Previous meta-analyses in adults comparing a full single dose vs. split doses of polyethylene glycol with electrolyte solution demonstrated that the split-dose group had a higher rate of successful bowel preparation. To date, no similar study in children has been conducted. Therefore, we compared the efficacy of bowel preparation between the two regimens of polyethylene glycol with electrolyte solution in pediatric colonoscopy. The secondary outcomes were tolerability, acceptability, and compliance.
Methods:
An investigator-blinded randomized controlled trial was conducted to enroll children aged 2-18 years who underwent an elective colonoscopy at a teaching hospital between March 2018 and February 2019. Patients were randomly assigned to receive polyethylene glycol with electrolyte solution as a full single dose or two split doses. The Boston Bowel Preparation Scale was used for the efficacy (i.e. successful bowel preparation if score ≥ 6). Secondary outcomes were evaluated by using a standardized questionnaire.
Results:
A total of 45 colonoscopies (22 in the full single-dose and 23 in the split-dose group) were performed. Mean age was 9.2 years old (SD 4.4). We noted a higher rate of successful bowel preparation in the split-dose group (95% vs. 72%, P = 0.047). Significant higher rate of willingness to repeat the same protocol (83% vs. 36%, P = 0.002) and a trend of lower rate of nausea/vomiting (39% vs. 68%, P = 0.051) in the split-dose group were found.
Conclusion:
The split-dose regimen of polyethylene glycol with electrolyte solution for bowel preparation suggests superior efficacy, potential tolerability, and acceptability as compared to the traditional full single-dose regimen.
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