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The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy
Anna Szaflarska-Popławska1, Dominika Tunowska2, Ola Sobieska-Poszwa2
1Department of Pediatric Endoscopy and Gastrointestinal Function Testing, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
Insights
The sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit) regimen is most suitable for pediatric bowel preparation before colonoscopy. This method demonstrated superior tolerability and patient acceptance compared to other tested bowel cleansing options.
Area of Science:
- Pediatric Gastroenterology
- Endoscopy
- Clinical Trials
Background:
- No universal protocol for pediatric bowel preparation before colonoscopy exists.
- Effective bowel cleansing is crucial for successful pediatric colonoscopy.
Purpose of the Study:
- Compare three 1-day bowel preparation methods for pediatric colonoscopy.
- Evaluate efficacy, safety, and patient-reported tolerability of different regimens.
Main Methods:
- Randomized, prospective, investigator-blinded study.
- Included children aged 10-18 years.
- Compared polyethylene glycol 3350 with bisacodyl, polyethylene glycol 4000 with electrolytes, and sodium picosulphate plus magnesium oxide plus citric acid.
- Assessed preparation using Boston Bowel Preparation Scale (BBPS) and patient questionnaires.
Main Results:
- All 123 participants completed colonoscopy with cecal visualization.
- No significant differences in BBPS scores among groups.
- Minor adverse events in 59.3% of patients; no serious adverse events.
- NaPico+MgCit group showed higher acceptability (palatability, volume, willingness to repeat).
- Nausea and apathy were more frequent in other groups compared to NaPico+MgCit.
Conclusions:
- All tested bowel cleansing methods are similarly effective for pediatric colonoscopy.
- The NaPico+MgCit regimen offers superior tolerability and acceptability.
- NaPico+MgCit is recommended for pediatric colonoscopy preparation.
Background:
Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children.
Aim:
The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability.
Material And Methods:
The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained.
Results:
One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p = 0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p = 0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient's grade for palatability, low volume of the solution, and willingness to repeat the same protocol.
Conclusion:
All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.
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