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Sodium Picosulphate with Magnesium Citrate versus Polyethylene Glycol for Bowel Preparation in Children: A Systematic
Piotr Dziechciarz1, Marek Ruszczyński1, Andrea Horvath1
1Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland.
Insights
Sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) offer similar bowel prep quality and safety for pediatric colonoscopy. PS/Mg demonstrates superior tolerability and acceptability in children.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
- Clinical Pharmacology
Background:
- Effective bowel preparation is crucial for successful colonoscopy in children.
- Sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) are commonly used laxatives for this purpose.
- Comparative data on their effectiveness, tolerability, and acceptability in pediatric populations are essential.
Purpose of the Study:
- To compare the effectiveness, tolerability, acceptability, and safety of PS/Mg versus PEG in children undergoing colonoscopy preparation.
- To evaluate bowel cleansing quality using standardized scales.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searches were performed in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to July 2020.
- Four RCTs involving 390 children were included, with data extraction and risk of bias assessment by two independent authors.
Main Results:
- Meta-analysis of two trials (n=224) showed no significant difference in excellent/good Boston Bowel Preparation Scale scores (RR: 0.99; 95% CI: 0.90-1.08).
- Meta-analysis of two other trials (n=150) found no significant difference in Ottawa Bowel Preparation Scale scores (MD: 0.20; 95% CI: -0.74-1.14).
- PS/Mg was significantly superior to high-volume PEG in tolerability and acceptability, despite comparable safety profiles.
Conclusions:
- Both PS/Mg and PEG provide comparable bowel cleansing quality and safety in children for colonoscopy.
- PS/Mg offers significantly better tolerability and acceptability compared to high-volume PEG in pediatric patients.
- PS/Mg may be a preferred option for pediatric bowel preparation due to improved patient experience.
Purpose:
To compare the effectiveness, tolerability, acceptability, and safety of sodium picosulphate with magnesium citrate (PS/Mg) and polyethylene glycol (PEG) in children (≤18 years) preparing for colonoscopy.
Methods:
Three electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were searched till July 2020. Only randomized controlled trials (RCTs) were included. At least two authors independently selected studies and performed risk of bias assessment and data extraction.
Results:
Four RCTs (n=390), with overall good quality were included. A meta-analysis of two trials (n=224) found no statistically significant difference between the groups with respect to the proportion of patients who had excellent and good scores (≥6 points) according to the Boston Bowel Preparation Scale (relative risk: 0.99; 95% confidence interval [CI]: 0.90 to 1.08). Excellent and good scores were observed in both groups in approximately 90% of children. A meta-analysis of two other trials (n=150) showed no significant difference between the groups with respect to the mean total score for the Ottawa Bowel Preparation Scale (mean difference: 0.20; 95% CI: -0.74 to 1.14). Both regimens provided a comparable safety profile; however, PS/Mg was significantly superior to high volume PEG in terms of tolerability (abdominal pain, nausea, vomiting, bloating/flatulence/fullness) and acceptability (ease of formulation consumption, taste acceptance, need for nasogastric tube, compliance with full dose).
Conclusion:
PS/Mg provides a quality and safety profile similar to PEG for bowel cleansing; however, it has better acceptance and tolerance in children preparing for colonoscopy.
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