A multicentre assessment of adequacy of bowel preparation for paediatric ileocolonoscopy

Adequate bowel preparation facilitates Ileocolonoscopy completion. Paediatric Endoscopy Quality Improvement Network (PEnQuIN) quality standards recommend unadjusted rates of adequate bowel preparation of ≥80% and terminal ileal intubation ≥85% for paediatric ileocolonscopy. A Boston Bowel Preparation Scale (BBPS) score of ≥6 is considered adequate. This study aims to identify whether UK hospitals are attaining these PEnQuIN standards and review medications used.

UK paediatric endoscopy centres were invited to complete standardised questionnaires and to provide anonymous BBPS data. Patients meeting the inclusion criteria were grouped according to the bowel preparation drug type for analysis, and a Kruskal-Wallis test was performed.

Complete data for 209 patients from 11 hospitals were collated. Seven hospitals achieved the PEnQuIN standard for adequate bowel preparation, and nine for terminal ileal intubation. Bowel preparation drugs varied greatly among hospitals. Considering drug subgroups, only Group D (Citric Acid and Magnesium Carbonate) achieved the desired adequate bowel preparation rate of ≥80%. A Kruskal-Wallis test revealed no statistically significant difference in median BBPS score between medication subgroups (H = 1.017, p = 0.907). There was significant variability within subgroups regarding timing, dosage and frequency of drug, resulting in heterogeneity.

This initial study highlights marked variability in the use of bowel preparation medications in the United Kingdom. While only subgroup D met the standard for bowel preparation, more met the standard for ileal intubation, raising the question of whether important pathology is being missed. A large prospective multicentre trial is required to establish the ideal medication type and protocol for bowel preparation in children.