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Preparing the bowel for colonoscopy
K Abubakar1, N Goggin, S Gormally
1Department of Paediatrics, University College Dublin, Our Lady's Hospital for Sick Children, Crumlin, Ireland.
Insights
Oral bisacodyl and a phosphate enema offer an effective bowel preparation for pediatric colonoscopy. This method allows for clear visualization and can be performed as a day case, enabling children to eat normally.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
Background:
- Traditional bowel preparation for pediatric colonoscopy often requires hospitalization and nasogastric tube administration of lavage solutions.
- Effective bowel cleansing is crucial for accurate colonoscopy in children.
Purpose of the Study:
- To evaluate the efficacy of oral bisacodyl combined with a single phosphate enema for bowel preparation in children undergoing total colonoscopy.
- To determine if this regimen allows for day case procedures and normal diet maintenance.
Main Methods:
- An open prospective trial involving 30 children (18 months-15 years).
- Administration of oral bisacodyl for two days prior to colonoscopy, with a normal diet.
- A single phosphate enema administered on the procedure morning.
Main Results:
- Excellent (Grade I) or good (Grade II) bowel preparation was achieved in 100% of patients.
- Adequate visualization of the bowel mucosa was obtained in all participants.
- Minor adverse events included transient abdominal cramps in 26.6% and crying during enema in 16.6% (all under 5 years).
Conclusions:
- Oral bisacodyl and a phosphate enema is an effective and well-tolerated bowel preparation regimen for pediatric colonoscopy.
- This method facilitates day case colonoscopy in children while allowing them to maintain a normal diet.
Abstract:
Bowel preparation methods for total colonoscopy in children generally involve whole gut irrigation with electrolyte lavage solutions, which in most children will require hospitalisation for nasogastric tube administration. The aim of the study was to determine the efficacy of oral bisacodyl combined with a single phosphate enema as a bowel preparation regimen in children. In an open prospective trial, 30 children (aged 18 months-15 years) were given oral bisacodyl on each morning of the two days before colonoscopy. The children were maintained on a normal diet. A phosphate enema was administered on the morning of the procedure. The adequacy of bowel preparation was graded as grade I if no faecal material was encountered, grade II if small amounts of faecal material were present in scattered locations, and grade III if there was poor preparation with faecal material precluding satisfactory visualisation of the bowel mucosa. Eight children (26.6%) had minor abdominal cramps when taking bisacodyl, but all had a previous history of similar pain. Five children (16.6%), all under 5 years of age, cried during the administration of phosphate enema. Bowel preparation was considered excellent (grade I) in 26 (86.6%) and good (grade II) in four (13.3%). In all patients adequate visualisation of the bowel mucosa was obtained. Oral bisacodyl combined with a single phosphate enema provides an ideal method of preparing the bowel for total colonoscopy. This preparation allows colonoscopy to be carried out as a day case procedure in children while maintaining them on a normal diet.