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Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in
D A Gremse1, A I Sacks, S Raines
1Division of Pediatric Gastroenterology and Nutrition, University of South Alabama, College of Medicine, Mobile 36640-0130, USA.
Insights
Oral sodium phosphate solution offers better tolerability and colon cleansing for pediatric bowel preparation compared to polyethylene glycol-based solutions. However, it frequently caused hyperphosphatemia, necessitating further safety and efficacy studies in children.
Area of Science:
- Pediatric Gastroenterology
- Colorectal Surgery
Background:
- Effective bowel preparation is crucial for pediatric colonoscopy.
- Comparing different bowel preparation solutions in pediatric populations is essential for optimizing patient outcomes and procedural success.
Purpose of the Study:
- To compare the tolerability, efficacy, and safety of oral sodium phosphate solution versus polyethylene glycol-based solution for bowel preparation in children undergoing elective colonoscopy.
Main Methods:
- A randomized trial involving 34 pediatric patients (aged 3-17 years) comparing oral sodium phosphate solution and polyethylene glycol-based solution.
- Patient compliance and tolerability were assessed.
- Colon cleansing quality was evaluated by a blinded endoscopist.
- Serum phosphorus and calcium levels were monitored for safety.
Main Results:
- Oral sodium phosphate solution demonstrated significantly better patient compliance and superior colon cleansing quality compared to polyethylene glycol-based solution.
- Abdominal pain was more frequent with polyethylene glycol-based solution, while vomiting rates were similar.
- Hyperphosphatemia occurred frequently in the oral sodium phosphate group, though without clinical symptoms or significant changes in serum calcium.
Conclusions:
- Oral sodium phosphate solution is better tolerated and more effective for pediatric bowel preparation than polyethylene glycol-based solutions.
- The frequent occurrence of hyperphosphatemia with oral sodium phosphate necessitates further research to establish safe and effective dosing regimens for pediatric use.
Abstract:
Thirty-four patients, aged 3 to 17 years, were randomized to receive oral sodium phosphate solution or a polyethylene glycol-based solution in preparation for elective colonoscopy. Nineteen patients received two doses of oral sodium phosphate solution (45 mL/1.7 m2/ dose) and 15 received polyethylene glycol-based solution (4 L/1.7 m2). Compliance with oral sodium phosphate solution was judged as easy or tolerable in 15 of 19 patients, but only in 5 of 15 who were given polyethylene glycol-based solution. The quality of colon cleansing was rated by an endoscopist who was blinded to the colon preparation method used. The bowel preparation was excellent or good (only liquid remaining in the colonic lumen) in 18 of 19 patients who received oral sodium phosphate solution and in 6 of 15 who received polyethylene glycol-based solution. The incidence of vomiting was similar in both groups, but abdominal pain occurred more frequently in the polyethylene glycol-based solution group. Hyperphosphatemia developed in patients who received oral sodium phosphate solution (serum phosphorus = 2.3 +/- 0.7 mmol/L (7.2 +/- 2.2 mg/dL; mean +/- SD), but only in 1 of 15 patients in the polyethylene glycol-based solution group. Patients did not exhibit symptoms of hyperphosphatemia and serum calcium concentrations were similar in both groups. In summary, oral sodium phosphate solution is better tolerated than polyethylene glycol-based solution for bowel preparation in children. However, hyperphosphatemia occurred frequently in patients who received oral sodium phosphate solution. Further studies are needed to determine the optimal dose for safety and efficacy for the use of these solutions in children.