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Colonoscopy preparation in children: safety, efficacy, and tolerance of high- versus low-volume cleansing methods
M M da Silva1, G L Briars, M K Patrick
1Department of Gastroenterology and Nutrition, Royal Children's Hospital, Brisbane, Australia.
Insights
Low-volume sodium phosphate solution is a better tolerated and less invasive colonoscopy preparation for children compared to high-volume polyethylene glycol lavage. Both methods are effective for colon cleansing.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Clinical Trial Design
Background:
- Large-volume electrolyte solutions for colonoscopy preparation lead to poor patient compliance.
- Pediatric colonoscopy preparation requires safe and effective methods with good patient acceptance.
Purpose of the Study:
- To compare the tolerance, safety, and efficacy of high-volume versus low-volume colon-cleansing methods in children undergoing colonoscopy.
Main Methods:
- A randomized, operator-blinded trial involving 29 children (ages 3.6-14.6 years).
- Group 1: High-volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/h).
- Group 2: Low-volume oral sodium phosphate solution (22.5-45 ml) with oral fluid intake.
Main Results:
- Both preparations achieved effective colon cleansing.
- Low-volume sodium phosphate was better tolerated with less discomfort.
- No significant differences in adverse symptoms (nausea, vomiting, diarrhea) or sleep disturbance.
- Transient, minor reductions in hematocrit and calcium; transient increases in sodium and phosphate with sodium phosphate, normalizing within 10 hours.
Conclusions:
- Low-volume oral sodium phosphate offers advantages in tolerance, reduced discomfort, and ease of administration for pediatric colonoscopy preparation.
- Adequate oral fluid intake is crucial for safe use of sodium phosphate.
- Contraindicated in patients with renal insufficiency.
Background:
The use of large-volume electrolyte balanced solutions as preparation for colonoscopy often results in poor patient compliance and acceptance. The tolerance, safety, and efficacy of high-versus low-volume colon-cleansing methods as preparation for colonoscopy in children were compared by randomized operator-blinded trial.
Methods:
Twenty-nine children ages 3.6-14.6 years had either high-volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/ h) until the effluent was clear (n = 15), or two oral doses of sodium phosphate solution (22.5-45 ml) separated by oral fluid intake (n = 14).
Results:
Both preparations were equally effective. The low-volume preparation was better tolerated and caused less discomfort that the high-volume preparation, judging by serial nurse observations. The incidence of abdominal symptoms, diarrhea, sleep disturbance, and vomiting was not significantly different between the two groups. Both groups had a small reduction in mean hematocrit and serum calcium levels. The sodium phosphate preparation caused increases in mean serum sodium concentrations from 140 to 145 mmol/L and serum phosphate concentrations from 1.41 to 2.53 mmol/L. Ten hours after the commencement of the preanesthetic fast, these concentrations had returned to normal.
Conclusions:
There are advantages in terms of tolerance, discomfort, and case of administration with acceptable colonic cleansing with the use of the less-invasive oral sodium phosphate low-volume colon-cleansing preparation in children. Safe use requires ensuring an adequate oral fluid intake during the preparation time and avoidance of use in patients with renal insufficiency.