Randomized clinical trial: efficacy and tolerability of two different split dose of low-volume polyethylene glycol electrolytes for bowel preparation before colonoscopy in hospitalized children

Abstract

Background

Eighty milliliter per kilogram of polyethylene glycol (PEG) for bowel preparation (BP) has been recommended, but the amount of liquid orally without nasogastric intubation is difficult to achieve. This study is to compare the efficacy and tolerability of two different low-volume PEG electrolyte solutions for BP in children.

Methods

The randomized, double‐blind, controlled trial enrolled 150 children aged 6–18 years undergoing colonoscopy in our center. Patients were randomly assigned to receive 60 ml/kg (PEG-ELS 60) or 40 ml/kg (PEG-ELS 40) of PEG electrolytes (PEG-ELS) 4000. The Boston Bowel Preparation Scale was used for bowel cleansing evaluation. Primary end point was overall colon cleansing. Tolerability was also evaluated.

Results

PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for both whole colon and various colonic segments. The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups. More patients considered the BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60.

Conclusions

Low volume of PEG-ELS for BP has good efficacy in bowel cleansing. PEG-ELS with 40 ml/kg volume was not inferior to that of 60 ml/kg.

Impact

  • PEG-ELS 40 and PEG-ELS 60 had similar efficacy in bowel cleansing for whole and various colonic segments.

  • The proportions of patients experiencing any adverse symptoms, or those who were willing to have BP repeated if necessary were similar in both groups.

  • More patients considered BP solution easy to take and be satisfied with the preparation in PEG-ELS 40 than PEG-ELS 60.

  • This study showed that low-volume PEG-ELS monotherapy was effective in bowel cleansing and explored a possibly feasible BP method for pediatrics in China that PEG-ELS 40 was comparable to PEG-ELS 60 regimen.

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References

  1. 1.

    Lightdale, J. R. et al. Modifications in endoscopic practice for pediatric patients. Gastrointest. Endosc. 79, 699–710 (2014).

    Article  Google Scholar 

  2. 2.

    Belsey, J., Epstein, O. & Heresbach, D. Systematic review: oral bowel preparation for colonoscopy. Aliment. Pharm. Ther. 25, 373–384 (2007).

    CAS  Article  Google Scholar 

  3. 3.

    Barkun, A. et al. Commonly used preparations for colonoscopy: efficacy, tolerability, and safety—a Canadian Association of Gastroenterology position paper. Can. J. Gastroenterol. 20, 699–710 (2006).

    Article  Google Scholar 

  4. 4.

    Pall, H. et al. Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee. J. Pediatr. Gastroenterol. Nutr. 59, 409–416 (2014).

    Article  Google Scholar 

  5. 5.

    Gordon, M., Karlsen, F., Isaji, S. & Teck, G. O. Bowel preparation for elective procedures in children: a systematic review and meta-analysis. BMJ Paediatr. Open 1, e000118 (2017).

    Article  Google Scholar 

  6. 6.

    Yoshioka, S. et al. Study to determine guidelines for pediatric colonoscopy. World J. Gastroenterol. 23, 5773–5779 (2017).

    Article  Google Scholar 

  7. 7.

    Di Nardo, G. et al. Bowel preparations for colonoscopy: an RCT. Pediatrics 134, 249–256 (2014).

    Article  Google Scholar 

  8. 8.

    Berger, T. et al. Bowel preparation in pediatric colonoscopy: results of an open observational study. Endosc. Int. Open 4, E820–E827 (2016).

    Article  Google Scholar 

  9. 9.

    Turner, D. et al. Evidence-based recommendations for bowel cleansing before colonoscopy in children: a report from a national working group. Endoscopy 42, 1063–1070 (2010).

    CAS  Article  Google Scholar 

  10. 10.

    Kierkus, J. et al. High- versus low-volume polyethylene glycol plus laxative versus sennosides for colonoscopy preparation in children. J. Pediatr. Gastroenterol. Nutr. 57, 230–235 (2013).

    CAS  Article  Google Scholar 

  11. 11.

    Lai, E. J., Calderwood, A. H., Doros, G., Fix, O. K. & Jacobson, B. C. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest. Endosc. 69, 620–625 (2009).

    Article  Google Scholar 

  12. 12.

    Garber, A. et al. Modifiable factors associated with quality of bowel preparation among hospitalized patients undergoing colonoscopy. J. Hosp. Med. 14, 278–283 (2019).

    PubMed  Google Scholar 

  13. 13.

    Lorenzo, F. et al. Factors that affect adequacy of colon cleansing for colonoscopy in hospitalized patients. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. Clin. Gastroenteral. Hepatol. S1542-3565(20)30342-30346 (2020).

  14. 14.

    Adamiak, T. et al. One-day bowel preparation with polyethylene glycol 3350: an effective regimen for colonoscopy in children. Gastrointest. Endosc. 71, 573–577 (2010).

    Article  Google Scholar 

  15. 15.

    Jibaly, R., LaChance, J., Lecea, N. A., Ali, N. & Weber, J. E. The utility of PEG3350 without electrolytes for 2-day colonoscopy preparation in children. Eur. J. Pediatr. Surg. 21, 318–321 (2011).

    CAS  Article  Google Scholar 

  16. 16.

    Abbas, M. I., Nylund, C. M., Bruch, C. J., Nazareno, L. G. & Rogers, P. L. Prospective evaluation of 1-day polyethylene glycol-3350 bowel preparation regimen in children. J. Pediatr. Gastroenterol. Nutr. 56, 220–224 (2013).

    Article  Google Scholar 

  17. 17.

    Turner, D. et al. Pico-Salax versus polyethylene glycol for bowel cleanout before colonoscopy in children: a randomized controlled trial. Endoscopy 41, 1038–1045 (2009).

    CAS  Article  Google Scholar 

  18. 18.

    Hunter, A. & Mamula, P. Bowel preparation for pediatric colonoscopy procedures. J. Pediatr. Gastroenterol. Nutr. 51, 254–261 (2010).

    PubMed  Google Scholar 

  19. 19.

    Hassan, C. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—update 2019. Endoscopy 51, 775–794 (2019).

    Article  Google Scholar 

  20. 20.

    Seo, E. H. et al. Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study. Gastrointest. Endosc. 75, 583–590 (2012).

    Article  Google Scholar 

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Acknowledgements

We thank Professor Ying kit Leung for guidance about research direction.

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Contributions

S.F. designed the study, collected and interpreted data, drafted the initial manuscript, and reviewed and revised the manuscript. Y.S. enrolled and followed up patients. Y.L. performed the endoscopy. L.W. is the head of the Pediatric Gastroenterology Unit, performed endoscopy, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Libo Wang.

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The authors declare no competing interests.

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Fang, S., Song, Y., Liu, Y. et al. Randomized clinical trial: efficacy and tolerability of two different split dose of low-volume polyethylene glycol electrolytes for bowel preparation before colonoscopy in hospitalized children. Pediatr Res (2020). https://doi.org/10.1038/s41390-020-01216-5

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