Bowel Preparation in Children

Abstract

of dose and duration of PEG preparations that will be useful for C olonoscopy is an important diagnostic and therapeutic procedure to evaluate the colon and terminal ileum in children. Anadequatebowelpreparationisnecessaryforcompletevisualization ofboththecolonandterminal ileum.Inadequatebowelpreparationcan lead topoorcolonicvisualization,missed lesions, increasedprocedure time, and possibly a repeat procedure. From the patient’s perspective, taking a complete bowel preparation is often the most difficult part of the procedure. Over the years, there have been many bowel preparations used in children (1). Medications that have been used include polyethylene glycol electrolyte lavage solution, magnesium citrate, sodiumphosphate, senna,bisacodyl, phosphateenemas,and, recently, polyethylene glycol without electrolytes (PEG). The protocols also vary regarding the length of preparation, length of duration of clear liquid diet, and doses of medications. There have been extremely few head-to-head comparison studies of different bowel preparations in children. In this issue of theJournalofPediatricGastroenterologyandNutrition,Terryetal (2) evaluated the efficacy of PEG versus senna for bowel preparation in children.The study was a well-designedblinded,prospective randomized trial. The authors aimed to recruit 166 children. Patients were randomlyassignedtoreceivePEG1.5g kg 1 day orsenna(15–30 mL/day) for 2 days before the colonoscopy. The interim analysis of 30 patients showed clear superiority of PEG preparation compared with senna, and the study was terminated. Good/excellent scores of colon cleanliness were seen in 88% of patients in the PEG group compared with 29% in the senna group. Both regimens were generally well tolerated without any significant clinical adverse effects or electrolyte changes. Despite the small sample size, the results of the PEG preparations were impressive compared with senna. PEG has revolutionized the treatment of constipation in children. It has been shown to be an effective and safe therapy long term (3). It is palatable, as it can be mixed in any beverage, and therefore the compliance with PEG therapy is excellent. Because of these properties, PEG is a good ‘‘candidate’’ for a bowel preparation regimen. In the first reported prospective study, our group gave PEG at a dose 1.5 g kg 1 day 1 for 4 days and documented