Abstract
Purpose: An inadequately cleansed colon might lead to missed lesions, repeat procedures, increased health care costs, and complications during colonoscopy. The effect of obesity on efficacy of bowel preparations in children has not been examined. The purpose of this study was to determine if BMI effects bowel preparation in pediatric patients undergoing colonoscopy. Methods: Retrospective chart review of 627 patients aged 7-21 years undergoing colonoscopy at Herman and Walter Samuelson Children's Hospital from July 2009-July 2012 was conducted. Data collected included: age, gender, race, BMI percentile, bowel preparation quality and type. BMI was categorized according to the CDC pediatric growth charts BMI for age/gender percentiles as: underweight (<5%), normal (5-84%), overweight (85-94%), and obese (>95%). Endoscopy reports utilizing the Olympus endoscopy software were analyzed for pediatric gastroenterologist assessment of bowel preparation as poor, fair, good, and excellent. Bowel preps were considered inadequate if they were poor or fair. Patients with missing information on the weight, height, or undetermined bowel preparation quality due to incomplete documentation were excluded. Results: A total of 566 patients were included in the study (52% female; with a mean age of 14.3 ± 3.5 years). The quality of 67 (12%) bowel preparations was recorded as inadequate. BMI classification had no effect on bowel preparation quality with 7 of 45 (16%) underweight patients, 35 of 354 (10%) of normal weight, 12 of 67 (18%) overweight, and 13 of 100 (13%) obese patients having inadequate bowel preparations (p = 0.22). Prescribed bowel preparation data was only available in 377 patients. A variety of bowel preparations including magnesium citrate, PEG3350 without electrolytes, and a combination of the two were utilized. When BMI classification was examined in the presence of the confounding variables of gender, age, and race, obesity failed to associate with inadequate preparation (p=0.37, odds ratio 1.4, 95% CI 0.7-2.8). However, race recorded as other than Caucasian or African American significantly predicted the occurrence of poor bowel preparation (p=0.01, odds ratio 2.7, 95% CI 1.3-5.7). Conclusion: An increased BMI is not associated with poor quality of bowel preparation in pediatric patients undergoing colonoscopy. Additionally, race defined as other significantly predicted the occurrence of poor bowel preparation. Due to the retrospective nature of the study it is unclear if linguistic barriers may have contributed. Prospective trials looking at smaller volume osmotic or stimulant laxatives versus larger volume lavage based on BMI percentile should be performed.Table
Published Version
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