How To Prepare Children for Colonoscopy: A Comparative Study

Abstract

How To Prepare Children for Colonoscopy: A Comparative Study Sudipta Misra, Maureen Knox There is no standard protocol for preparing children for colonoscopy. In this prospective study, we evaluated the acceptability and effectiveness of different laxatives used for this purpose. Methods: Children were treated with age sensitive medication specific standard protocols. Parents were requested to grade the taste, ease of preparation and overall experience in a scale of 1 to 3 (1 poor, 3 good). The cleanliness of the colon was graded during endoscopy in a scale of 1 to 5. Descriptive and t statistics were used to analyze the data. Results: 70 children were enrolled in this study. In children below 3 years of age (nZ5), milk of magnesia (MM) (nZ4) produced acceptably clean colon and grades for ease, taste and overall (4.08, 2.8, 2.4 and 2.4 respectively) with vomiting in 1. The other did well on lactulose. Children between 3 and 5 years (nZ13) were given magnesium citrate (MC) (nZ3), MM (nZ5), lactulose (nZ1) and combinations of laxatives (CL) (nZ3). The colon was less clean (3.35) and other scores were lower than the toddlers probably because of poor tolerance of MM (Group/MM: 2.25/1.8, 1.58/1 and 2.08/1.6 for ease, taste and overall respectively). Fifty-two children between 5 and 18 years of age were prepared with MC (nZ9), Polyethylene Glycol 3350 (PEG) (nZ17), Fleet phospho soda (PS) (nZ15), reconstituted PEG electrolyte solution (Nulytely ) (nZ8) and CL (nZ2). Nausea and vomiting were reported in 2 on MC (22.2%), 2 on PEG (11.76%), 7 on PS (43.75%) and 6 on Nulytely (75 %). PEG scored highest in acceptability and tolerance (Table) (p ! .05 to !.01). However, its effectiveness was lowest; comparable to MC (p O .05). PS and Nulytely were comparable and significantly more effective than PEG or MC (p ! .01). Conclusion: MM is effective for preparing children below 3 years for colonoscopy. In children between 5 and 18 years, PEG had the highest acceptability. However, PS provided better results than PEG. Nulytely was effective but had low acceptability and high incidence of adverse reactions. W1313 Synergistic Sedation with Oral Midazolame as a Premedication and Intravenous Propofol Versus Intravenous Propofol Alone, in Upper Gastrointestinal Endoscopies in Children: A Prospective, Randomized Study Gregorios Paspatis, Ioanna Charoniti, Maria Manolaraki, Emmanouil Vardas, Nikolaos Papanikolaou, Almoud Anastasiadou, Aliki Gritzali Background and Study Aims: The need for gastrointestinal procedures, such as upper gastrointestinal endoscopies (UGIE), in children has been increased in the recent years. Our study sought to compare the safety, the efficacy, the ease of intravenous (IV) line placement and the ease of the parents’ separation of the synergistic sedation with an oral dose of midazolam as premedication combined with IV propofol versus IV propofol alone in diagnostic UGIE in children. To the best of our knowledge, this is the only prospective, randomized study in this issue. Material and Methods: 54 consecutive children (age over 3 yr) who underwent UGIE were randomly assigned to one of the two medication regimens. Patients in group A (nZ26, mean age: 8.1 yr) received orally midazolam (0.5 mg/kgr). 30 minutes after the midazolam dose given, repeated IV doses of propofol 0.5 mg/kgr were administered titrated to achieve the level of deep sedation. Patients in group B (nZ28, mean age: 9 yr) received IV propofol alone with the same methodology and sedation end point. The ease of IV line placement and the ease of the parents’ separation were assessed by a three and five point scale, respectively. The patient’s comfort level was assessed by a three point scale. The time to recover from the sedation was assessed by using the REACT score. Results: The mean dose (1.8G0.7 mg/kg) of propofol administered in group A patients was remarkably lower compared to that (2.9G0.9 mg/kg) of group B. Multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the sort of sedation, the synergistic sedation was the only factor associated with the ease of IV line placement (chi-squareZ16.3, p!0.001) and the ease of parents’ separation (chi-squareZ41.6, p!0.001). Additional multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the sort of sedation, the synergistic sedation was the only factor associated with a higher level of patient comfort (chi-squareZ35.5, p!0.001). The recovery time was significantly shorter in group B patients (7.7G3.6 min) compared to that of group A (25.9G4.1 min) (p!0.01). The two regimens were equally safe. Conclusions: Our data suggest that the synergistic sedation with oral midazolame as a premedication and IV propofol was superior to sedation with IV propofol alone as far as the IV line placement, the parents’ separation and patient comfort in UGIE in children.