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Abstract
BackgroundThe adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.MethodsThe standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively abstracted relevant indices including patient demographics, prep quality, procedure impairment, duration and completion from an institutional quality monitoring survey tool between 2015 and 2016 and similarly abstracted prospectively recorded indices that included the dataset above as well as additional fields for procedure deviations and additional laxative use.ResultsA total of 642 procedures (mean age 12.2 years; F: 380) were accrued, nonadherence to the cleanout regimen (7.3%) and additional laxative use (3.1%) were observed in a small proportion of the prospective dataset subjects, adequate cleanout defined as thin or thick liquid but no solids present was reported in 79.5% and 15.8% of cases and impaired study from inadequate cleanout was reported in 11.8% of studies albeit the cecum was reached and the terminal ileum was intubated in 97.8 and 93.6% of studies. The duration of the study was significantly longer with the presence of a fellow trainee assisting in the procedure. Patient age and gender did not correlate with prep adequacy or cecal and ileal intubation rates, inadequate cleanout was significantly associated with impairment and incomplete studies.ConclusionA one day, single agent, osmotic laxative (Polyethylene glycol) based cleanout regimen is effective in routine pre-procedure cleanout for standard colonoscopy in pediatric age range patients.
Highlights
The adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients
The adequacy of colon cleansing before colonoscopy is a principal determinant of the quality of colonoscopy in the pediatric as in the adult population
A 2014 review by NASPHGHAN found that while Polyethylene glycol (PEG) was the regimen of choice for monotherapy, dual therapy with PEG and stimulant laxative was used by between 36% and 61% of physicians [5]
Summary
The adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. Of the several determinants of bowel prep including regimen, timing, diet, co-morbidities, and patient characteristics, preparation regimen is by far the most important predictor of successful procedure outcomes [1]. In the treatment of pediatric constipation, stimulant laxatives are recommended as a second-line therapy if a PEG-only regimen fails [7]. Despite these important caveats, stimulant laxatives remain a popular choice for dual-therapy bowel prep in pediatric colonoscopy
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