Abstract
For colonoscopy, bowel preparation, especially that using polyethylene glycol (PEG) or senna, is performed among children with gastrointestinal disorders; however, it is not fully grounded in evidence. This study reviewed via meta-analyses the approaches to bowel preparation for colonoscopy in children.Electronic databases and trial registries were searched until April 2021. Quality assessment was conducted using the Grading of Recommendations, Assessment, Development, and Evaluation method.In total, three randomized controlled trials (318 patients) were identified. PEG was observed as a preferred protocol of bowel preparation compared with senna (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.05-1.74; I2 = 15%). It was less painful than senna (RR 0.62, 95% CI 0.44-0.87; I2 = 0%). No serious adverse events were noted. Overall, the certainty of the evidence was low to moderate.PEG might be a preferred preparation agent for colonoscopy in children. Given the limited data, more studies are recommended.
Highlights
BackgroundGastrointestinal disorders are commonly seen in children, and colonoscopy is considered the gold standard for diagnosis and treatment of patients with gastrointestinal disorders [1]
The earlier systematic review [12] reported a similar efficacy for preparing the bowel for colonoscopy between polyethylene glycol and senna (RR 0.73, 95% confidence intervals (CIs) 0.31-1.76; I2 = 95%) according to pooled data
We reviewed using a meta-analysis to assess the efficacy of polyethylene glycol and senna in bowel preparation before colonoscopy in children
Summary
Gastrointestinal disorders are commonly seen in children, and colonoscopy is considered the gold standard for diagnosis and treatment of patients with gastrointestinal disorders [1]. Colonoscopy is performed in children with inflammatory bowel disease, bleeding colitis, colon polyps, and malignancies [25]. Bowel preparation is reported to be inadequate in one-third of colonoscopies and in approximately 5% of cases, and inadequate preparation led to cancellation or interruption of the examination [8]. The cost of cancelled or interrupted examinations has increased from 12% to 22% [9,10]. Even if bowel preparation is performed with consideration of the patient’s age, body size, and medical condition [1,11], a standard protocol for bowel preparation for children with gastrointestinal disorders is required
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