A Pilot Study of Randomized Controlled Trial of Bowel Preparation for Pediatric Colonoscopy

Background: Adequate bowel preparation is crucial for colonoscopy though no standardized regimen exists for children. Polyethylene glycol with electrolyte solution (PEG-ELS) is a widely used osmotic agent due to its good efficacy and high safety profile. However, some children may not tolerate large volume and poor palatability. Previous meta-analyses in adults comparing between a full single dose vs. split doses of PEG-ELS showed that the split dose group had a higher rate of successful bowel preparation. Similar study in children is limited.

Objectives: We compared the efficacy (i.e., successful bowel preparation) of using PEG-ELS as a full single dose vs. split doses for bowel preparation before pediatric colonoscopy. The secondary outcomes were tolerability, acceptability, and compliance between two regimens.

Methods: Investigator-blinded randomized controlled trial was conducted to enroll children aged 2-18 years who underwent an elective colonoscopy at a teaching hospital between March 2018 and February 2019. Patients were randomly assigned to receive PEG-ELS as a full single dose or two split doses. The Boston Bowel Preparation Scale was used for the efficacy (i.e., successful if score ≥ 6). Tolerability, acceptability, and compliance were evaluated by using a standardized questionnaire.

Results: A total of 43 colonoscopies (21 in the full single dose and 22 in the split dose group) were performed. Median age was 9.1 years old (IQR: 5.2-13.6). We found a higher rate of successful bowel preparation in the split dose group (95% vs. 71%, P= 0.046). Significant lower rate of nausea/vomiting (36% vs. 71%, P= 0.02) and higher rate of willingness to repeat the protocol (82% vs. 33%, P= 0.001) in the split dose group were also noted.

Conclusion: The split dose regimen of PEG-ELS for bowel preparation before pediatric colonoscopy provides a superior efficacy, potential tolerability and acceptability as compared to the traditional full single dose regimen.