Background: There are no current recommendations for bowel cleansing before colonoscopy in children.
The Israeli Society of Pediatric Gastroenterology and Nutrition (ISPGAN) established
an iterative working group to formulate evidence-based guidelines for bowel cleansing
in children prior to colonoscopy.
Method: Data were collected by systematic review of the literature and via a national-based
survey of all endoscopy units in Israel. Based on the strength of evidence, the Committee
reached consensus on six recommended protocols in children. Guidelines were finalized
after an open audit of ISPGAN members.
Results: Data on 900 colonoscopies per year were accrued, which represents all annual pediatric
colonoscopies performed in Israel. Based on the literature review, the national survey,
and the open audit, several age-stratified pediatric cleansing protocols were proposed:
two PEG-ELS protocols (polyethylene-glycol with electrolyte solution); Picolax-based
protocol (sodium picosulphate with magnesium citrate); sodium phosphate protocol (only
in children over the age of 12 years who are at low risk for renal damage); stimulant
laxative-based protocol (e. g. bisacodyl); and a PEG 3350-based protocol. A population-based
analysis estimated that the acute toxicity rate of oral sodium phosphate is at most
3/7320 colonoscopies (0.041 %). Recommendations on diet and enema use are provided
in relation to each proposed protocol.
Conclusion: There is no ideal bowel cleansing regimen and, thus, various protocols are in use.
We propose several evidence-based protocols to optimize bowel cleansing in children
prior to colonoscopy and minimize adverse events.
References
turnerd@szmc.org.il
