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Endoscopy 2010; 42(12): 1063-1070
DOI: 10.1055/s-0030-1255646
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Evidence-based recommendations for bowel cleansing before colonoscopy in children: a report from a national working group

D.  Turner1 , A.  Levine2 , B.  Weiss4 , A.  Hirsh3 , R.  Shamir3 , R.  Shaoul5, on behalf of The Israeli Society of Pediatric Gastroenterology and Nutrition (ISPGAN)
  • 1Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel
  • 2Pediatric Gastroenterology Unit, Wolfson Hospital, Tel Aviv University, Israel
  • 3Institute of Pediatric Gastroenterology, Nutrition and Liver Disease, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
  • 4Pediatric Gastroenterology Unit, Safra Hospital, Tel Aviv University, Israel
  • 5Pediatric Gastroenterology Unit, Rambam Medical Center, Technion, Haifa, Israel
Further Information

Publication History

submitted 1 September 2009

accepted after revision 16 June 2010

Publication Date:
28 July 2010 (online)

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Commentaire de travail de D. Turner et al., pp. 1063Endoscopy 2010; 42(12): 1121-1121
DOI: 10.1055/s-0032-1306714

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.

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D. Turner MD, PhD 

Pediatric Gastroenterology and Nutrition Unit
Shaare Zedek Medical Center
The Hebrew University of Jerusalem

PO Box 3235
Jerusalem 91031
Israel

Fax: +972-2-6555756

Email: turnerd@szmc.org.il