The Utility of PEG3350 without Electrolytes for 2-Day Colonoscopy Preparation in Children
received 11 February 2011
accepted after revision 14 May 2011
12 August 2011 (online)
Successful colonoscopy preparation requires a method which is easy to administer. Simplifying this technique would be useful for adult and pediatric gastroenterologists. Most cleanout agents are not well tolerated by children. Polyethylene glycol without electrolytes (PEG3350 without electrolytes) has been used for constipation and bowel cleanout, but has not been studied as 2-day preparation for colonoscopy in children. This study evaluates the dosing, effectiveness and satisfaction with PEG3350 without electrolytes as a 2-day cleanout for colonoscopy preparation in children.
Parents of patients aged 5 years or older undergoing colonoscopies were approached for participation. All caretakers received standard instructions with a suggested food handout and a diary to track the doses of PEG3350 administered and to document other adjunct measures (suppository, enema). On the procedure day, parents and children completed appropriate satisfaction questionnaires. Post procedure, the physician rated the visualization of the mucosa. A pediatric gastroenterologist investigator and a second blinded pediatric gastroenterologist assessed the effectiveness using standard procedure photos.
30 patients aged 5–16 years were recruited (15 males, 15 females). The majority of parents and children reported being “very satisfied” or “satisfied” with the preparation. The preparation was rated by the principal investigator and independent pediatric gastroenterologist as effective in all cases. The mean number of doses was 4.7 on Day 1 and 4.9 on Day 2. The average dose given was 1.90 g/kg/day.
PEG3350 without electrolytes appears to be safe, effective, and well tolerated as a 2-day clean out for colonoscopy preparation in children with an average dose of 1.90 g/kg/day.
- 1 Hendry PO, Jenkins JT, Diament RH. The impact of poor bowel preparation on colonoscopy: a prospective single centre study of 10571 colonoscopies. Colorectal Dis 2007; 9 (08) 745-748
- 2 Burke CA, Church JM. Enhancing the quality of colonoscopy: the importance of bowel purgatives. Gastrointest Endosc 2007; 66: 565-573
- 3 Wexner SD, Beck DE, Baron TH et al. A consensus document on bowel preparation before colonoscopy: prepared by a Task Force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 2006; 20: 1161
- 4 DiPalma JA, Brady CE. Colon cleansing for diagnostic and surgical procedures: polyethylene glycol-electrolyte lavage solution. Am J Gastroenterol 1989; 84: 1008-1016
- 5 Davis GR, Santa Ana CA, Morawski SG et al. Development of a lavage solution associated with minimal water and electrolyte absorption or secretion. Gastroenterology 1980; 78: 991-995
- 6 Brady CE, DiPalma JA, Morawski SG et al. Urinary excretion of polyethylene glycol 3350 and sulfate after gut lavage with a polyethylene glycol electrolyte lavage solution. Gastroenterology 1986; 90: 1914-1918
- 7 DiPalma JA, DeRidder PH, Orlando RC et al. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000; 95: 446-450
- 8 Tolia V, Fleming S, Dubois RS. Use of Golytely in children and adolescents. Pediatr Gastroenterol Nutr 1984; 3: 468-470
- 9 Sondheimer JM, Sokol RJ, Taylor SF et al. Safety, efficacy, and tolerance of intestinal lavage in pediatric patients undergoing diagnostic colonoscopy. J Pediatr 1991; 119: 148-152
- 10 Tuggle DW, Hoelzer DJ, Tunell WP et al. The safety and cost-effectiveness of polyethylene glycol electrolyte solution bowel preparation in infants and children. J Pediatr Surg 1987; 22: 513-515
- 11 da Silva MM, Briars GL, Patrick MK et al. Colonoscopy preparation in children: safety, efficacy, and tolerance of high-versus low-volume cleansing methods. J Pediatr Gastroenterol Nutr 1997; 24: 33-37
- 12 Gremse DA, Sacks AI, Raines S. Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr 1996; 23: 586-590
- 13 Dahshan A, Lin CH, Peters J et al. A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol 1999; 94: 13497-13501
- 14 Narsinghani U, Chadha M, Farrar HC et al. Life-threatening respiratory failure following accidental infusion of polyethylene glycol electrolyte solution into the lung. J Toxicol Clin Toxicol 2001; 39: 105-107
- 15 Bell EA, Wall GC. Pediatric constipation therapy using guidelines and polyethylene glycol 3350. Ann Pharmacother 2004; 38 (04) 686-693
- 16 Arora M, Okolo PI. Use of powder PEG-3350 as a sole bowel preparation: clinical case series of 245 Patients. Gastroenterology & Hepatology 2008; 4: 489-492
- 17 Pashankar DS, Uc A, Bishop WP. Polyethylene glycol 3350 without electrolytes: a new safe, effective, and palatable bowel preparation for colonoscopy in children. J Pediatr 2004; 144: 358-362
- 18 Safder S, Demintieva Y, Rewalt M et al. Stool consistency and stool frequency are excellent clinical markers for adequate colon preparation after polyethylene glycol 3350 cleansing protocol: a prospective clinical study in children. Gastrointest Endosc 2008; 68 (0:) 1131-1135
- 19 Adamiak T, Altaf M, Jensen MK et al. One-day bowel preparation with polyethylene glycol 3350: an effective regimen for colonoscopy in children. Gastrointest Endosc 2010; 71: 573-577
- 20 Engum SA, Carter ME, Murphy D et al. Home bowel preparation for elective colonic procedures in children: cost savings with quality assurance and improvement. J Pediatr Surg 2000; 35: 232-234
- 21 El Sayed AM, Kanafani ZA, Mourad FH et al. A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation. Gastrointest Endosc 2003; 58: 36-40
- 22 Abuksis G, Mor M, Segal N et al. A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department. Am J Gastroenterol 2001; 96: 1786-1790