Polyethylene glycol 3350 without electrolytes: A new safe, effective, and palatable bowel preparation for colonoscopy in children

doi:10.1016/j.jpeds.2003.11.033

The Journal of Pediatrics

Volume 144, Issue 3, March 2004, Pages 358-362

https://doi.org/10.1016/j.jpeds.2003.11.033 Get rights and content

Abstract

Objective

To assess safety, efficacy, and acceptance of polyethylene glycol 3350 without electrolytes (PEG) for bowel preparation for colonoscopy in children.

Study design

In a prospective study, 46 children (mean age, 11.2 years; range, 2.8-17.8) were given PEG at a dose of 1.5 g/kg/day for 4 days before colonoscopy. Patients were allowed to mix PEG in the beverage of their choice. Stool frequency and adverse effects were monitored during PEG therapy. Compliance, tolerance, and quality of colonic preparation were assessed. Serum electrolytes were measured before and after PEG therapy in 29 children.

Results

Daily stool frequency increased with PEG therapy from baseline of 2.6±0.3 to 3.0±0.5 on day 1, 4.6±0.4 on day 2, 5.5±0.7 on day 3, and 6.0±0.6 on day 4 (days 2, 3, and 4, P<.001 for difference vs baseline). The colonic preparations were rated as excellent or good in 91% and 95% in the right and left colon, respectively, at endoscopy. Adverse effects were mild nausea (13%), abdominal pain (11 %), and vomiting (11%). Electrolyte profile revealed small, clinically insignificant changes with PEG therapy. Compliance and tolerance were rated as excellent by 89% and 85% of patients, respectively.

Conclusions

Electrolyte-free PEG 3350 can be used as an effective and safe bowel preparation that is well accepted by children for colonoscopy.

Section snippets

Patients

Children (age 2-19 years) undergoing colonoscopy were eligible for the study. Patients were excluded if they had known allergy to PEG, had metabolic or renal disease, or required emergency colonoscopy. Patients (n = 46) were enrolled in the study over a period of 8 months from August 2002 to April 2003. The main indications for colonoscopy included diarrhea (33%), abdominal pain (30%), and blood in stools (26%). Colonoscopies were performed by one of the authors under conscious sedation with

Results

Forty-six children (24 male) completed the study; the mean age was 11.2 years (range, 2.8-17.8), and the mean weight was 44 kg (range, 12.1-87.8). The average dose of PEG solution per day was 870 mL (range, 240-1440). Children used two different beverages on average (range, one to six) to prepare the PEG solution. The beverages used were fruit juices (30), water (12), sports drinks (11), Kool-Aid (Kraft Foods; 11), carbonated soft drinks (10), lemonade (9), Crystal Light (Kraft Foods; 8), and

Discussion

This study shows that electrolyte-free PEG can be used as an effective, safe, and palatable bowel preparation in children. Similar to results in previous reports,7., 8., 9., 10. PEG administration led to an increase in stool frequency and a liquid stool consistency in all children. This laxative effect was significant on the second day of therapy, and by the fourth day, all patients had frequent watery stools. Colon preparations were rated as excellent or good in 91% of patients in the right

Acknowledgements

We thank Kathy Bell and Jacque Comstock for their assistance in the study.

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Describir la efectividad, adherencia y efectos adversos de protocolos de LI diferenciados por edad en pacientes pediátricos sometidos a colonoscopia.
Estudio descriptivo que incluyó pacientes < 18 años sometidos a colonoscopia. Se aplicaron esquemas de LI diferenciados por edad: < 6 meses (supositorio de glicerina); 6 meses-3 años, 11 meses (polietilenglicol [PEG] 3.350 sin electrolitos); 4 años-9 años, 11 meses (PEG 3.350 sin electrolitos + bisacodilo); 10 años-18 años (PEG 3.350 con electrolitos). Se registraron datos demográficos, clínicos, adherencia y efectos adversos. La efectividad fue determinada durante colonoscopia de acuerdo con la escala previamente validada (Boston modificada).
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Adequate intestinal cleanliness is crucial to achieve optimal colonoscopy performance. Several bowel preparation (BP) schemes have been proposed, but there is still no consensus as regards which is the most suitable in paediatric patients.
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Prospective, study that included patients < 18 years subjected to colonoscopy. BP protocols differentiated by age group were indicated as follows: < 6 m (glycerine suppository); 6 m-3y 11 m (poly-ethylene-glycol (PEG 3350 without electrolytes); 4y-9y 11 m (PEG 3350 without electrolytes + bisacodyl); 10 y-18 y (PEG 3350 with electrolytes). Demographic, clinical information, adherence and adverse effects were registered. Effectiveness was determined using a validated scale (Boston modified) during colonoscopy.
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El objetivo del estudio fue comparar la efectividad y seguridad del polietilenglicol con y sin electrolitos (EL) en el estreñimiento funcional pediátrico a lo largo de 12 semanas.
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Las formulaciones PEG con o sin EL tienen una efectividad, seguridad y aceptabilidad similar. PEG sin EL presentó un mayor número de alteraciones electrolíticas, pero ninguna fue sintomática.
To compare the effectiveness and safety of polyethylene glycol with and without electrolytes (EL) over a 12 week period in treatment of chronic constipation in paediatrics.
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Evaluar la seguridad renal del tratamiento con polietilenglicol 3350 con electrolitos durante 1, 3 y 6 meses, la tolerancia digestiva y la dosis de eficacia.
Fueron evaluados 3 grupos de 30 pacientes sanos, 2-10 años (media 6,2) con estreñimiento funcional (criterios de Roma III), con 1, 3 y 6 meses de tratamiento. La eficacia fue evaluada por el número de deposiciones/semana y la consistencia de las heces (escala de Bristol). La natriuria y la osmolaridad urinaria se midieron al inicio, 1, 3 y 6 meses. Los principios inmediatos en heces (análisis de reflexión de infrarrojos [FENIR]) y un test de hidrógeno espirado fueron efectuados en el grupo de un mes de tratamiento.
La dosis efectiva fue de 0,37 g/kg/día (rango 0,18-0,8). El número de deposiciones/semana en la inclusión (2,4 ± 0,64) muestra diferencia significativa (p < 0,001) vs. (6,21 ± 1,5) tras el tratamiento. También se demostró una diferencia significativa en la puntuación en la escala de Bristol (1,9 ± 0,75 vs. 4,9 ± 1,1 [p < 0,001]). La ingesta media de sodio fue de 112 mg (5 mg/kg/día [rango de 4-12 mg/kg/día]). Los valores de sodio y osmolaridad en orina fueron normales en todos los grupos sin diferencia estadística con respecto a controles (90 niños sanos sin tratamiento). Los valores de FENIR fueron normales en todos los pacientes. La prueba de aliento con hidrógeno fue normal, con una media de 7 ppm.
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To assess the renal safety of treatment with polyethylene glycol 3350 with electrolytes at 1, 3 and 6 months, its gastrointestinal tolerance and dose effectiveness.
Three groups of 30 healthy patient aged 2-10 years (mean 6.2 years) who suffered functional constipation (Rome III criteria) with 1, 3 and 6 months of treatment were evaluated. Efficacy was evaluated by the change in the number of stools per week and stool consistency (Bristol scale). Urine screens, sodium and osmolality, were performed at the beginning and after 1, 3 and 6 months of treatment. Stool sample NIRA (near-infrared reflectance analysis) and hydrogen breath test analysis samples were performed on the one-month treatment group.
The mean dose was 0.37 g/kg/day (range 0.18 to 0.8) titrated according to age, weight and response. The number of stools per week during treatment (2.4 ± 0.64) showed a significant difference (P<.001) vs (6.21 ± 1.5) after treatment. There was also a significant difference in the Bristol scale score (1.9 ± 0.75 vs 4.9 ± 1.1 [P<.001]). The mean sodium intake was 112 mg (5 mg/kg/day [range 4-12 mg/kg/day]). The values of sodium and urine osmolality were normal in all groups with no statistical difference compared to normal control values (90 healthy children without treatment). NIRA values were normal in all patients. The hydrogen breath test was normal with a median of 7 ppm.
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^☆: Supported in part by Braintree Laboratories, Braintree, Massachusetts.

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Polyethylene glycol 3350 without electrolytes: A new safe, effective, and palatable bowel preparation for colonoscopy in children☆

Abstract

Objective

Study design

Results

Conclusions

Section snippets

Patients

Results

Discussion

Acknowledgements

J Pediatr

Am J Gastroenterol

J Pediatr

Gastrointest Endosc

J Pediatr

Gastroenterology

Gastrointest Endosc

Colon cleanout preparations in children and adolescents

Gastroenterol Nurs