Colonoscopy in children: risk factors for poor preparation and evaluation of colon cleansing methods

Aim of the study: identify potential risk factors for unsatisfactory colonoscopy preparation: history of constipation, gender, age, body mass index, diet, completeness of dosage after intestinal cleansing with sodium picosulfate with magnesium citrate (SPMC), cleansing enemas (CE) or a combination of both (CM). A secondary aim is to evaluate the effectiveness, safety and tolerability of the above methods. Methods: Children (0-18 years old) were randomly assigned 3 types of preparation and a low-fiber diet. Endoscopists evaluated the effectiveness of cleaning according to the Boston Bowel Preparation Scale (BBPS), the depth of insertion of the device was recorded. Tolerability of the methods, frequency of adverse events and diet compliance were assessed using a questionnaire for patients. Results: 440 children (average age of 12 years) were prepared by SPMC (n=135), CE (n=79) or CM (n=226). A satisfactory result of preparation (BBPS ≥2 in each segment) was achieved in 127 (94.1%) patients in the group with SPMC; 71 (90%) with CE and 201 (89%) with CM. Age, gender, body mass index and constipation did not affect the preparation success in all groups (p>0.05). With constipation, intubation of the cecum and/or ileum was 6.8 times less likely (OR=0.146; 95% CI:0.036-0.602, p=0.014). When following a diet, unsatisfactory preparation was 7.4 times less likely (OR=0.135; 95% CI: 0.053-0.345, p<0.001). With full dosage the probability of unsatisfactory preparation was 7,393 times lower (OR=0.135; 95% CI:0.053-0.345, p<0.001). The incidence of minor adverse events was higher with CM (SPMC-29%, CE-27%, CM-39%, p=0.03). In the CE group, 14% of children/parents rated the tolerability of training as «poor/extremely difficult», with 8% in the groups with PSCM and CM (p=0.001). Conclusion: The results of our study show that in children without constipation, adherence to a diet and dosages of medications make it easier to tolerate preparation, clean the bowel qualitatively and perform a full colonoscopy. Regardless of the methods of colon preparation, we consider these criteria to be the most important for bowel cleansing and the quality of colonoscopy performed in pediatrics.

colonoscopy, children, preparation

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