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


METHODS
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.


CONCLUSIONS
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.
Turner
D
D
Pediatric Gastroenterology and Nutrition Unit, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel. turnerd@szmc.org.il
Levine
A
A
Weiss
B
B
Hirsh
A
A
Shamir
R
R
Shaoul
R
R
Berkowitz
D
D
Bujanover
Y
Y
Cohen
S
S
Eshach-Adiv
O
O
Jamal
Gera
G
Kori
M
M
Lerner
A
A
On
A
A
Rachman
L
L
Rosenbach
Y
Y
Shamaly
H
H
Shteyer
E
E
Silbermintz
A
A
Yerushalmi
B
B
D001726:Bisacodyl; D002400:Cathartics; D002648:Child; D002675:Child, Preschool; D002951:Citrates; D003113:Colonoscopy / Q000379:methods*; D004032:Diet; D004573:Electrolytes; D004733:Enema; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D009942:Organometallic Compounds; D010710:Phosphates; D010847:Picolines; D011092:Polyethylene Glycols
D002400:Cathartics; D002951:Citrates; D004573:Electrolytes; D009942:Organometallic Compounds; D010710:Phosphates; D010847:Picolines; D001726:Bisacodyl; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C018279:sodium phosphate