title: Bowel preparations for colonoscopy: an RCT.
abstract: BACKGROUND
  The ideal preparation regimen for pediatric colonoscopy remains elusive, and available preparations continue to represent a challenge for children. The aim of this study was to compare the efficacy, safety, tolerability, and acceptance of 4 methods of bowel cleansing before colonoscopy in children.
  
  
  METHODS
  This randomized, investigator-blinded, noninferiority trial enrolled all children aged 2 to 18 years undergoing elective colonoscopy in a referral center for pediatric gastroenterology. Patients were randomly assigned to receive polyethylene glycol (PEG) 4000 with simethicon (PEG-ELS group) or PEG-4000 with citrates and simethicone plus bisacodyl (PEG-CS+Bisacodyl group), or PEG 3350 with ascorbic acid (PEG-Asc group), or sodium picosulfate plus magnesium oxide and citric acid (NaPico+MgCit group). Bowel cleansing was evaluated according to the Boston Bowel Preparation Scale. The primary end point was overall colon cleansing. Tolerability, acceptability, and compliance were also evaluated.
  
  
  RESULTS
  Two hundred ninety-nine patients were randomly allocated to the 4 groups. In the per-protocol analysis, PEG-CS+Bisacodyl, PEG-Asc, and NaPico+MgCit were noninferior to PEG-ELS in bowel-cleansing efficacy of both the whole colon (P = .910) and colonic segments. No serious adverse events occurred in any group. Rates of tolerability, acceptability, and compliance were significantly higher in the NaPico+MgCit group.
  
  
  CONCLUSIONS
  Low-volume PEG preparations (PEG-CS+Bisacodyl, PEG-Asc) and NaPico+MgCit are noninferior to PEG-ELS in children, representing an attractive alternative to high-volume regimens in clinical practice. Because of the higher tolerability and acceptability profile, NaPico+MgCit would appear as the most suitable regimen for bowel preparation in children.
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and giovanni.dinardo@uniroma1.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and.
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.affiliation: Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy; and.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.affiliation: Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy; and.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and.
authors.forename: Fortunata
authors.initials: F
authors.lastname: Civitelli
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and.
authors.forename: Federica
authors.initials: F
authors.lastname: Nuti
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ziparo
authors.affiliation: Departments of Paediatrics, Pediatric Gastroenterology and Nutrition Unit, and.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pession
authors.affiliation: Pediatric Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Lima
authors.affiliation: Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.affiliation: Departments of Pediatrics, Pediatric Gastroenterology Unit, and.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
mesh_terms: D000293:Adolescent; D001726:Bisacodyl / Q000008:administration & dosage*; D002400:Cathartics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D019343:Citric Acid / Q000008:administration & dosage*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008277:Magnesium Oxide / Q000008:administration & dosage*; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D013431:Sulfates / Q000008:administration & dosage*
chemical_list: D002400:Cathartics; D013431:Sulfates; C012036:sodium sulfate; D001726:Bisacodyl; D019343:Citric Acid; D008277:Magnesium Oxide; D011092:Polyethylene Glycols
keywords: children; colon cleansing; colonoscopy