Use of ERCP in Pediatric Patients With Acute Recurrent and Chronic Pancreatitis: a Report From the Insppire (International Study Group of Pediatric Pancreatitis: in Search for a Cure) Consortium
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Su1752 Comparison of Colonoscopy Preparations in a Pediatric Population Caroline T. Meyer*, Christina a. Hickey, June Y. Hu, Charles M. Samson, Elizabeth C. Utterson Pediatric Gastroenterology, Washington University in St. Louis, Saint Louis, MO; Pediatrics, Washington University in St. Louis, Saint Louis, MO Background: Poor quality colonoscopy preparation in pediatric patients can lead to inadequate visualization of colonic mucosa resulting in missed diagnoses, increased time under anesthesia and the need for repeat procedures. There have been few studies in the literature comparing colonoscopy preparation regimens in pediatric patients. Aims: To compare the efficacy of 2 different colonoscopy preparation regimens in pediatric patients at our institution. Methods: For our institutional quality improvement project, three endoscopists scored the visualization of colonic mucosa based on the Boston Bowel Prep Score (scores 0-9) and time to completion of colonoscopy (measured in!30 minutes, 30 minutes-1 hour, and O1 hour) in patients 8 years and older throughout a six month time period. An adequate cleanout was determined by a score R 5. Patients were prescribed either a regimen of 240 ml of magnesium citrate with two 10mg bisacodyl suppositories (phase 1) or polyethylene glycol (PEG) 3350 (8-12 years old: 119 grams in 960 ml of fluid and O12 years old: 238 grams of PEG 3350 in 1.92 liters of fluid) with oral bisacodyl (8-12 years old: 10mg and O12 years old: 20mg) (phase 2). Both groups were instructed to drink clear liquids the day prior to the procedure. The patients and their families were asked if they had completed all portions of the regimen prior to colonoscopy. Appropriate statistical tests were performed using IBM SPSS. Results: Forty-four patients were scored on the magnesium citrate/bisacodyl suppository prep and fifty patients were scored on the PEG 3350/oral bisacodyl prep. Two patients (one in each group) completed!75% of the regimen. Patients ranged in age from 8-25 years old. There was no significant difference in the mean age (pZ0.29) or the male to female ratio between groups (pZ0.85). The mean bowel prep score of the PEG 3350 group was 6.4 compared to 5.14 in the magnesium citrate group; the distributions of the two groups differed significantly (p!0.001) with statistically different medians (pZ0.03). The proportion of patients in the PEG 3350 group with a bowel prep score R 5 was 76% compared to 59% in patients receiving magensium citrate (pZ0.08) The percent of patients where the colonscopy was completed in less than 30 minutes was significantly higher in the PEG 3350 group (46% vs. 24%, pZ0.03). Conclusions: In our quality improvement project, there was a significant improvement in the efficacy as measured by visualization of colonic mucosa in the PEG 3350/oral bisacodyl treated group and improvement in the percent of colonoscopies completed in less than 30 minutes compared to the magnesium citrate/bisacodyl suppository group. Future studies utilizing patient questionnaire data and larger prospective blinded trials would provide additional information on tolerance and efficacy of bowel preparatory regimens in pediatric patients.Keywords:
Bisacodyl
Regimen
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The ideal bowel cleansing regimen for colonoscopy has yet to be determined.To compare the cleansing efficacy, and patient tolerability and safety of four bowel preparation regimens.A total of 834 patients undergoing outpatient colonoscopy were randomly assigned to one of four regimens: 4 L polyethylene glycol (PEG); 2 L PEG + 20 mg bisacodyl; 90 mL of sodium phosphate (NaP); or two sachets of a commercially available bowel cleansing solution (PSMC) + 300 mL of magnesium citrate (M). The primary outcome measure was cleansing efficacy, which was scored by blinded endoscopists using the Ottawa Bowel Preparation Scale. Secondary outcome measures were bowel preparation quality according to time of colonoscopy, and patient tolerability and safety.The mean total cleansing score was significantly worse in the NaP group compared with the other three groups (P<0.0001). The mean cleansing scores were worse in patients who underwent morning versus afternoon colonoscopy, a finding that was consistent in all four groups. PSMC + M was the best tolerated regimen. No clinically significant mean changes in creatinine or electrolyte levels were identified, although a significantly higher proportion of patients in the NaP group developed hypokelemia (P<0.0001).2 L PEG + 20 mg bisacodyl, or PSMC + M was as efficacious as 4 L PEG and superior to NaP for bowel cleansing. A short interval between the completion of bowel preparation and the start of colonoscopy (ie, 'runway time'), irrespective of bowel preparation regimen, appeared to be a more important predictor of bowel cleanliness than the cathartic agents used.
Tolerability
Regimen
Bisacodyl
Intention-to-treat analysis
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Background and Aim: Post-marketing studies comparing low-volume polyethylene glycol (PEG)-based regimens are limited. The aim of this randomized controlled non-inferiority study was to compare the efficacy and tolerability of two commercially available low-volume PEG-based preparations: PLENVU (Norgine) macrogol 3350, sodium ascorbate, sodium sulfate, ascorbic acid, sodium chloride and potassium chloride and Prepkit-C (Fresenius Kabi) macrogol 3350, sodium chloride, potassium chloride and sodium sulfate, sodium picosulfate, magnesium oxide, citric acid and aspartame in an unselected adult colonoscopy outpatient population. Methods: Patients undergoing outpatient colonoscopy were randomized to receive either split-dose Prepkit-C or PLENVU. Patient compliance, satisfaction, and tolerability were captured using a standardized questionnaire on the day of the procedure. A blinded endoscopist assessed the quality of bowel preparation using the Boston Bowel Preparation Scale (BBPS) and Aronchick Scale during the colonoscopy. The procedure times, rates of cecal intubation, and polyp detection rates were also recorded. Results: The study was terminated at 19 months, as recruitment was halted due to the coronavirus disease 2019 pandemic, and an unplanned interim analysis was performed. A total of 164 patients were randomly assigned to either Prepkit-C (n = 82) or PLENVU (n = 82). In the PLENVU group, 89% of patients achieved satisfactory preparation (total BPPS score ≥6 and each subscore ≥2), compared with 85.4% in the Prepkit-C group, resulting in an estimated difference of 3.7% (95% CI, -6.6% to 13.9%;P = 0.48). The median BBPS score with PLENVU was significantly better in the right, middle, and left colonic subsegments with PLENVU (BBPS score, 3;IQR, 2-3) than with Prepkit-C (BBPS score, 2;IQR, 2-3) (P < 0.001). A significantly higher proportion of patients in the PLENVU group had a BBPS score of ≥7, compared with patients in the Prepkit-C group (80% vs 57%;P = 0.002). A significantly greater proportion of patients had good-excellent quality of bowel preparation in the PLENVU group compared with the Prepkit-C group (84% vs 57%;P < 0.001) (Fig. 1). More patients in the PLENVU group reported moderate to severe nausea compared with those in the Prepkit-C group (P = 0.028);however, there were no other differences in patient satisfaction or tolerability between the two groups. Conclusion: The quality of bowel preparation achieved with PLENVU is at least non-inferior to that with Prepkit-C in a real-world unselected group of colonoscopy outpatients, with equivalent tolerability outcomes. This is despite a lower volume of preparation (by 500 mL) that is required to be ingested with PLENVU. Further studies are required in patients at risk of suboptimal bowel preparation.
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Objective
To investigate the clinical effects of different bowel preparation methods before colonoscopy in elderly patients.
Methods
A total of 84 elderly patients undergoing colonoscopy during July 2015 and July 2016 were divided into two groups (n=42 for each group) . Repeat group was treated with 1 L Polyethylene Glycol (PEG) orally for bowel preparation at night before the colonoscopy and 2 L PEG on the day of colonoscopy respectively. Single group was treated with 3 L PEG for bowel preparation on the day of colonoscopy. In the two groups, bowel preparation efficacy, patient′s compliance, tolerability and adverse reactions were evaluated.
Results
According to the Boston bowel preparation scale (BBPS) , the score of total colon cleaning effect was (7.49±1.33) in repeat group and (5.29±1.45) in single group with a significant difference (t=2.78, P 0.05) .
Conclusions
It is the proper method for elderly patients who are treated with PEG orally and repeatedly before colonoscopy.
Key words:
Aged; Bowel preparation; Repeat oral method; Signal oral method
Bowel preparation
Tolerability
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Objective: To evaluate the efficacy and safety of oral magnesium sulfate solution in split doses as bowel preparation in elderly patients undergoing colonoscopy. Methods: A total of 368 elderly patients undergoing colonoscopy were enrolled at PLA General Hospital. The patients were randomly divided into magnesium sulfate solution orally in split doses group (group A, n=178) and single dose group (group B, n=190). Parameters including general information, defecation frequency, Boston bowel preparation score (BBPS), detection rate of lesions and adverse reactions. Results: The frequency of defecations in group A was (7.6±1.4), more than that in group B (6.6±1.5) with statistical significance (P<0.05). The duration of bowel preparation in group A was (128.6±25.3) min, shorter than that of group B (165.4±29.7) min (P<0.05). The BBPS in group A was (8.09±0.67), better than that of group B (7.34±0.58) (P<0.05). The detection rates of intestinal polyps and micropolyps (diameter<0.5 cm) in group A were 73/178 (41.0%) and 51/178 (28.7%) respectively, compared with 58/190 (30.5%) and 37/190 (19.5%) in group B (both P<0.05). In group A, 8 patients reported adverse reactions as abdominal distension and discomfort. One patient had ST-T abnormality of electrocardiogram (ECG). No nausea or vomiting occurred, yet 2 cases needed enema for inadequate bowel preparation. Twenty-one cases in group B reported adverse events including 7 with nausea and vomiting. There were 13 patients treated with enema. Abnormal ECG was found in 4 patients in group B. The satisfaction rate of group A was 97.8%, higher than that of group B (91.6%) (P<0.05). Conclusions: The effect of bowel preparation of elderly patients with magnesium sulfate solution in split dose has a better tolerance, good cleaning effect and low incidence of adverse reactions. It is an ideal choice for the elderly to prepare colonoscopy.目的： 评估硫酸镁溶液分次口服法在老年人结肠镜检查肠道准备应用中的有效性及安全性。 方法： 纳入解放军总医院368例拟行结肠镜检查的老年患者，按随机数字法分为硫酸镁溶液分次口服组（分次组，178例）和硫酸镁溶液单次口服组（单次组，190例），比较两组患者一般资料、排便次数、波士顿肠道准备评分（BBPS）、病变检出率以及不良反应发生率、满意度等。 结果： 分次组总排便次数为（7.6±1.4）次，多于单次组的（6.6±1.5）次，P<0.05；分次组检查当日完成肠道准备所需时长为（128.6±25.3）min，少于单次组的（165.4±29.7）min，P<0.05；分次组肠道准备BBPS总评分为（8.09±0.67）分，优于单次组的（7.34±0.58）分，P<0.05；分次组肠道息肉及微息肉（直径<0.5 cm）检出率分别为41.0%（73/178）及28.7%（51/178），均高于单次组相应的30.5%（58/190）及19.5%（37/190），P均<0.05。分次组有8例出现腹胀不适，无一例发生恶心、呕吐，2例因肠道准备不充分需进一步接受灌肠处理；单次组有27例出现腹胀不适，7例发生恶心、呕吐，13例因肠道准备不充分需进一步接受灌肠处理。分次组患者肠镜检查后有1例出现ST-T改变，但无动态变化，单次组有4例在检查过程中出现心电异常表现。分次组肠道准备满意率达97.8%（174/178），高于单次组的91.6%（174/190），P=0.001。 结论： 硫酸镁溶液分次口服的肠道准备方法在老年人中耐受性高，清洁效果好，不良反应发生率低，是老年人结肠镜检查肠道准备的理想选择。.
Abdominal distension
Group B
Enema
Bowel preparation
Flatulence
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A Randomized Comparison of Oral Sodium phosphate within 30 and 75 Minutes In Bowel Preparation for Colonoscopy Tassanee Sirirutamaprapan BN, BHEcon* Chanpreecha Chamtrachamnong MD** Somboon Charoenthamaha MD** Prayuth Sirivongs MD** Nipa Orprasert BN* Boonchai Ngamsirimas MD** * Nursing Department, BMA Medical College and Vajira Hospital ** Department of Surgery, BMA Medical College and Vajira Hospital Objective: To compare the side effects (nausea and vomiting) and large bowel cleanness of 90 ml oral sodium phosphate within 30 minutes and 75 minutes for large bowel preparation before colonoscopy. Study design: Prospective, randomized controlled study. Subjects: Two hundred and thirteen patients who underwent elective colonoscopy from various indications at Endoscopic Surgery Division, Department of Surgery, BMA Medical College and Vajira Hospital during January 2005 to July 2005, were enrolled in this study. Methods: The subjects were allocated into 2 groups. The first, 99 cases drank 90 ml of sodium phosphate for large bowel preparation within 30 minutes as controls. The second, 114 cases drank the same amount within 75 minutes as study group, Research assistants interviewed all subjects to evaluate nausea and vomiting after taking this laxative, The surgeons performing colonoscopy did not know about the administration techniques and assessed the cleanness of large bowel by using the scores that prepared before the study. Main outcome measures: Incidence of nausea and vomiting, large bowel cleanness score. Results: Nausea occurred in 71.7% of the patients in 30 minutes group which was higher significantly than 45.6% in the 75 minutes group (p-value < 0.001). In addition, vomiting occurred in 45.4% and 27.2% in the 30 minutes group and 75 minutes group respectively (p-value < 0.05). The cleanness score of large bowel were not different with the same mean score of 3.4. Conclusion: Large bowel preparation by taking sodium phosphate orally within 75 minutes had less side effects than the 30 minutes group. Furthermore, the cleanness of the large bowel was not different between two techniques. Key words: bowel preparation, oral sodium phosphate, colonoscopy, nausea, vomiting
Laxative
Bowel preparation
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OBJECTIVE To evaluate the impact of a new same‐day, low‐dose 1‐L polyethylene glycol‐based (1‐L PEG) bowel preparation on the diagnostic rating of selected hospitalized patients and its tolerability, with risk factors for inadequate bowel preparation. METHODS A single‐center prospective pilot study was conducted with hospitalized patients scheduled for colonoscopy, presenting risk factors for poor bowel preparation, such as bleeding or subocclusive symptoms. The included patients were randomly divided in two groups, which received either a same‐day 1‐L PEG (group A) or a split‐dose 4‐L PEG (group B), and performed a colonoscopy within 4 h of the last dose. RESULTS In all, 44 inpatients [27 males; mean age 63.5 years (range 20–94 years)] were enrolled. Optimal bowel cleansing was reached in 64% and 55% ( P = 0.64) of patients in groups A and B, respectively. The adenoma detection rate was 14% (group A) and 18% (group B) ( P = 0.34). A valid diagnosis was reached in 38 (86%) of 44 patients (21 in group A and 17 in group B) after a mean hospitalization of 3 days for group A and 6 days for group B ( P = 0.04). CONCLUSIONS Our data support the conclusion that the schedule protocol proposed in this study enables a clear diagnosis in most of the inpatients at high risk of poor bowel preparation and no statistical differences were found between the two groups in terms of successful bowel cleansing achieved. Therefore, the same‐day, low‐dose 1‐L PEG bowel preparation could be introduced for selected inpatients.
Bowel preparation
Group B
Tolerability
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In an exploratory study we compared a new regimen of low-volume polyethylene glycol plus ascorbic acid (PEG-Asc) with the standard regimen for same-day bowel cleansing in constipated patients.Between January and June 2015 we studied consecutive patients with constipation (Rome III constipation criteria) scheduled for colonoscopy. The initial group received the standard regimen of PEG-Asc. The subsequent group received the new regimen. The new regimen involved ingestion of 10 mL of sodium picosulfate and 50g of magnesium citrate dissolved in 0.2 L of water followed by 0.2 L of PEG-Asc +0.2 L of water given 6 or 7 times over 3 hours. Bowel cleansing was prospectively evaluated using the Boston bowel preparation scale (BBPS). Bowel cleansing, adenoma detection rates and adverse events were reviewed using electronic medical records and endoscopic filing system.Sixty-two patients used the standard regimen and sixty used the new regimen. The basic characteristics of the two groups were similar. The mean volume of PEG-Asc and total liquid intake was less with the new regimen compared to the standard regimen (1.3 L vs. 2.0 L, P<0.001; 2.6 L vs. 3.0 L, P<0.001). The proportion of patients with a BBPS score ≥ 6 was significantly greater with the new than the standard regimen (93% vs. 76%, P=0.008). Nausea and/or vomiting was also significantly less frequent than with the standard regimen (5% vs. 16%, P=0.046).The new regimen of PEG-Asc gave improved same-day bowel cleansing for colonoscopy in constipated patients.
Regimen
Enteral administration
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Objective
To investigate the safety and effectiveness of Glifeet in bowel preparation before colonoscopy.
Methods
A prospective, single blind, randomized controlled trial of patients undergoing colonoscopy was conducted. A total of 67 inpatients were randomized to the control group, who received a low-residue and semiliquid diet (n=31) and the experimental group, who received Glifeet all day (n=36) before the procedure. All patients took polyethylene glycol electrolyte powder 1 000 ml at 7 pm on the day before colonoscopy and 2 000 ml at 8 am on the examination day. Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS). Side effects were also observed.
Results
The time of the first bowel movement of the experimental group was significantly shorter [(77.43±54.21) min VS (149.35±118.15) min, P=0.002]. An increased defecating frequency was observed in the experimental group, but there was no significant difference when compared with the control group (11.44±6.95 VS 8.74±3.58, P=0.055). Patient tolerance and acceptance did not differ. There was no significant difference in BBPS between the two groups. But the bowel preparation quality of the right colon was significantly better in the experimental group (2.56±0.50 VS 2.23±0.81, P=0.045).
Conclusion
Glifeet could meet the needs of basic energy in most patients for colonoscopy. Furthermore, Glifeet is well tolerated and can partially improve the quality of bowel preparation.
Key words:
Colonoscopy; Bowel preparation; Diet; Polyethylene glycols
Bowel preparation
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The aim of the present study was to evaluate efficacy, safety, and tolerability of a pediatric colonoscopy bowel preparation regimen composed of polyethylene glycol-3350 (PEG-3350) and a sports drink completed in a few hours.A prospective, open-label trial of a colonoscopy bowel preparation in children ages 8 to 18 years that included 238 g of PEG-3350 mixed with 1.9 L of Gatorade completed in a few hours. Efficacy was determined using the Boston Bowel Preparation Scale. Basic metabolic profiles and questionnaires were obtained that assessed for safety, adverse effects, tolerability, and patient acceptability.Forty-six patients completed the study. Patients were predominately boys (56.5%) with a mean age of 14.50 years (SD ± 2.9 years). Forty-three (93.5%) were able to complete the regimen. All of the colonoscopies were completed to the cecum and 84% had terminal ileum visualization. Seventy-seven percent were found to be effective preparations. Nausea/vomiting were the most common reported adverse effect (60%) followed by abdominal pain/cramping (44%) and fatigue/weakness (40%). Overall, the regimen was acceptable with 1 exception being the large volume to drink. There were no clinically significant changes in basic metabolic profiles, although there was a statistically significant decrease in the mean potassium (0.16 mEq/L; P = 0.016), blood urea nitrogen (2.68 mg/dL; P < 0.0001), and carbon dioxide (1.89 mmol/L; P < 0.0001).This study demonstrated that PEG-3350 + Gatorade administered in a few hours is an effective, safe, and moderately tolerable bowel preparation regimen for colonoscopy in children.
Tolerability
Regimen
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Objective
To compare the efficacy of bowel-cleansing, patients′ compliance, tolerability and side effects of different doses of polyethylene glycol(PEG) electrolyte solution for colonoscopy preparation.
Methods
Single-blind prospective randomized trial was performed. A total of 100 inpatients undergoing elective colonoscopy were randomized into three groups to receive 4 L PEG(n=35), 2 L PEG(n=31) or 2+ 1 L PEG(n=34), respectively, on the day of colonoscopy from May to July 2014. Bowel-cleansing efficacy was separately assessed with the Ottawa Scale for the right, middle, and left colon. Total score was obtained by adding the scores for individual evaluation of the three colon segments with the score of overall fluid in the entire colon. All patients filled in a questionnaire and were interviewed about their compliance to the assigned bowel preparation, tolerability, and side effects.
Results
Patients who did not complete the colonoscopy were excluded. A total of 91 patients were included in the last analysis: 31 cases of 4 L group, 30 cases of 2 L group and 30 cases of 2+ 1 L group. The efficacy of bowel-cleansing of the three groups of patients according to the Ottawa Scale were similar(P>0.05), but the excellent and good rate of cleansing quality of the right colon was higher in 4 L group than in 2 L group(P<0.05). Compared with 4 L group and 2+ 1 L group, patients in the 2 L group had higher compliance and tolerability, as well as lower rate of side effects(P<0.05).
Conclusion
The efficacy and safety of taking 2 L polyethylene glycol electrolyte solution in bowel-cleansing on the day of colonoscopy is good and suitable for use. Taking 4 L polyethylene glycol electrolyte solution for bowel preparation on the day of colonoscopy is more suitable for patients who are suspected highly with lesions of the right colon.
Key words:
Polyethylene glycols; Electrolytes; Colonoscopy; Bowel preparation
Tolerability
Bowel preparation
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