Split dose versus full single-dose regimen of polyethylene glycol for bowel preparation in pediatric colonoscopy: a pilot study of randomized controlled trial

Abstract

OBJECTIVES: Previous meta-analyses in adults comparing a full single dose vs. split doses of polyethylene glycol with electrolyte solution demonstrated that the split-dose group had a higher rate of successful bowel preparation. To date, no similar study in children has been conducted. Therefore, we compared the efficacy of bowel preparation between the two regimens of polyethylene glycol with electrolyte solution in pediatric colonoscopy. The secondary outcomes were tolerability, acceptability, and compliance. METHODS: An investigator-blinded randomized controlled trial was conducted to enroll children aged 2-18 years who underwent an elective colonoscopy at a teaching hospital between March 2018 and February 2019. Patients were randomly assigned to receive polyethylene glycol with electrolyte solution as a full single dose or two split doses. The Boston Bowel Preparation Scale was used for the efficacy (i.e. successful bowel preparation if score ≥ 6). Secondary outcomes were evaluated by using a standardized questionnaire. RESULTS: A total of 45 colonoscopies (22 in the full single-dose and 23 in the split-dose group) were performed. Mean age was 9.2 years old (SD 4.4). We noted a higher rate of successful bowel preparation in the split-dose group (95% vs. 72%, P = 0.047). Significant higher rate of willingness to repeat the same protocol (83% vs. 36%, P = 0.002) and a trend of lower rate of nausea/vomiting (39% vs. 68%, P = 0.051) in the split-dose group were found. CONCLUSION: The split-dose regimen of polyethylene glycol with electrolyte solution for bowel preparation suggests superior efficacy, potential tolerability, and acceptability as compared to the traditional full single-dose regimen.