Effectiveness and safety of polyethylene-glycol-4000 versus sodium picosulphate plus magnesium oxide and citric acid for bowel cleansing before colonoscopy in children: A systematic review with meta-analysis

Abstract

Colonoscopy is performed for diagnostic and therapeutic purposes. The quality of colonoscopy depends on adequate bowel cleansing. However, there is no standardized protocol for bowel preparation in children. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effectiveness, safety, and tolerability profile of polyethylene glycol (PEG) compared with those of sodium picosulfate magnesium citrate (SPMC) in children. The primary sources of the reviewed studies were Scopus, PubMed, and Cochrane Library. The databases were systematically searched for RCTs comparing PEG 4000 to SPMC as a bowel cleansing solution. Six studies were included. The analysis showed that both PEG and SPMC are effective for bowel cleansing, while a split-dose regimen may be preferable to a day-before one. There were no differences between the two groups regarding adverse events (AEs) such as abdominal pain, nausea, vomiting, bloating, and anal discomfort. Additionally, preparation with SPMC was preferred in terms of acceptability and compliance. Still, the need to place a nasogastric tube was significantly lower in the SPMC group compared to the PEG group and in the split dose regimen compared to the day before. In conclusion, PEG and SPMC are equally effective in obtaining an adequate bowel cleansing with a comparable AE rate; moreover, split-dose administration may be preferable to day-before one in terms of effective bowel cleansing. However, SPMC preparation is more acceptable seems to result in higher compliance, and to reduce the use of a nasogastric tube, that we encounter daily in clinical practice, is perceived as a stressful experience for children and their families.

Keywords: bowel preparation; endoscopy; pediatric.

Figure 1

Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow diagram of the search process.

Figure 2

Use of the nasogastric tube in intestinal preparations. (A) The nasogastric tube was required in 34.1% of PEG standard cases, 3.2% of plus magnesium oxide and citric acid (PMC) standard cases, 19% of PEG split cases, and 0.4% of PMC split cases. A significantly lower rate of nasogastric tube utilization was noted in the PMC cohort (p < 0.01), both in standard and split administration modes. (B) Necessity of nasogastric tube insertion among all patients who underwent PEG and PMC, without differentiating the administration mode. In the PEG group, the nasogastric tube was required in 28.9% of cases, while in the PMC group, it was needed in 1.9% of cases, with a statistically significant difference favoring the PMC group (p < 0.01). PEG, polyethylene glycol; PMC, picosulphate plus magnesium oxide and citric acid.

Figure 3

Meta‐analysis of studies assessing the effectiveness of PEG day before versus PEG split overall cleansing success p < 0.001 (A), nasogastric tube p = 0.095 (B), nausea and vomiting p = 0.002 (C), bloathing p = 0.033 (D), abdominal pain p = 0.09 (E), compliance p = 0.531 (F). Meta‐analysis of studies assessing the effectiveness of PEG day before versus PMC day before overall cleansing success p = 0.748 (A), nasogastric tube p = 0.26 (B), nausea and vomiting p < 0.001 (C), anal discomfort p = 0.579 (D), abdominal pain p = 0.251 (B), compliance p = 0.111 (E). PEG, polyethylene glycol; PMC, plus magnesium oxide and citric acid.