Su1752 Comparison of Colonoscopy Preparations in a Pediatric Population

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.