Colon cleansing with oral sodium phosphate in adolescents: dose, efficacy, acceptability, and safety.

BACKGROUND AND AIMS: Standardized bowel preparation in children and adolescents has not been established. Our aim was to compare two bowel preparation regimens and determine which was more effective, acceptable, and safer for children undergoing colonoscopy.

METHODS

We compared the efficacy and acceptability of a 1-day regimen with oral sodium phosphate solution (NaP solution) (1 mL/kg/day, maximum 90 mL in two divided doses; regimen A) to our standard 3-day regimen magnesium citrate (4 mL/kg/day x 3 days, maximum 237 mL, followed by an enema the morning of colonoscopy; regimen B). After informed consent was obtained, 48 children were randomized (N = 25, 23, respectively). Weight, electrolytes, calcium, phosphorus, and magnesium were measured at screening and the day of the colonoscopy. Questionnaires were given to assess acceptability and adverse events. Endoscopists rated the quality of bowel preparation on a 4-level scale from excellent to poor.

RESULTS

Median age and weight at screening were 14 yr, 53 kg, and 15 yr, 51 kg in regimen A and B, respectively. No statistical significance was observed in electrolytes, phosphorus, or adverse events apart from higher nausea intensity in regimen A (P= 0.012). Bowel cleansing was similar between groups (71% excellent or good). Subjects were more willing to repeat regimen A than B (77%vs 32%, respectively, P < 0.006). All 10 subjects who received regimen A and had prior colonoscopies using regimen B, preferred regimen A.

CONCLUSIONS

In a selected group of otherwise healthy children and adolescents over 10.5 yr and above 34 kg, 1-day oral NaP solution was more acceptable than 3-day magnesium citrate with an enema, and both regimens were found to be safe and efficacious.