Macrogole Versus Sodium Picosulfate in Bowel Cleansing for Colonoscopy in Pediatric Inflammatory Bowel Disease

Evaluation of the Efficacy, Tolerability, and Safety of Two Colonoscopy Preparation Regimens in Children With Inflammatory Bowel Disease: a Randomized Study.

Children hospitalized at the Department of Pediatric Gastroenterology and Nutrition at the Medical University of Warsaw with suspected or confirmed inflammatory bowel disease (IBD) will be invited to participate in the study.

Data regarding demographics, current body weight, height, and the number of daily bowel movements during the week prior to the colonoscopy will be collected for each patient.

On the day before the colonoscopy, all patients will be placed on a low-residue diet until 3:00 PM. Children will be randomly assigned-based on a computer-generated randomization list-to one of two groups:

• one group will receive a high-volume polyethylene glycol (PEG)-based preparation at a dose of 100 ml/kg of body weight (maximum 4 liters),
• the other group will receive a low-volume preparation containing sodium picosulfate and magnesium oxide at the following doses: for patients ≤9 years of age, two doses of ½ sachet (150 ml total); for patients >9 years of age, two doses of 1 sachet (300 ml total); along with an appropriate volume of fluids: a minimum of 1500 ml for patients ≤9 years of age and a minimum of 3000 ml for patients >9 years of age.

The children will receive the preparations after 3:00 PM on the day before the colonoscopy. In addition to the aforementioned fluid intake, the patient may consume any amount of clear fluids; the total volume of fluids consumed will be recorded in the patient's chart.

Each patient will receive detailed written instructions outlining the individual dosage of the preparation and the colonoscopy preparation regimen. Additionally, a discussion will be held with the patient and their parent or guardian to review the preparation process and emphasize the importance of proper bowel cleansing for the quality of the examination.

The quality of bowel preparation will be assessed using the Bristol Bowel Preparation Scale (BBPS) scale by the physician performing the colonoscopy.

The patient and their parent or guardian will rate the tolerability of the colonoscopy preparation using a 10-point visual analogue scale.

In all cases, a prerequisite for inclusion in the study will be obtaining written or verbal consent from the child's parents or guardians and from any child over the age of 16, as well as from a younger child if they are capable of understanding the purpose of the study.

Inclusion Criteria:

• suspected IBD or IBD diagnosed according to the widely accepted Porto criteria (incorporating clinical, endoscopic, and histopathological criteria);
• eligibility for colonoscopy;
• normal laboratory test results: sodium, potassium, and creatinine levels;
• informed consent from the child's parents or guardians for participation in the study; for children over 16 years of age, additional consent from the child participating in the study.

Exclusion Criteria:

• following gastrointestinal surgery;
• with renal failure or heart failure;
• with conditions other than IBD that constitute an indication for colonoscopy;
• whose parents or guardians have not consented to participation in the study; or, in the case of children over 16 years of age, lack of consent from the child.