Introduction There are various indications for colonoscopies, including Inflammatory Bowel Disease (IBD) diagnosis, surveillance and investigating bowel symptoms. IBD is diagnosed by biopsies but visual observation of the bowel can aid treatment choices. Adequate bowel preparation is imperative to clear the bowel of stool to ensure clear visualisation of the bowel mucosa. Poor bowel preparation is not uncommon and can lead to missed lesions, longer procedure sessions and repeated procedures.¹

Aim To compare the effectiveness of standard bowel preparation (senna and sodium picosulfate) with another licensed preparation, Picolax® (magnesium citrate with sodium picosulfate) pre-colonoscopy.

Method Patients in a tertiary paediatric gastroenterology centre due for a planned colonoscopy were randomly assigned, using Excel, either standard bowel preparation or Picolax®. All patients had a clinic appointment to explain the bowel preparation they had been assigned to and given the same diet sheets to follow pre-colonoscopy. The gastroenterologist performing the colonoscopy and the medical student scoring the quality of the bowel preparation using the Boston Bowel Preparation Scale (BBPS)1 were blinded to which bowel preparation had been given. 3 sections of the bowel were scored out of 3 (ascending colon, transverse colon and descending colon) to give a total score out of 9.

Results 18 patients between ages 7 and 17 were recruited; 9 given senna and sodium picosulfate and 9 given Picolax®. A total BBPS score of 5 or more is considered adequate. All of the Picolax® group had adequate bowel preparation compared to 67% of the senna and picosulfate group. Mean BBPS scores were: senna and sodium picosulfate = 5.2 and Picolax® = 6.3.

Conclusion In this small study the patients who received Picolax® had a higher BBPS score, indicating a more effective clearance of the bowel pre-colonoscopy. The sample size is small; this was in part due to manufacturing problems affecting the supply of senna liquid. A further confounding factor could be variable adherence to the medication and diet plan as this was not assessed. Due to the positive results from the comparison, the standard treatment at this centre was switched to Picolax® for bowel preparation pre-colonoscopy in paediatrics.

Reference

1. Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointestinal Endoscopy 2009;69(3):620–625.