Araştırma Makalesi
BibTex RIS Kaynak Göster

The Comparison of Efficacy and Tolerability of Two Bowel Preparation Agents in Children: Polyethylene Glycol vs Sodium Phosphate

Yıl 2020, Cilt: 42 Sayı: 6, 613 - 619, 09.11.2020
https://doi.org/10.20515/otd.748846

Öz

Adequate bowel cleansing with a good patient tolerability is important for high-quality and safe colonoscopy. We aimed to compare the efficacy and tolerability of an osmotic agent, polyethylene glycol (PEG) and a less frequently used stimulant agent, sodium phosphate (NP) for pediatric patients. We analyzed the records of pediatric patients who underwent colonoscopy and used either PEG or NP for bowel cleansing between January 2016 and December 2019. The patient tolerability of bowel preparation was assessed using a patient questionnaire that consisted of acceptance and adverse events, recording abdominal pain, nausea, vomiting, dizziness and severity of these symptoms. The quality of bowel preparation was assessed according to the Ottawa scale, including cleanliness and fluid quantity. The colonoscopic video records were retrospectively and blindly evaluated for Ottawa scale. There were a total of 145 patients (65 boys, 44.8%) with a mean age of 12.3±4.2 years. PEG was used in 93 patients (64.1%), while NP was used in 52 patients (35.9%). The mean age of the patients was significantly lower in PEG group (11.2±4.6 years) when compared to NP group (14.2±2.7 years) (p<0.0001). The patients who used PEG had significantly better tolerance without any complaints when compared to the patients who used NP (49/93 patients (52.7%) vs 14/52 patients (26.9%), respectively, p=0.003). Regarding the severity of symptoms in patients who had adverse events, the NP group had significantly more frequent moderate-severe side effects when compared to PEG group (15/52 patients (28.8%) vs 15/93 patients (16.1%), respectively, p=0.014). One of the children in NP group had severe hyperphosphatemia, which required fluid resuscitation. Regarding the efficacy of the preparations, 39/93 (41.9%) of the patients in PEG group had required wash and suctioning in any segments of the colon, this ratio was significantly lower in NP group (12/52 (23%)), (p=0.029). The Ottawa bowel preparation quality score in right colon and total Ottawa scale rating was significantly better in NP group when compared to PEG group (p=0.009 and 0.034, respectively). The Ottawa scores in mid and rectosigmoid colons were not significantly different between two groups. As conclusion, NP is more efficient in bowel cleansing when compared to PEG. But PEG had less frequent moderate-severe side effects compared to NP. Additionally, NP should be carefully used in selected cases where other bowel cleansing methods cannot be used, because of the severe side effects like hyperphosphatemia in children.  

Kaynakça

  • 1. Dahshan A, Lin CH, Peters J, Thomas R, Tolia V. A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol. 1999;94(12):3497‐3501.
  • 2. Pall H, Zacur GM, Kramer RE, et al. Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee. J Pediatr Gastroenterol Nutr. 2014;59(3):409‐416.
  • 3. Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality [published correction appears in Gastrointest Endosc. 2004 Aug;60(2):326]. Gastrointest Endosc. 2004;59(4):482‐486.
  • 4. Rostom A, Jolicoeur E, Dubé C, et al. A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy. Gastrointest Endosc. 2006;64(4):544‐552.
  • 5. Gordon M, Karlsen F, Isaji S, Teck GO. Bowel preparation for elective procedures in children: a systematic review and meta-analysis. BMJ Paediatr Open. 2017;1(1):e000118.
  • 6. Gremse DA, Sacks AI, Raines S. Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr. 1996;23(5):586‐590.
  • 7. da Silva MM, Briars GL, Patrick MK, Cleghorn GJ, Shepherd RW. Colonoscopy preparation in children: safety, efficacy, and tolerance of high- versus low-volume cleansing methods. J Pediatr Gastroenterol Nutr. 1997;24(1):33‐37.
  • 8. Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147(4):903‐924.
  • 9. Parmar R, Martel M, Rostom A, Barkun AN. Validated Scales for Colon Cleansing: A Systematic Review. Am J Gastroenterol. 2016;111(2):197‐205.
  • 10. Sriphongphankul H, Tanpowpong P, Lertudomphonwanit C, Treepongkaruna S. Split dose versus full single-dose regimen of polyethylene glycol for bowel preparation in pediatric colonoscopy: a pilot study of randomized controlled trial. Eur J Gastroenterol Hepatol. 2019;31(11):1382‐1386.
  • 11. Tutar E, Bayrak NA, Volkan B, Ertem D. Bowel Preparation for Colonoscopy in Children: 1 Day PEG-3350 with Bisacodyl versus 3 Day Sennosides. Dig Dis. 2019;37(4):334‐342.
  • 12. Szaflarska-Popławska A, Tunowska D, Sobieska-Poszwa O, Krogulska A. The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy. Gastroenterol Res Pract. 2019;2019:3230654.
  • 13. Cisarò F, Andrealli A, Calvo P, Guanà R, Pinon M, Barletti C. Bowel Preparation for Gastrointestinal Endoscopic Procedures With Sodium Picosulphate-Magnesium Citrate Is an Effective, Safe, and Well-Tolerated Option in Pediatric Patients: A Single-Center Experience. Gastroenterol Nurs. 2018;41(4):312‐315.
  • 14. Moseley PK, Segar WE. Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease. Am J Dis Child 1968;115:714.
  • 15. Sotos JF, Cutler EA, Finkel MA, Doody D. Hypocalcemic coma following two pediatric phosphate enemas. Pediatrics 1977;60:305-7.
  • 16. Oxnard SC, O'Bell J, Grupe WE. Severe tetany in an azotemic child related to a sodium phosphate enema. Pediatrics 1974;53:105-6.
  • 17. Davis RF, Eichner JM, Bleyer A, Okamoto G. Hypocalcemia, hyperphosphatemia, and dehydration following a single hypertonic phosphate enema. J Pediatr 1977;90:484-5.
  • 18. Hassall E, Lobe TE. Risky business: oral sodium phosphate for precolonoscopy bowel preparation in children. J Pediatr Gastroenterol Nutr. 2007;45(2):268‐269.
  • 19. Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution. Gastrointest Endosc. 1996;43(5):463‐466.
  • 20. Coskun A, Uzunkoy A, Duzgun SA, Bozer M, Ozardali I, Vural H. Experimental sodium phosphate and polyethylene glycol induce colonic tissue damage and oxidative stress. Br J Surg. 2001;88(1):85‐89.
  • 21. Atkinson RJ, Save V, Hunter JO. Colonic ulceration after sodium phosphate bowel preparation. Am J Gastroenterol. 2005;100(11):2603‐2605.

Çocuklarda İki Bağırsak Hazırlık İlacının Etkinlik ve Kullanılabilirliğinin Karşılaştırılması: Polietilen Glikol ve Sodyum Fosfat

Yıl 2020, Cilt: 42 Sayı: 6, 613 - 619, 09.11.2020
https://doi.org/10.20515/otd.748846

Öz

Hastalar tarafından iyi tolere edilebilen, yeterli bir bağırsak temizliğinin uygulanabilmesi, iyi kalitede ve güvenilir bir kolonoskopi yapılabilmesi açısından önem taşımaktadır. Çalışmamızda, çocuk hastalarda polietilen glikol (PEG) gibi ozmotik bir bağırsak temizleyici ile daha az kullanılan sodyum fosfat (SF) gibi uyarıcı bir ajanın etkinliğini ve kullanılabilirliğini karşılaştırmayı amaçladık. Hastanemizde, Ocak 2016 ve Aralık 2019 yılları arasında kolonoskopi yapılmış ve kolonoskopi hazırlık rejimi olarak PEG veya SF kullanılmış olan çocuk hastalarımızın kayıtlarını geriye dönük olarak değerlendirdik. Bağırsak temizliğinin kullanılabilirliği (tolerabilite), ilacın kullanım kolaylığı ve karın ağrısı, bulantı, kusma, baş dönmesi gibi yan etkileri ve bunların şiddetini sorgulayan bir anket ile değerlendirildi. Bağırsak temizliğinin kalitesi, temizliği ve sıvı miktarını değerlendiren Ottawa ölçeği ile belirlendi. Ottawa ölçeği, kolonoskopi video kayıtlarından kör bir şekilde ve geriye dönük olarak ölçüldü. Ortalama yaşları 12,3±4,2 yaş olan toplam 145 hasta (65 erkek, %44,8) çalışmaya alındı. Doksan üç (%64,1) hastada PEG, 52 hastada (%35,9) SF kullanılmıştı. Hastaların ortalama yaşları PEG grubunda (11,2±4,6 yaş) SF grubuna (14,2±2,7 yaş) göre anlamlı olarak düşüktü (p<0,0001). Bağırsak temizliğinin kullanılabilirliği değerlendirildiğinde, PEG’nin, SF kullanan hastalara göre anlamlı olarak daha iyi tolere edildiği görüldü (sırasıyla, 49/93 hasta (%52,7) ve 14/52 hasta (%26,9), p=0,003). Yan etki oluşan hastalarda semptom şiddeti değerlendirildiğinde, SF grubunda, PEG grubuna kıyasla orta-ağır şiddetteki etkilerin daha sık oluştuğu gözlendi (sırasıyla, 15/52 hasta (%28,8) ve 15/93 hasta (%16,1), p=0,014). Sodyum fosfat kullanan çocukların birinde sıvı tedavisini gerektiren ağır hiperfosfatemi geliştiği görüldü. Kullanılan ilaçların etkinliği değerlendirildiğinde, PEG grubundaki 39/93 (%41,9) hastanın işlem sırasında aspirasyon gerektirdiği veya kolonun herhangi bir bölümünde katı kıvamlı dışkı izlendiği görüldü, bu oran SF grubunda anlamlı olarak daha düşüktü (12/52 (%23)), (p=0,029). Ottawa ölçeğine göre değerlendirildiğinde, NP grubu, PEG grubuna göre sağ kolon ve toplam Ottawa skorlarında daha etkin bulundu (sırasıyla, p=0,009 ve p=0,034). Her iki gruptaki orta kolon ve rektosigmoid kolon Ottawa skorları arasında anlamlı fark bulunmadı. Sonuç olarak, bağırsak temizliğinde SF, PEG’e göre daha etkindi. Fakat orta-ağır yan etkiler PEG kullanan hastalarda, SF kullanan hastalara göre daha az görüldü. Ek olarak SF’nin çocuklarda hiperfosfatemi gibi ağır yan etkiler nedeniyle dikkatli kullanılması gerektiği görüldü.

Kaynakça

  • 1. Dahshan A, Lin CH, Peters J, Thomas R, Tolia V. A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children. Am J Gastroenterol. 1999;94(12):3497‐3501.
  • 2. Pall H, Zacur GM, Kramer RE, et al. Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee. J Pediatr Gastroenterol Nutr. 2014;59(3):409‐416.
  • 3. Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality [published correction appears in Gastrointest Endosc. 2004 Aug;60(2):326]. Gastrointest Endosc. 2004;59(4):482‐486.
  • 4. Rostom A, Jolicoeur E, Dubé C, et al. A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy. Gastrointest Endosc. 2006;64(4):544‐552.
  • 5. Gordon M, Karlsen F, Isaji S, Teck GO. Bowel preparation for elective procedures in children: a systematic review and meta-analysis. BMJ Paediatr Open. 2017;1(1):e000118.
  • 6. Gremse DA, Sacks AI, Raines S. Comparison of oral sodium phosphate to polyethylene glycol-based solution for bowel preparation for colonoscopy in children. J Pediatr Gastroenterol Nutr. 1996;23(5):586‐590.
  • 7. da Silva MM, Briars GL, Patrick MK, Cleghorn GJ, Shepherd RW. Colonoscopy preparation in children: safety, efficacy, and tolerance of high- versus low-volume cleansing methods. J Pediatr Gastroenterol Nutr. 1997;24(1):33‐37.
  • 8. Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147(4):903‐924.
  • 9. Parmar R, Martel M, Rostom A, Barkun AN. Validated Scales for Colon Cleansing: A Systematic Review. Am J Gastroenterol. 2016;111(2):197‐205.
  • 10. Sriphongphankul H, Tanpowpong P, Lertudomphonwanit C, Treepongkaruna S. Split dose versus full single-dose regimen of polyethylene glycol for bowel preparation in pediatric colonoscopy: a pilot study of randomized controlled trial. Eur J Gastroenterol Hepatol. 2019;31(11):1382‐1386.
  • 11. Tutar E, Bayrak NA, Volkan B, Ertem D. Bowel Preparation for Colonoscopy in Children: 1 Day PEG-3350 with Bisacodyl versus 3 Day Sennosides. Dig Dis. 2019;37(4):334‐342.
  • 12. Szaflarska-Popławska A, Tunowska D, Sobieska-Poszwa O, Krogulska A. The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy. Gastroenterol Res Pract. 2019;2019:3230654.
  • 13. Cisarò F, Andrealli A, Calvo P, Guanà R, Pinon M, Barletti C. Bowel Preparation for Gastrointestinal Endoscopic Procedures With Sodium Picosulphate-Magnesium Citrate Is an Effective, Safe, and Well-Tolerated Option in Pediatric Patients: A Single-Center Experience. Gastroenterol Nurs. 2018;41(4):312‐315.
  • 14. Moseley PK, Segar WE. Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease. Am J Dis Child 1968;115:714.
  • 15. Sotos JF, Cutler EA, Finkel MA, Doody D. Hypocalcemic coma following two pediatric phosphate enemas. Pediatrics 1977;60:305-7.
  • 16. Oxnard SC, O'Bell J, Grupe WE. Severe tetany in an azotemic child related to a sodium phosphate enema. Pediatrics 1974;53:105-6.
  • 17. Davis RF, Eichner JM, Bleyer A, Okamoto G. Hypocalcemia, hyperphosphatemia, and dehydration following a single hypertonic phosphate enema. J Pediatr 1977;90:484-5.
  • 18. Hassall E, Lobe TE. Risky business: oral sodium phosphate for precolonoscopy bowel preparation in children. J Pediatr Gastroenterol Nutr. 2007;45(2):268‐269.
  • 19. Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution. Gastrointest Endosc. 1996;43(5):463‐466.
  • 20. Coskun A, Uzunkoy A, Duzgun SA, Bozer M, Ozardali I, Vural H. Experimental sodium phosphate and polyethylene glycol induce colonic tissue damage and oxidative stress. Br J Surg. 2001;88(1):85‐89.
  • 21. Atkinson RJ, Save V, Hunter JO. Colonic ulceration after sodium phosphate bowel preparation. Am J Gastroenterol. 2005;100(11):2603‐2605.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Yusuf Aydemir 0000-0003-3318-2747

Zeren Barış 0000-0002-4976-9924

Gözde Yurttaş 0000-0002-8208-5401

Aslı Yavuz 0000-0002-2424-3870

Makbule Eren 0000-0002-7105-7165

Yayımlanma Tarihi 9 Kasım 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 42 Sayı: 6

Kaynak Göster

Vancouver Aydemir Y, Barış Z, Yurttaş G, Yavuz A, Eren M. The Comparison of Efficacy and Tolerability of Two Bowel Preparation Agents in Children: Polyethylene Glycol vs Sodium Phosphate. Osmangazi Tıp Dergisi. 2020;42(6):613-9.


13299        13308       13306       13305    13307  1330126978