Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate

OBJECTIVES: The objective of this study was to evaluate the safety and efficacy of polyethylene glycol-electrolyte solution vs polyethylene glycol-3350 for the treatment of fecal impaction in pediatric patients. METHODS: A retrospective, observational, institutional review board–approved study was conducted over a 1-year time period. Patients were included in the study if they were admitted to the hospital with a diagnosis of fecal impaction or constipation and were treated with either polyethylene glycol-electrolyte solution (PEG-ES) or polyethylene glycol-3350 (PEG-3350). Patients were excluded if they were discharged prior to resolution of treatment and/or did not receive PEG-ES or PEG-3350. RESULTS: Fifty-one patients (ranging in age from 1 month to 15 years) were evaluated: 23 patients received PEG-ES and 28 patients received PEG-3350. Sex, race, age, and weight were not statistically different between the 2 groups. Resolution of fecal impaction was not significantly different between PEG-ES vs PEG-3350 (87% and 86%, respectively; p = 0.87). There was only 1 reported side effect with PEG-3350, vs 11 reported side effects with PEG-ES (p < 0.01). CONCLUSIONS: Theses results suggest that PEG-3350 is as effective as PEG-ES for the treatment of fecal impaction in pediatric patients and is associated with fewer side effects.

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Pattern of Constipation and Response to Polyethylene Glycol in Children

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i3.15726 ◽

2017 ◽

Vol 36 (3) ◽

pp. 263-267

Author(s):

Sudip Saha ◽

Kallol Bose ◽

Kallol Das ◽

Dhrubojyoti Mridha ◽

Ira Das ◽

...

Keyword(s):

Polyethylene Glycol ◽

Abdominal Mass ◽

Functional Constipation ◽

Study Data ◽

Fecal Impaction ◽

Age Group ◽

Number Of Children ◽

Male Preponderance ◽

Polyethelene Glycol ◽

Definition Of

Introduction: Constipation is a common problem in children with worldwide prevalence between 0.7% and 29.6%.Materials and Methods: Total number of children was 232 out of which 16 were discarded due to loss in follow up. Inclusion criteria: Any child aged one month to ten years presenting with constipation. We used NASPGHAN definition of constipation. Exclusion criteria: Critically sick and hemodynamically unstable patients were excluded from the study. Data were collected for age, sex, duration of constipation, symptoms and signs such as stool frequency, stool consistency, pain during defecation, presence of blood in stool, fecal and urinary incontinence, and presence of fecal impaction or an abdominal mass. Clinical evaluation (history and physical examination) of all patients was done by the same physician to avoid bias in clinical finding. Polyethylene glycol (PEG) was tried in all patients in a dose of 0.3 to 2.1g/kg. Response was defined as passage of at least one semisolid stool without discomfort with use of PEG for at least 4 weeks.Results: In our prospective study done on 232 patients with constipation over three year period (dividing patient’s into1month to 5months, 6months to 5year and 6 years to 10 years) revealed that constipation is mostly prevalent in 6 months to 5 year age group with slight male preponderance. Most of them had symptom onset after six months of age. Commonest symptom was hard stool in general (79.6%) but prevalence of pain abdomen increases with age and peaks in above five year group. Commonest sign is palpable fecal mass. Complications-urinary dysfunction, fecal incontinence, fissure are common in older age group. Functional constipation was the commonest cause (96.2%). Hirschprung disease was diagnosed in 1.4%. Polyethylene glycol shows good response in above 6 months of age groups.Conclusion: Functional constipationis the commonest cause of constipation. Mostly affected group is six months to five years. Polyethelene Glycol is an effective treatment especially after six months. J Nepal Paediatr Soc 2016;36(3):263-267.

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Laxative management in ambulatory cancer patients on opioid therapy: a prospective, open-label investigation of polyethylene glycol, sodium picosulphate and lactulose

European Journal of Cancer Care ◽

10.1111/j.1365-2354.2011.01286.x ◽

2011 ◽

Vol 21 (1) ◽

pp. 131-140 ◽

Cited By ~ 24

Author(s):

S. WIRZ ◽

J. NADSTAWEK ◽

C. ELSEN ◽

U. JUNKER ◽

H.C. WARTENBERG

Keyword(s):

Polyethylene Glycol ◽

Cancer Patients ◽

Opioid Therapy ◽

Open Label ◽

Sodium Picosulphate

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Sodium picosulphate or polyethylene glycol before elective colonoscopy in outpatients? A systematic review and meta-analysis

World Journal of Gastrointestinal Endoscopy ◽

10.4253/wjge.v10.i12.422 ◽

2018 ◽

Vol 10 (12) ◽

pp. 422-441 ◽

Cited By ~ 4

Author(s):

Rodrigo Silva de Paula Rocha ◽

Igor Braga Ribeiro ◽

Diogo Turiani Hourneaux de Moura ◽

Wanderley Marques Bernardo ◽

Maurício Kazuyoshi Minata ◽

...

Keyword(s):

Systematic Review ◽

Polyethylene Glycol ◽

Meta Analysis ◽

Sodium Picosulphate

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Short report: comparison of two orally administered bowel preparations for colonoscopy-polyethylene glycol and sodium picosulphate

Alimentary Pharmacology & Therapeutics ◽

10.1111/j.1365-2036.1992.tb00566.x ◽

2007 ◽

Vol 6 (4) ◽

pp. 513-519 ◽

Cited By ~ 23

Author(s):

M. DAKKAK ◽

K. AZIZ ◽

J. R. BENNETT

Keyword(s):

Polyethylene Glycol ◽

Short Report ◽

Sodium Picosulphate ◽

Bowel Preparations

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A Single or Split Dose Picosulphate/Magnesium Citrate Before Colonoscopy: Comparison Regarding Tolerance and Eficacy with Polyethylene Glycol. A Randomized Trial

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.vk1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 141-146 ◽

Cited By ~ 11

Author(s):

Vladimir Kojecky ◽

Jiri Dolina ◽

Bohuslav Kianicka ◽

Miroslav Misurec ◽

Michal Varga ◽

...

Keyword(s):

Single Dose ◽

Polyethylene Glycol ◽

Magnesium Citrate ◽

Split Dose ◽

Sodium Picosulphate ◽

Solution Type ◽

Bowel Cleansing ◽

Significant Difference ◽

Colonic Preparation

Background & Aims: To compare the eficacy and tolerance of sodium picosulphate/magnesium citrate(PMC) and polyethylene glycol (PEG) in a single or split dose regimen for colonoscopy bowel preparation.Methods: A prospective, randomized, endoscopist-blinded, multicenter study. The patients were randomly assigned to receive PMC (PMC4/0) or PEG (PEG4/0) in a single dose 4L day before colonoscopy or a split dose 2+2L PMC (PMC2/2) or 3+1L PEG (PEG3/1) one day before and in the morning before the colonoscopy. Each patient was interviewed to determine his/her subjective tolerance of the preparation before the procedure. The quality of bowel cleansing was assessed in a blinded test performed by multiple endoscopists using the Aronchick scale.Results: A total of 600 patients were enrolled, 88.2% were included in the analysis. Satisfactory bowel cleansing (Aronchick score 1 and 2) was signicantly more frequent when a split dose was used irrespective of the solution type (81.6% PMC2/2, 87.3% PEG3/1 vs. 73.0% PEG4/0, p = 0.024). In single dose regimens, PMC performed better than PEG (82.6% vs. 73.0%). Single or split dose PMC preparations were comparable. A PMC based solution was generally better tolerated than PEG regardless of the regimen used (p < 0.001). Nausea was reported mostly after the 4L PEG (32.8%, p < 0.001), incontinence after a split PMC dose (34.4%, p = 0.002), and bloating after the 4L PEG (38.0%, p < 0.001). There was no significant difference in the prevalence of vomiting.Conclusion: Colonic preparation with PMC yields similar results as a split PEG dose, regardless of whether PMC is administered in single or separate doses. PMC is better tolerated than any PEG-based preparation. A single 4L PEG the day before the colonoscopy is less appropriate for bowel cleansing.

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The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy

Gastroenterology Research and Practice ◽

10.1155/2019/3230654 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Anna Szaflarska-Popławska ◽

Dominika Tunowska ◽

Ola Sobieska-Poszwa ◽

Anna Gorecka ◽

Aneta Krogulska

Keyword(s):

Polyethylene Glycol ◽

Adverse Events ◽

Bowel Preparation ◽

Similar Efficacy ◽

Serious Adverse Events ◽

Preparation Methods ◽

Sodium Picosulphate ◽

Bowel Cleansing ◽

Patient Reported ◽

Colonoscopy Preparation

Background. Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children. Aim. The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability. Material and Methods. The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained. Results. One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p=0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p=0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient’s grade for palatability, low volume of the solution, and willingness to repeat the same protocol. Conclusion. All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.

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