Gordon Morris, Karlsen Fiona, Isaji Sahira, Teck Guan-Ong
School of Medicine and Dentistry, University of Central Lancashire, Preston, UK.
Department of Paediatrics, Blackpool Victoria Hospital, Blackpool, UK.
BMJ Paediatr Open. 2017 Sep 18;1(1):e000118. doi: 10.1136/bmjpo-2017-000118. eCollection 2017.
Reviews have investigated preparation for colonoscopy, but not for surgery, They are also often limited to patients up to 16 years, despite many paediatric gastroenterologists caring for older patients. We carried out a systematic review investigating the optimum bowel preparation agents for all indications in children and young people.
A Cochrane format systematic review of randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool.
Young people requiring bowel preparation for any elective procedure, as defined by the primary studies.
RCTs comparing bowel preparation with placebo or other interventions.
Adequacy of bowel preparation, tolerability and adverse events.
The search yielded 2124 results and 15 randomised controlled studies (n=1435)but heterogeneity limited synthesis. Meta-analysis of two studies comparing polyethylene glycol (PEG) with sodium phosphate showed no difference in the quality of bowel preparation (risk ratio (RR) 1.27(95% CI 0.66 to 2.44)). Two studies comparing sodium picosulfate/magnesium citrate with PEG found no difference in bowel preparation but significantly higher number of patients needing nasogastric tube insertion in the polyethylene glycol-electrolyte lavage solution (RR 0.04(95% CI 0.01 to 0.18), 45 of 117 in PEG group vs 2 of 121 in sodium picosulfate group). Meta-analysis of three studies (n=241) found no difference between PEG and sennasoids (RR 0.73(95% CI 0.31 to 1.71)).
The evidence base is clinically heterogeneous and methodologically at risk of bias. There is evidence that all regimens are equally effective. However, sodium picosulfate was better tolerated than PEG. Future research is needed with all agents and should seek to consider safety and tolerability as well as efficacy.
已有综述对结肠镜检查的肠道准备进行了研究，但未涉及手术的肠道准备。这些综述通常也仅限于16岁以下的患者，尽管许多儿科胃肠病专家也会诊治年龄更大的患者。我们进行了一项系统综述，以研究适用于儿童和青少年各种适应症的最佳肠道准备药物。
采用Cochrane格式对随机对照试验（RCT）进行系统综述。由两名综述员独立进行数据提取和方法学质量评估。使用Cochrane偏倚风险工具评估方法学质量。
根据初步研究定义，需要为任何择期手术进行肠道准备的青少年。
比较肠道准备与安慰剂或其他干预措施的随机对照试验。
肠道准备的充分性、耐受性和不良事件。
检索获得2124条结果，15项随机对照研究（n = 1435），但异质性限制了综合分析。两项比较聚乙二醇（PEG）与磷酸钠的研究的荟萃分析显示，肠道准备质量无差异（风险比（RR）1.27（95%CI 0.66至2.44））。两项比较比沙可啶/枸橼酸镁与PEG的研究发现，肠道准备无差异，但聚乙二醇电解质灌洗液组需要插入鼻胃管的患者数量显著更多（RR 0.04（95%CI 0.01至0.18），PEG组117例中有45例，比沙可啶组121例中有2例）。三项研究（n = 241）的荟萃分析发现，PEG与番泻叶类药物之间无差异（RR 0.73（95%CI 0.31至1.71））。
证据基础在临床上存在异质性，且在方法学上存在偏倚风险。有证据表明所有方案同样有效。然而，比沙可啶的耐受性优于PEG。未来需要对所有药物进行研究，并应在考虑疗效的同时兼顾安全性和耐受性。
