Kumar Ashwath S, Beutler Brooke L, Attard Thomas M
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Children's Mercy Hospital, Kansas City, USA.
BMC Gastroenterol. 2018 Nov 7;18(1):170. doi: 10.1186/s12876-018-0895-7.
The adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.
The standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively abstracted relevant indices including patient demographics, prep quality, procedure impairment, duration and completion from an institutional quality monitoring survey tool between 2015 and 2016 and similarly abstracted prospectively recorded indices that included the dataset above as well as additional fields for procedure deviations and additional laxative use.
A total of 642 procedures (mean age 12.2 years; F: 380) were accrued, nonadherence to the cleanout regimen (7.3%) and additional laxative use (3.1%) were observed in a small proportion of the prospective dataset subjects, adequate cleanout defined as thin or thick liquid but no solids present was reported in 79.5% and 15.8% of cases and impaired study from inadequate cleanout was reported in 11.8% of studies albeit the cecum was reached and the terminal ileum was intubated in 97.8 and 93.6% of studies. The duration of the study was significantly longer with the presence of a fellow trainee assisting in the procedure. Patient age and gender did not correlate with prep adequacy or cecal and ileal intubation rates, inadequate cleanout was significantly associated with impairment and incomplete studies.
A one day, single agent, osmotic laxative (Polyethylene glycol) based cleanout regimen is effective in routine pre-procedure cleanout for standard colonoscopy in pediatric age range patients.
与成人患者一样，术前准备是否充分是儿童结肠镜检查质量的主要决定因素。医疗服务提供者对于标准术前方案缺乏共识。专业学会指南包括使用聚乙二醇（PEG）。在此，我们报告在一家三级医疗机构中，对接受结肠镜检查的儿童采用基于PEG的一日按年龄分类给药清洁方案，由医疗服务提供者评估的充分性。
我们机构的标准肠道准备方案包括根据年龄确定的最低PEG给药方案，以及在检查前一天饮用清液。我们从2015年至2016年的机构质量监测调查工具中回顾性提取了相关指标，包括患者人口统计学数据、准备质量、操作障碍、持续时间和完成情况，并同样前瞻性提取了记录的指标，这些指标包括上述数据集以及操作偏差和额外泻药使用的其他字段。
共累积了642例操作（平均年龄12.2岁；女性380例），在前瞻性数据集的一小部分受试者中观察到未遵守清洁方案（7.3%）和额外使用泻药（3.1%），79.5%和15.8%的病例报告清洁充分，定义为稀薄或浓稠液体但无固体，11.8%的研究报告因清洁不充分导致研究受损，尽管在97.8%和93.6%的研究中到达了盲肠并插入了回肠末端。有实习医生协助操作时，研究持续时间显著更长。患者年龄和性别与准备充分性或盲肠和回肠插管率无关，清洁不充分与操作障碍和研究不完整显著相关。
基于单剂渗透泻药（聚乙二醇）的一日清洁方案在儿科年龄范围患者的标准结肠镜检查常规术前清洁中有效。
